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Grievance Pertains to Office
Department - Health & Family Welfare
Office
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BR
CMOH
DH
GMCH
MCH
SDH
SGH
SH
SSH
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Grievance Category
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Complainant Name
*
Aadhar UID
PAN Card No.
Voter Id. / Card No
Building No.
Street Name
Police Station
City / Town /Village
Post Office
District
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Bankura
Birbhum
Burdwan
Coochbehar
Dakshin Dinajpur
Darjeeling
Hooghly
Howrah
Jalpaiguri
Kolkata
Malda
Murshidabad
N.A.
Nadia
North 24-Parganas
Paschim Midnapore
Purba Midnapore
Purulia
South 24-Parganas
Uttar Dinajpur
PIN
State
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Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
Email Id
Mobile No
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Date of Incidence (if any)
Description of Grievances
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Action Wanted
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