On Line Complaint on Sexual Harassment at Workplace

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The Fields with (*) are mandatory, please select / fill the appropriate inputs.
Details of Survivor ::
*Name : :
State ::
 *District ::
*Pin No. ::
Email ::
*Phone ::
*Sex ::
*Address :: 
   
Date of Birth :: *Religion ::
*Whether Challenged person::     *Caste ::
Details of Complainant ::
*Name ::
State ::
*District ::
*Pin No. ::
Email ::
*Phone ::
*Sex ::
*Address ::
*Relationship with survivor:
Details of Respondent (Opposite party) ::
*Name :: 
State ::
*District ::
Pin No. ::
Email ::
*Phone ::
*Sex ::
*Address :: 
Details of Complaint ::
 
*Category of the Complaint ::   
*Department of the Complainant (if applicable) ::   
* Date of Incident :: 
Insert complete details of the incident ::*

Declaration:
I hereby declare that    this form has been filled up by me with  a good sense and information furnished above are true to the best of my knowledge and belief.

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