To
The Banking Ombudsman
Reserve Bank of India
(*Territorial jurisdiction, Place of BO’s office……) |
| |
| Dear Sir, |
| Sub: Complaint
against *
. (Name of the bank’s branch) of *
(Name of the Bank) |
| Being aggrieved
the complainant named herein has submitted a complaint with the above
referred bank. Details of the complaint are as under: |
| 1. NAME OF THE
COMPLAINANT * |
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| 2. MAIL ID OF THE COMPLAINT *
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| 3. FULL ADDRESS OF THE COMPLAINANT * |
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| PIN CODE * |
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| PHONE NO. / FAX NO. |
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4. COMPLAINT AGAINST
(NAME AND FULL ADDRESS OF THE BRANCH/ BANK ) * |
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| PIN CODE * |
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| PHONE NO. / FAX NO. |
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| 4. PARTICULARS OF BANK ACCOUNT *
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| (Please state
nature of account viz. Savings bank/current/cash credit/term deposit/loan
account etc. related to the subject matter of the complaint being made
) |
| 5. (a) DATE OF REPRESENTATION
BY THE COMPLAINANT TO THE BANK * |
|
| (Please enclose
three copies of the representation) * |
| (b) Whether any reminder was
sent by the complainant? * |
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| (If yes, please
enclose three copies of the reminder *) |
| 6. SUBJECT MATTER OF THE COMPLAINT *
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|
| (Please refer
to Clause 8 of the Scheme) * |
| 7. DETAILS OF THE
COMPLAINT * |
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| (If space is
not sufficient Please enclose separate sheet) |
| 8. (a) Whether any reply (Within
a period of one month after the bank concerned received the representation)
has been received? * |
|
| *(If yes, please
enclose ‘three copies’ of the bank’s reply) |
| (b) Whether the representation
has been rejected ? |
|
| *(If yes, please
enclose ‘three copies’ of the bank’s letter) |
| (c) Whether the complainant
has received any other final decision of the bank? |
|
| *(If yes, please
enclose ‘three copies’ of the bank’s letter conveying its final decision) |
| *Note: Online
applicants: Please send the proofs while submitting the case |
| 9 NATURE OF RELIEF SOUGHT FROM
THE BANKING OMBUDSMAN * |
|
| (Please enclose
‘three copies’ of documentary proof, if any, in support of your claim) |
10. NATURE AND EXTENT OF MONETARY
LOSS, IF ANY, CLAIMED
BY THE COMPLAINANT BY WAY OF COMPENSATION * |
Rs.
|
| (Please enclose
documentary proof, if any, to show that such loss is actual loss caused
as a direct consequence of alleged omission or commission of the bank) |
| 11. LIST OF DOCUMENTS ENCLOSED * |
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| (Please enclose
‘three copies’ of all the documents) |
| Already approached the branch office |
| (c) Whether the complainant
has received any other final decision of the bank? |
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| 12.Whether the complianant have approached the Bank |
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13.Attach Supporting Files :
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| 14. DECLARATION |
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1. I/ We , the complainant/s
herein declare that:
(a) the information
furnished herein above is true and correct; and
(b) I/ We have not
concealed or misrepresented any fact stated in aforesaid columns
and the documents submitted herewith.
2. The complaint is filed
before expiry of period of one year reckoned in accordance with the
provisions of Clause 9(3) (a) and (b) of the Scheme.
3. (a) The subject matter
of the present complaint has never been brought before the Office
of the Banking Ombudsman by me/ or by any one of us or by any of the
parties concerned with the subject matter to the best of my/ our knowledge.
(b) The subject matter of the present
complaint is not in respect of the same which was settled through
the Office of the Banking Ombudsman in any previous proceedings.
(c). The subject matter
of the present complaint has not been decided by any forum/court/arbitrator.
1. I/We authorise the
bank to disclose any such information/ documents furnished by us to
the Banking Ombudsman and disclosure whereof in the opinion of the
Banking Ombudsman is necessary and is required for redressal of any
other complaint or our complaint.
2. I/We have noted the
contents of the Banking Ombudsman Scheme, 2006.
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