Caste Based Complaint Form FORM FOR LODGING COMPLAINT OF CASTE BASED DISCRIMINATION BY SC/ST/OBC/ STUDENTS / FACULTY / NON-TEACHING STAFF Name of the Complainant (in Block Letters) For Students Department / Course Registration / Roll No For Faculty / Non-Teaching Staff Designation & Official Employee ID Contact Details (Postal Address) with Mobile Number and Email ID Discrimination Pertains to (SC/ST/OBC) Nature of the Complaint (in brief) with Details of Accused: Date, Time and Place of the Incident Details of Witness of the Incident Number of Attachment of Evidences (if any) Signature and Date Cast Based Discrimination Committee
