Before the District Consumer Disputes Redressal Forum at

_________________________

1. [COMPLAINANT NAME], [COMPLAINANT ADDRESS].

Complainant
Versus

2. . [COMPANY NAME], [COMPANY REGISTERED OFFICE ADDRESS]

[ADD MORE PARTY IF THE COMPANY HAS BRANCH OFFICE IN YOUR CITY]

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Opposite Party

Complaint under Section 12 of the Consumer Protection Act, 1986

RESPECTFULLY SHOWETH:
1. That the Complainant is a resident of [Complainants Address] and had [describe
the issue].
That the facts of the present case, in brief, are as follows.
2.
___________________________________________________________________
[Briefly describe facts of the complaint in point numbers 2, 3, 4, 5 and 6] .
3. That the __________________________________________________________.
4. That _____________________________________________________________.
5. That _____________________________________________________________.

6. That the complainant is unhappy with the service meted out to him and he stands
on very firm legal ground in claiming __________________________. This apathetic
and apparently deceitful attitude of the opposite party reflects its indifference to the
complainants plight. [Add a case law if available].
7. That this Honble Forum has got pecuniary jurisdiction to entertain this Complaint
as the compensation claimed does not exceed Rs.____________/-. [In case of
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district forum enter amount Rs. 20,00,000/-, State Forum enter Rs. 1 crore and in
case of National Forum enter more than 1 crore]
8. That this Honble Forum has got the jurisdiction to adjudicate and decide the same
as the opposite party have a branch office [or head office] in __________. Hence, the
matter falls within the territorial jurisdiction of this forum.
9. That the Opposite Party have inflicted enormous amount of mental agony and
financial loss on the Complainant.
10. That the present complaint is within the limitation as prescribed under the Act
because the deficient service was provided to the Complainant by the Opposite
Party.
11. That the Complainant has not filed any such or similar complaint before Honble
Court. No such or similar complaint is pending adjudication before any competent
court of law.

It is, therefore, respectfully prayed that this Honble Court may kindly be pleased to:i) direct the opposite party to apologize for all the inconvenience caused to the
Complainant;
ii) direct the opposite party to make up for the mistake by refunding the full ticket
amount to the complainant;
iii) pay a sum of Rs. 50,000/- towards the physical strain and mental agony
suffered by the Complainant and his family members; and
iv) direct the opposite party to pay a sum of Rs. 1,000/- towards cost of this
petition
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For which act of kindness, the Complainant shall, as is duty bound, ever pray.

[Place]

Complainant

Dated

Verification:Verified that the contents of Para nos. 1 to 11 of the complaint are true and
correct to the best of my knowledge. No part of it is false and nothing has been
concealed there from.

[Place]

Dated:

Complainant

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AFFIDAVIT IN SUPPORT OF THE COMPLAINT

Before the District Consumer Disputes Redressal Forum _________

Complaint No. _______________ of 2011

[COMPLAINANT NAME], [COMPLAINANT ADDRESS].

Complainant
Versus

. [COMPANY NAME], [COMPANY REGISTERED OFFICE ADDRESS]

Opposite Party
AFFIDAVIT
Affidavit of [COMPLAINANT NAME AND ADDRESS]
I the above named deponent do hereby solemnly affirm and declare as under:1.

That I am the complainant in the above case, thoroughly

conversant with the facts and circumstances of the present case and
competent to swear this affidavit.
2.

That the facts contained in my accompanying complaint, the

contents of which have not been repeated herein for the sake of brevity
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may be read as an integral part of this affidavit and are true and correct
to my knowledge.
[Place]
Dated:

Deponent

Verification:I, the above named deponent do hereby solemnly verify that

the contents of my above affidavit are true and correct to my
knowledge. No part of it is false and nothing material has been
concealed therein.
Verified this .......day of 20.......at........
[Place]
Date:

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Deponent