Surname of the student *

First name of the student *

Father's name *

Mother's name *

Gender
Male
Female
Other

Name of the program and semester *

Roll number *

Permanent registration number (provided by University of Mumbai) *

Mobile number (preferably WhatsApp number) *

Your Email*

Permanent address of the student *

Mailing address of the student (if it is different from the residential address)*

Name of the teacher / non-teaching staff / against whom the complaint is to be lodged *

Nature of Grievance/s for which redressal is sought *

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