Caste Based Complaint Form

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