Complaint Of CGRF

APPLICATION TO CONSUMER GRIEVANCES REDRESSAL FORUM

తెలుగు

ELECTRICITY CONSUMER COURT

Individual

Firm

Company

Name of the Complainant with surname*

C/o*

Full address of the Complainant*

District *

Mandal *

Pin Code

Phone Number *

E-Mail Id

Aadhaar No.*

LT HT REGNO (SCNo or Reg of in 1912)

Category *

Whether any court case or Tribunal case is pending ?*

Is complainant addressed the problem to the APEPDCL previously ? *

Relief/prayer to the CGRF*

Nature of Grievance (Please tick(✔) the relevant box)

When cause of action arose ?*

Any other relevant information

Note : Please Upload written complaint and it must be signed by the complainant,
otherwise will be returned*

Note : Upload other proof of attachments pertaining to registered consumer
and duly self attested*

Declaration :

I/We, the Complainant/s herein declare that:
the information furnished herein above is true and correct; and
I/ We have not concealed or misrepresented any fact stated herein above and the documents submitted herewith.
The subject matter of the present Grievance has never been submitted to the Forum by me/or by any one of us or by any one of the parties concerned with the subject matter to the best of my/our knowledge.
The subject matter of my/our Grievance has not been settled through the Forum in any previous proceedings.
The subject matter of my/our Grievance has not been decided by any competent authority/court/arbitrator, and is not pending before any such authority/court/arbitrator.

Yours Faithfully

(Complainant's name in block letters) *

NOMINATION

(If the Complainant wants to nominate his representative to appear and make submission on his behalf before the Forum, the following declaration should be submitted.)

I/We the above named consumer here by nominate Sri/Smt

Whose address is :

Phone No. *

as my/our REPRESENTATIVE in the proceedings and confirm that any statement, acceptance or rejection made by him/her shall be binding on me/us. He/She has signed below in my presence.

APPLICATION TO CONSUMER GRIEVANCES REDRESSAL FORUM

Declaration :

Yours Faithfully

NOMINATION

ACCEPTED

(Signature of Representative)

(Signature of Complainant)