Ministry of Commerce & Industry
Department of Commerce
Grievance Redressal Committee

Application Form for Submission of On-Line Grievance Representation

(*) Mandatory entries

1. Name of the Company (*)
2. IEC Number (*)
3. Address (*)
4. City (*)
5. State/UT (*)
6. Pin Code (*)
7. E-Mail Address (*)
8. Phone No.
9. Grievance Relates to (*)
10. Relates to which Schemes/Policy Provisions
11. Order/ Rejection by which Authority
12. Particulars of File No./ Corr. Ref. No. (if any)
13. Whether matter is Sub-Judice
14. Whether matter is Statutory
15. Subject/ Grievence in brief (*)
16. Name of the Applicant (*)
17. Designation of the Applicant (*)
18. Date of filing Application			22/5/2012

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