Non-SEBI Regulated Investor Grievances

Full Name of Investor *

PAN *

Email ID *

Contact Number *

Address

Nature of Service *

Name of Issuer *

ISIN
YesNo

Series / Tranche / Scheme

Folio / DP ID / Client ID

Description of Issue

Whether Complaint Logged with the Issuer

YesNo

Date

Acknowledgement / Reference No *

PAN / KYC Document

Holding Statement / Folio Proof

Payment Proof / Bank Statement

Correspondence with Issuer

Transaction / Contract Documents

Certificate / Allotment Letter