Details of the Complainant

Name of Complainant^*

Telephone Number

Mobile Number^*

Email Id ^*

PAN No.

Passport No.

Whether the complainant is Buyer ? ^* Yes No

Official/Residential Address

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Address for Service of All Notices Same as above

Address line 1^*

Address line 2^*

State^*

District^*

Pin code^*

Complaint Details

Complaint against ? ^* Project Agent

Registered under Goa RERA ? ^* Yes No

Name of Project ^*

Name of Respondent ^* Name of Respondent/Agent ^* Name of Respondent/Promoter ^*

Telephone Number

Mobile Number^*

Email Address^*

Subject of Complaint^*

Facts of Complaint^*

Relief Sought from RERA^*

Interim Order Required^*

Yes No

Official/Residential Address (Agent/Firm/Promoter/Developer)

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Address for Service of All Notices Same as above

Address line 1^*

Address line 2^*

State^*

District^*

Pin Code^*

Supporting Documents

DELETE

Caption

Attachment

Add more

Payment

Amount (INR)^*

Verification

I (name in full block letters) son/daughter of the complainant do hereby verify that the contents mentioned above are true to my personal knowledge and beliefs and that I have not suppressed any material fact(s).

Notarized Document^*

(The printout of the application should be taken separately notarized and uploaded)

Complaint Registration Form

Details of the Complainant

Official/Residential Address

Address for Service of All Notices Same as above

Complaint Details

Official/Residential Address (Agent/Firm/Promoter/Developer)

Address for Service of All Notices Same as above

Supporting Documents

Payment

Verification