Citizen's Feedback Form
Subject of Feedback :
Name of Person:
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Father's Husband's Name:
Date of Birth:
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Mobile no:
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Mailing Address of Person:
District:
Block:
Municipality / NAC:
Gram Panchayat:
Pincode:
EPIC / Voter ID Card No:
Aadhaar No:
PAN No:
Detail Description
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Feedback Details :
Claim made / Relief Required :
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