Grievance Redressal

Name

First

Last

Confirm Email

and Filing

Mobile Number

Please mention the relevant country code in brackets.

Grievance pertaining to

Date of knowledge (DD/MM/YYYY)

The date when the claimant became aware of the necessary facts to initiate a claim.

Date of Initial Filing (DD/MM/YYYY)

The date on which the claimant initiated the claim. Completion of this form is strictly prohibited unless the initial claim has been formally filed.

Reason for Appeal

Subject

Detailed Description of the Grievance

Agreement to and Abidance by Terms and Conditions

I hereby acknowledge that I have read and understood the Platform's Terms and Conditions, and I agree to be bound by them.

Acknowledgement

I hereby declare that the above statements are true to the best of my knowledge and belief. I understand that I may be required to furnish further information to substantiate my claim, if necessary and agree to provide such information.

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