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INVESTORS' GRIEVANCES FORUM
Complaint Format
(To be submitted in Duplicate)
(Use separate forms for each company/complaint)
Please tick ( ) the appropriate item and complete all columns in Capital Letters.

Complaint Received
No.  
Date  
Initial  
At  
For Office Use Only
Complaint Code
Type
Cat
     
     
     

To,

The Secretary,
Investors's Grievances Forum,
9/C, Neelam Nagar, Mulund (E),
Mumbai -40081.

Dear Sirs,
I have complaint as under, particulars of which are as under :

1) Name & Address of the Investor

2) Name & Address of the Company

 
 
 
 
 
 
 
 
3) Name, Address & T. No. of the Register
  & Transfer Agent/Broker (If any)
 
 
 
 
4) Nature of complaint :
    Type /Category:
 
 
 
 
  i) Issue/Offers ________________ non-receipt of :
Refund Order/Allotment Advice
Cancelled stock Invest
(S.I)
Allot against encashed
S.I.
Revaluation of Refund Order (RO)
RO after details
furnished.
Duplicate RO after
correction.
Duplicate RO for correct amount
Copy of encashed
RO.
Short Refund.
Duplicate RO after indemnity
Duplicate RO for correct bank details.    
ii) Dividend _____________________non-receipt of :
   Dividend Details:_____________________________________________________
iii) Shares_____________________non-receipt of certificates in/after :
Exchange of allotment letter
Transfer
Transmission
Conversion Endorsement Consolidation
Splitting Bonus
Duplicate on submission of idemnfy bond
Details:_________________________________________________________________
iv) Debentures/ Bond_________________non-receipt of certificates in/after :
Interest Redemption Amount
Exchange of Allotment Letter
Transfer Transmission Endorsement
Consolidation Splitting
Duplicate on submission of idemnfy bond
Details:_________________________________________________________________
v) Fixed Deposit_________________non-receipt of :
FD Receipt Interest Cheque Bounced
Interest Principal Amount Cheque Bounced.
Principal Amount    
Details:_________________________________________________________________
vi) Miscellanious_________________non-receipt of :
Annual Report Offer for Rights
Registration of change in address
Interest on delayed Refund Payment
Interest on
delayed dividend
Non-listing of securities on stock exchange
Details:_________________________________________________________________
6) Particulars of the application / securities held
a)
Full name of first applicant/
security holder

____________________________________________
b)
Application form No./Folio No. (Seller'sin case of Transfer)
____________________________________________
c)
No. of Securities applied / held
____________________________________________
d) Kind of Security Shares Debentures Others
e)
Mode of payment details
Cash Cheque/D.D Stock-invest
    No.________________Dated_____________________
    Drawn on_____________________________________
f) Application
deposited at
___________________________________________
g) Bank Serial No.
___________________________________________
h) Photocopy of Bank
Certificate enclosed.
   Yes No
i) Photocopy of
acknowledged slip
enclosed.
   Yes No
j)
Original / Refund Order No. (In case of revalidation
/ duplicate)
________________________________________________
k)
Period on/for which
dividend/interest/maturity
amount/redemption amount
due
________________________________________________
l)
Date on which securities
were forwarded to
Company/Registrars
________________________________________________
m) Idemnify Bond sent for
issue of duplicate
   Yes No. If Yes, Date:
7) Other details if any, in brief ________________________________________________
_______________________________________________________________________
_______________________________________________________________________
8)
Other of earlier correspondence
with the Company/Registrars
__________________________________________
9) Enclosure, if any
__________________________________________
 
__________________________________________
___________ ___________
__________________________________________
Place Date
Signature of the First Applicant/Security holder
Note:
1) It would be advisable to address the complaints to IGF only if Company/Registrars has not reponded inspiteof having sent two reminders over a period of atleast one month.
  2) Enclose Xerox copies of Shares/FD etc. and correspondence made (Duplicate).
Investors Consent (Optional)
I hereby give my consent to sharing of information on my complaint with IGF to facilitate filling of CLASS ACTION SUITS in consumer courts or suitable courts against defaulting companies / authorities.
___________ ___________
__________________________________________
Place Date
Signature of the First Applicant/Security holder

Click here for Complaint Form of Consumer Disputes Redressal Forum

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