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Grievance Redressal Application
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Grievance Application
Application Form
Name
*
* Please give applicant name.
Please use alphabets, numeric along with special characters .
I Am
*
Select
Student
* Please choose course name.
Mobile Number
*
* Please give permanent mobile number*
Please give valid mobile number.
Confirm Mobile Number
*
* Please give Correspondence mobile number*
Please give valid mobile number.
Email
*
* Please give email address
Please give valid email address
Confirm Email
*
* Please give email address
Please give valid email address
Address
*
* Please give address.
Please use only alphabets, numerics with , : . @ & - / and # special characters
District
*
* Please give district.
Please use alphabets, numeric along with special characters .
State
*
Select State*
Andaman & Nicobar(UT)
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh(UT)
Chhattisgarh
Dadra & Nagar Haveli(UT)
Daman & Diu (UT)
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu & Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep (UT)
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Orissa
Puducherry (UT)
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttaranchal
West Bengal
* Please choose state.
Detail of Your Grievance
*
* Please give detail of your grievance.
Please use only alphabets, numerics with , : . @ & - / and # special characters
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