Details of the Complainant

Name of Complainant^*

Telephone Number

Mobile Number^*

Email Id ^*

PAN No.

Passport No.

Whether the complainant is Buyer ? ^* Yes No

Official/Residential Address

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Address for Service of All Notices Same as above

Address line 1^*

Address line 2^*

State^*

District^*

Pin code^*

Complaint Details

Complaint against ? ^* Project Agent

Registered under Goa RERA ? ^* Yes No

Name of Project ^*

Name of Respondent ^* Name of Respondent/Agent ^* Name of Respondent/Promoter ^*

Telephone Number

Mobile Number^*

Email Address^*

Subject of Complaint^*

Facts of Complaint^*

Relief Sought from RERA^*

Interim Order Required^*

Yes No

Official/Residential Address

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Address for Service of All Notices Same as above

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Supporting Documents

DELETE

Caption

Attachment

Add more

Payment

Payment Mode^*

Bank Name^*

Amount (INR)^*

Branch^*

Demand Draft No^*

Attach Scan Copy^*

Declarations

I, complainant, here by declare that the subject matter of the above claim falls within the Jurisdiction of the Authority
I, complainant, here by declare that the matter regarding which the complaint has been made is not pending before any Court of Law or any other Authority or any other Tribunal(s)
I verify that the contents of the above sections are true to my personal knowledge and belief and I have not suppressed any material fact(s)

Complaint Registration Form

Details of the Complainant

Official/Residential Address

Address for Service of All Notices Same as above

Complaint Details

Official/Residential Address

Address for Service of All Notices Same as above

Supporting Documents

Payment

Declarations