A:
Details of the government organisation
1.
Name of government organisation
*
e.g.
Maharashtra Housing Board
2.
State *
Select State
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
Orrisa
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
3.
City *
4.
Department in the government organisation *
e.g.
Accounts Department
5.
Location of the government department in the city *
e.g.
Bandra East
6.
Designation of government official involved
*
e.g.
Junior Accountant
7.
Website of the government organisation
8.
Address of the government organisation
Please provide complete postal address so that the complaint
will be forwarded
300
characters left
B:
Complaint Details
Please
be precise and to the point regarding your complaint.
Do not give a background / history / reasons for your
complaint as this often confuses the issue, and we need
to know only the exact problem point. If you have any
additional information that you would like to share,
please use the "Browse" feature that is provided to
attach documents of your choice.
1.
Period of your incident *
Select Year
2008
2007
Before
2007
Select Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
If Before 2007
2.
What services did you require from the government organisation?
*
300 characters
left
3.
What problem/s did you face ?
*
300
characters left
4.
What was the bribe amount? *
100
characters left
(either
5a or 5b is compulsory)
5 a) Did you pay the bribe? If yes, why?
200 characters
left
5
b) Could you get your work done without paying the bribe?
if so, how?
200
characters left
6.
What has been the result of your action? *
200
characters left
C:
To attach additional information
Details
of Content
100
characters left
Attach
additional Information
Attachment
1
Browse File should not exceed 2 MB (to attach documents
such as correspondence with government department, photographs,
press articles, detailed story, etc.)
Attach
additional Information
Attachment
2
Browse File should not exceed 2 MB
Attach
additional Information
Attachment
3
Browse File should not exceed 2 MB
D:
Your Suggestions
Please
make practical and implementable suggestions that can
be converted to policy or procedural changes within
the concerned government organisation. Please assume
that the government officer at a high enough level has
a genuine desire to resolve / prevent such problems
so please be as polite as you can.
1.
Your suggestions for the head of that government department
to stop / prevent such incidents *
e.g. changes in procedure, use of technology, attitudinal
change of staff, display of information on signboards,
website, leaflets, etc
Suggestion
1
1000
characters left
Suggestion 2
500
characters left
Suggestion 3
500
characters left
2.
Your suggestions for the Anti Corruption Bureau (ACB)
/ Central Bureau of Investigation (CBI) *
e.g. to issue directions to government department; to
catch the corrupt official/s, etc.
Suggestion
1
1000
characters left
Suggestion 2
500
characters left
Suggestion 3
500
characters left
3.
Your suggestions for other citizens to avoid a similar
situation *
(Please do not suggest that they resist offering a bribe,
as that is not the purpose of this form.)
Suggestion
1
1000
characters left
Suggestion 2
500
characters left
Suggestion 2
500
characters left
E:
Your Contact Details
Are
you willing to reveal your contact details?
What
repercussions do you fear from government / others?
200
characters left
F:
To receive a confirmation email
If
you want a confirmation email from us, please write
your email id in the textbox.
Please note that this will neither be displayed nor
given to the government department.
G:
Your Location
State
*
Select State
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
Orrisa
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Tripura
Uttar Pradesh
Uttarakhand
West Bengal
City
*