[01]complaint only against one individual/firm can be filed through one form. For complaints against more than one member, use separate forms
| * Fields marked with asterisk (*) are mandatory/required |
|
| *Name of the Complainant: |
(comma separated names in case there are more than one complainant)
|
| Membership Number(ICAI) of Complainant, if applicable: |
(comma separated MRN in case there are more than one complainant)
|
| *Name of the Member/Firm Against whom complaint is being made[01]: |
|
| Membership Number: |
|
| Firm Registration Number: |
|
| Latest address of the Complainant for Communication |
| *Address Line 1: |
|
| Address Line 2: |
|
| Address Line 3: |
|
| *City: |
|
| *State: |
|
| *Country: |
|
| *Pincode: |
|
| Last available professional address of the Member or the firm against whom the complaint is made |
| *Address Line 1: |
|
| Address Line 2: |
|
| Address Line 3: |
|
| *City: |
|
| *State: |
|
| *Country: |
|
| *Pincode: |
|
*Particulars of allegation(s), serially numbered together with corresponding
clause/part of the relevant Schedule(s): |
(.DOC .PDF file only)
|
| *Details of documents against Column No. 6: |
|
| *Schedules: |
|
| *Particulars of evidences: |
(.DOC .PDF file only)
|
| *Knowledge of facts: |
|
| *Name(s) of the Person who have knowledge of the facts of the case: |
|
| *Date: |
|
| *Place: |
|
*Attach Complainant Scanned Signature:
(Please attach only one signature per Complainant) |
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
| VERIFICATION |
|
I,, the Complainant, do hereby declare that what is stated above is true to the best of my information and belief.
|
|
Verified today the
day of
at
|
| *Date: |
|
| *Place: |
|
*Attach Complainant Scanned Signature:
(Please attach only one signature per Complainant) |
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
|
(JPEG file only)
|
| *Email ID of the Complainant: |
|
| *Mobile number of the Complainant: |
|
| *Attached Personal ID (Any Government Recognized id): |
(PDF or JPEG file only)
|
| *Complainant Type |
|
| GST Number: |
|
| *Amount : ( Rs. 2950/- including 18% GST ) |
|
|
Captcha:
SUMW4R
|
|
Enter the code above here :
|
