SC/ST Cell

Name *

Father's Name *

Roll No Cum Registration No.*

Gender *

Male Female

Person With Disability *

Yes No

Category *

SC ST BC-A BC-B

Faculity/Institute/College *

Course *

Department*

Semester *

Choose 1st 2nd 3rd 4th

Address *

Mobile No. *

Please Enter Valid Mobile No.

E-Mail Id*

Please Enter Valid Email Id

Date On Which Event/Issue Occured *

Detail of Complaint *