Securities and Exchange Board of India - Investor Complaint Format

1. Investor Name*
Address of the Investor*
2. Email Address*
3. Name of the Company*
Address of the Company*
4. Name and Address of the Registrar
5. SEBI Acknowledgement Reference No. (in case of reminder)
6. Complaint Details
Refund Order (RO / Allotment Advice: Non-Receipt of	Refund Order / Allotment Advice RO after revalidation RO after details furnished Duplicate RO after correction Duplicate RO for correct amount Copy of encashed RO Short Refund Duplicate RO after Indemnity Duplicate RO for correct bank details Interest on delayed RO
Others (Please Specify)

7. Particulars of the application/securities held
a)Full name of first applicant/ security holder
b)Application form No./Folio No. (Seller's in case of Transfer)
c)No. of Securities applied/held
d)Client ID
e)DP ID
f)Kind of Security
g)Mode of payment details
	No. Dated
	Drawn On
h)Application deposited at
i)Bank serial No.
j)Original refund order No. (in case of revalidation/duplicate)
k)Indemnity Bond sent for issue of duplicate	If Yes, Date
* Indicates Mandatory Field