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 of the Broker
Address of the Broker
5. Name and Address of the Registrar
6. SEBI Acknowledgement Reference No. (in case of reminder)
7. Complaint Details
Non receipt of Shares in / after:	Exchange of Allotment Letter Conversion Splitting Transfer Endorsement Bonus Transmission Consolidation Duplicate on submission of Indemnity

8. Particulars
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
d)Client ID
e)DP ID
f) Any Additional Information
* Indicates Mandatory Field