Versus

M/s………………… Opposite Party(ies)

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Complaint under Section 21 of the Consumer Protection Act, 1986

The complainants beg to submit as under :

1. ……………….. (stall all the facts related to the complaint furnishing particulars of cause of action and defects in goods or deficiency in services)

2. ………………..

3. ………………..

4. ………………..

5. ………………..

6. That the commission has jurisdiction to entertain the complaint because

(a) the value of the goods/services and compensation claimed works out at Rs…………. which exceeds Rs. 20 lacs and

(b) the cause of action arose on…….. (date) ……… at (Place)

Prayer

It is therefore most respectfully prayed that the complaint be kindly allowed and following relief be kindly granted to the complainant.

1. ………………..

2. ………………..

3. ………………..

4. ………………..

5. ………………..

Verification

I, ……………….. s/o……………….. do hereby verify that the contents of this complaint are true to my personal knowledge and belief and that no part of it is false nor any material has been concealed verified today dated 19.5.2001 at Allahabad.

Deponent