ICRPC

Complaint membership application form

YOU WILL NOT GET SECOND CHANCE TO FILL THIS FORM FROM SAME COMPUTER ONCE YOU CLICK ON THE SUBMIT BUTTON.

Please proceed only if your complaint details and payment details are handy with you right now to be filled-in, because this is ONE TIME FORM with no option to change or modify the details once the form is submitted.

Instruction about a field will appear on right side when u place the mouse over that field.

After clicking on the SUBMIT button, your complaint ID number with further instructions for sending complaint by surface mail will be sent to the e-mail address that you entered in this form.

This is ONE TIME FORM with no option to change or modify the details once submitted. So, please be sure that you have filled the correct information.

We record the location of your computer and your IP address for security, and to also check for duplicates.

Copy of the details that you filled-in here will be sent to you by e-mail with your complaint number.

Name * First Last
Write full name. Middle name not required. No initials please.
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email *

Your complaint ID number will be sent to this e-mail ID
Cell Number *
Must be between 12 and 12 characters. Currently Used: 2 characters.

Write your 10 digit cell number following 91 for India.
Instead of 91 you can use your country code also. Do not use + sign before country code.
Name, Address, Fax and E-mail of defaulter company *

Name and registered office address of the company with telephone number, fax no. and e-mail address.

E-MAIL ADDRESS IS VERY IMPORTANT (If you do not have, please get from their website)

You can also mention address, tel, fax, e-mail of the branch, agent or representative with whom you dealt.
Email ID of the Chairman/MD/GM/HO/customercare/senior officer, etc *

It is mandatory to mention the E-mail of the Opposite Party so that we send legal notice to them by e-mail. If you do not provide this, then we will ask you to deliver the notice.
Complaint summary

Very brief note (no long story) of your grievance.
Payment mode *
Net banking Local Mumbai Cheque OR Ar Par Cheque Demand Draft
Rs 300 paid vide Cheque / Transaction Number, dated, and bank name *
Date of sending complaint to ICRPC by post/courier DD / MM / YYYY
This is approximate date when you have sent or intend to send your complaint to ICRPC. Correctness of this date will help us locate your complaint if misplaced or lost. Avoid speed post as it is unreliable.
Type the two words from the image below. *
Do Not Fill This Out

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