CoCOnlineApps

Grievance Registration

Grievance Application

* fields are mandatory
Grievance Details
Grievance Title Grievance Number Grievance Status
Category Name Sub Category
Name
Officer Responsible
Complaint Date Complaint Redressal Deadline
Grievance Location Details
Area Locality Street
Specific Location
Applicant Details
Applicant Type Residential Status
First Name Middle Name Last Name
Address Line1 Address Line2 Address Line3
Country
State
District
Pincode
UID Ward No Mode Of Communication
Residence/Office Number (Eg:04846618993) Mobile Number (Eg:9495537231) Email Address (Eg:test@abc.com)
Grievance Description
Grievance Description/
Feedback
Supporting Document Details
Supporting Documents Formats:-jpg,jpeg,png,gif,doc,xls,pdf Max Size:- 256KB

Security Question Details
Security Question    Answer
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Declaration
I hereby declare that the grievance details provided above are correct, complete and true to the best of my knowledge.