Form VI
(See Regulation 6)
Complaints to the Regulatory Authority
IN THE REGULATORY AUTHORITY’S OFFICE OF ODISHA
Fields marked with * is mandatory.

1. Particulars of the complainant(s):


2. Particulars of the respondents:



3. Jurisdiction of the authority:


The complainant declares that the subject matter of the claim falls within the jurisdiction of the Authority..

4. Facts of the case:


5. Relief(s) sought:


In view of the facts mentioned in paragraph 4 above, the complainant prays for the following relief(s)

6. Interim order, if prayed for:


Pending final decision on the complaint the complainant seeks issue of the following interim order:

7. Complainant not pending with any other court, etc.:


The complainant further declares that the matter regarding which this complaint has been made is not pending before any court of law or any other authority or any other tribunal(s).

8. List of enclosures:


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Verification


I (name in full block letters), the complainant do hereby verify that the contents ofparagraphs [1 to 8] are true to my personal knowledge and belief and that I have not suppressed any material fact(s).
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