IN THE CONSUMER DISPUTES REDRESSAL DISTRICT FORUM AT…………………….
Consumer Complaint No………………… of 19………………..
A. B. (add description and residence)………………………… Complainant/Complainants

versus

C. D. (add description and residence)………………… Opposite Party/Opposite Parties
To
The Hon’ble President and his companion members of the District Forum
Sirs,
The Complainant/Complainants named above respectfully submits/submit as follows:
1. All facts relating to the complaint, particulars, place, date etc. are to be stated.
2.
3.
4. Details regarding cause of action at the place where the complaint is being filed.
5. Details relating to jurisdiction and value of goods/services and compensation claim are to be
given. (The value of goods/services and compensation claimed should not exceed
Rs………………… Ten Lakhs).
6. Prayer clause with details of relief/reliefs being claimed are to be stated.

Place……………….. Complainant/Complainants
Date……………….. In person or through Counsel
VERIFICATION

I/We……………….. (Complainant/Complainants) son/sons of……………….. resident
of……………….. do hereby solemnly declare and state that the contents particulars of the
complaint stated above are true to the best of knowledge and belief. Nothing stated therein is
false and nothing has been mis-stated/concealed therein.
Verified at……………….. this…………….. day of……………….. 19………………..
at………………..

Deponent

Annexures
1. ……………………
2. ……………………