Complaint of Caste Based Discrimination by SC/ST/OBC/ Students/ Faculty/ Non-Teaching Staff Name of the Complainant (in Block Letters) Complainant ByStudent(s)FacultyNon-Teaching Staff Name of Department/School Name of Course Registration/Roll No. Name of Department Designation Official employee ID Contact Details (Postal Address with Pin Code) Mobile Number Email ID Discrimination Pertains to (SC/ST/OBC) —Please choose an option—Scheduled CasteScheduled TribeOther Backward Classes Nature of Complaint (in brief) with the details of Accused Date, Time and Place of the incident Details of the Witness of the Incident Attachment of Evidences (if any in .jpg/.jpeg/.pdf) Signature of the Complainant (in .jpg/.jpeg) Date Δ
