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*
3. Name of the Broker
Address of the Broker
4. Name and Address of the Registrar
5. SEBI Acknowledgement Reference No. (in case of reminder)
6. Complaint Details
Debentures Related	Interest Transfer Consolidation Interest on delayed interest payment Redemption amount Transmission Splitting Interest on delayed redemption amount Exchange of Allotment Letter Endorsement Duplicate on submission of Indemnity

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)Application deposited at
g) Any Additional Information
* Indicates Mandatory Field