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 informtion
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
*