FORM OF COMPLAINT WITH THE BANKING OMBUDSMAN

FORM OF COMPLAINT (TO BE LODGED) WITH THE BANKING OMBUDSMAN

(TO BE FILLED UP BY THE COMPLAINANT)

To:

The Banking Ombudsman

Address of office…………………………..

Dear Sir,

Sub: Complaint against …… (Name of the bank’s branch) of ………… (Name of the Bank)

Details of the complaint are as under:

1. Name of the Complainant …………………..

2. Full Address of the Complainant …………………………………………………………… Pin Code ………………..

Phone No/ Fax No. .…………………… Email …………………….

3. Complaint against (Name and full address of the branch/bank) ………………………….………………………….Pin Code ……………………. Phone No. / Fax No. …………………….

4. Particulars of Bank or Credit card Account (If any) ………………………………………………………………………

5. (a) Date of representation already made by the complainant to the bank (Please enclose a copy of the representation) ……………………….

 (b) Whether any reminder was sent by the complainant? YES/NO

 (Please enclose a copy of the reminder) ……………………….

6. Subject matter of the complaint (Please refer to Clause 8 of the Scheme)

…………………………………………………………………………………………

7. Details of the complaint: (If space is not sufficient, please enclose separate sheet)

…………………………………………………………………………………………………………………………………

…………………………………………………………………………………………………………………………………

8. Whether any reply (Within a period of one month after the bank concerned received

the representation) has been received from the bank? Yes/ No

(If yes, please enclose a copy of the reply )

9. Nature of Relief sought from the Banking Ombudsman ………………………………………………………………………………

(Please enclose a copy 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 (please refer to clauses 12 (5) & 12 (6) of the Scheme) Rs………….…

11. List of documents enclosed:

(Please enclose a copy of all the documents)

12. Declaration:

(i) 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 the above columns and

in the documents submitted herewith.

(ii) 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.

(iii) The subject matter of the present complaint has never been brought before

the Office of the Banking Ombudsman by me/ us or by any of the parties

concerned with the subject matter to the best of my/ our knowledge.

(iv) The subject matter of the present complaint has not been decided

by/pending with any forum/court/arbitrator.

(v) 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

our complaint.

(vi) I/We have noted the contents of the Banking Ombudsman Scheme, 2006.

Yours faithfully,

(Signature of Complainant)

NOMINATION – (If the complainant wants to nominate his representative to appear

and make submissions on his behalf before the Banking Ombudsman or to the Office of

the Banking Ombudsman, the following declaration should be submitted.)

I/We the above named complainant/s hereby nominate

Shri/Smt………………………………………….. Who is not an Advocate and whose

address is ………………………………………………………………………………

as my/our REPRESENTATIVE in all proceedings of this complaint and confirm that

any statement, acceptance or rejection made by him/her shall be binding on me/us.

He/She has signed below in my presence.

ACCEPTED

(Signature of Representative)

(Signature of Complainant)

Note: If submitted online, the complaint need not be signed