SAMPLE COMPLAINT PETITION

For defective good

CASE : Mr. X purchases a mixer grinder from M/s Y & Co. operating in the same town, in December 1998.
Even within the warranty period of 1 year the grinder fails. M/s Y & Co. fails to rectify the defect. The
manufacturer M/s Z Ltd., was also unable to rectify the mixer grinder. Frustrated, Mr. X finally approaches
the District Forum.

COMPLAINT PETITION

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, <NAME OF THE DISTRICT>

Consumer Dispute Case No. ........./200 <Year of filing>

A petition under Section -11 of Consumer Protection Act

and In the mater of :

Mr. X
<Address of Mr. X> ...... Complainant

Vs.

1. Proprietor,
M/s Y & Co.
<Address of Y & Co.>

2. Managing Director,
M/s Z Ltd.,
<Address of Z> ..... Opposite Parties

To
Hon'ble President and
Members of District Forum
<Name of District>

May it please your honours :

This complaint petition is being filed on behalf of Mr. X, <Address of X>, referred hereafter as Complainant,
and is as follows :

1.0 That this complaint Petition is being filed under Sec.

2 (1)(b)(i) of the Consumer Protection Act.
2.1 That the opposite party No. 1 is engaged in the business of selling Consumer durables like refrigerator, TV, Mixer
Grinder, etc. to the public for a consideration, apart from other activities. (Description about the O.P.)

2.2 That the Opposite Party No. 2 is the manufacturer of 'A' brand mixer grinders and other electrical household
gadgets and that the mixer grinders of O.P. No. 2 are sold in retail by O.P. No. 1. (Description about the O.P)

(Narration of the incident)

.1 That on 26th December 1998 (date of purchase), the complainant purchased one 'A' brand Mixer Grinder, Sl.
No....... (Details about the equipment purchased) manufactured by O.P. No. 2 from the show room of O.P. No. 1, vide
Cash memo No...(Cash memo /Cash receipt No.), a photocopy of the said document is furnished at Annexure - I.

3.2 That the mixer grinder abruptly stopped functioning (Nature of problem encountered) on 8th January 1999
(when)
and the matter was immediately reported to O.P. No. 1. As per his advice the defective mixer grinder was handed
over in their Service Centre, on 9th January 1999. A photocopy of the Service Centre receipt is furnished at
Annexure - II.

3.3 That the mixer grinder was returned back after rectification on 24th January 1999.

3.4 That the mixer grinder was put to use on 25th January 1999. After running hardly for 5 minutes, the mixer grinder
once again totally failed.

3.5 That the Complainant immediately reported the matter to O.P. No. 1 and also complained to O.P. No. 2. Copy
of the letter is furnished at Annexure - III. (Furnish important relevant documents.)

3.6 That as per the advice of O.P. No. 1 the defective Mixer Grinder was once again handed over to their Service
Centre on 30th January 1999. There was inordinate delay in rectifying the defect by O.P. No. 1. In April 1999 O.P.
No. 2 advised O.P. No. 1 to replace the Mixer Grinder, Copy of the said letter is furnished at Annexure - IV.

3.7 That the O.P. No. 1 did not bother to honour the directive of O.P. No. 2 and till date the Complainant is suffering
due to non-availability of the Mixer Grinder.

4.0 That the O.P.s had supplied defective good and they have to make good the losses suffered by the complainant.

PRAYER

In view of the submissions contained in the preceding paragraphs, the complainant most respectfully prays
to the Hon'ble Forum to direct the Opposite Parties to :

(a) refund the cost of the Mixer Grinder, Rs. <Cost> along with 18 % interest ;
(b) pay a sum of Rs. 10,000/- towards the physical strain and mental agony suffered by the complainant and
his family members (compensation) ; and
(c) pay a sum of Rs. 1,000/- towards cost of this petition (Cost) ;
 for which act of kindness, the complainant shall, as is duty bound, ever pray.
Signature
(X) (Name)
Complainant

SAMPLE COMPLAINT PETITION

For deficient service

CASE : Mr. X invests a sum of money with M/s Y & Co., a NBFC (Non Banking Finance Company), operating in the
same town, in December 1998. The deposit matures in December 1999, but the Company fails to honour its
commitment. It does not pay the dues. Frustrated, Mr. X finally approaches the District Forum.

COMPLAINT PETITION

BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL FORUM, <NAME OF THE DISTRICT>

Consumer Dispute Case No. ........./200 <Year of filing>

A petition under Section -11 of Consumer Protection Act

and

In the mater of :

Mr. X
<Address of Mr. X> ...... Complainant

Vs.

Chairman & Managing Director

M/s Y & Co.
<Address of Y & Co.> ..... Opposite Party

To
Hon'ble President and
Members of District Forum
<Name of District>

May it please your honours :

This complaint petition is being filed on behalf of Mr. X, <Address of X>, referred hereafter as Complainant, and
is as follows :

1.0 That this complaint Petition is being filed under Sec.

2 (1)(b)(i) of the Consumer Protection Act.

2.0 That the opposite party is a NBFC, engaged in the business of accepting deposits from the public, apart from
other activities. (Description about the O.P.)
 (Narration of the incident)

3.1 That on 26th December 1998 (date of deposit), the complainant deposited a sum of Rs.............(amount
deposited) with the O.P., for a period of 1 year, vide Fixed Deposit receipt No........, a photocopy of the said
document is furnished at Annexure - I.

3.2 That the F.D. matured on 25th December 1999 and the Complainant approached the office of the O.P., on 26th
December 1999, for encashing the FD. But the staff of the Company, on some some pretext or the other delayed
making the payment (Nature of problem encountered). Hence the Complainant wrote to the O.P., requesting his
immediate intervention. A photocopy of the said letter is furnished at Annexure - II. But the Complainant has not
been paid his dues till date.

3.3 That the non-payment of the maturity value of FD, by the O.P., on the scheduled date, amounts to deficiency in
service as defined under sec. 2(1)(g) of the Consumer Protection Act.

4.0 That the O.P. has inflicted enormous amount of mental agony and financial loss on the Complainant and his
family.

PRAYER

In view of the submissions contained in the preceding paragraphs, the complainant most respectfully prays to
the Hon'ble Forum to direct the Opposite Party to :

(a) pay the maturity value of the fixed deposit, Rs.........., along with 18 % interest ;
(b) pay a sum of Rs. 10,000/- towards the physical strain and mental agony suffered by the complainant and his
family members (compensation) ; and
(c) pay a sum of Rs. 1,000/- towards cost of this petition (Cost);

for which act of kindness, the complainant shall, as is duty bound, ever pray.
Signature
(X) (Name)
Complainant

AFFIDAVIT

I,____________________________________________________, Son of,

__________________________________________________, and residing at
___________________________________, do hereby solemnly affirm and declare as under :

1) That the facts stated in the complaint petition paras ___________ to _________, in
_________________________________________ Vs. _______________________________________________,
being filed before the Hon'ble (District Consumer Disputes Redressal Forum (, Place) /State Consumer Disputes
Redressal Commission(, State)/National Consumer Disputes Redressal Commission, New Delhi are true to the best
of my knowledge and based on the records maintained by me, which I believe to be true.

Deponent
 Verification

Varified at <Place>, on this ____________ day of <Month> <Year> that the contents of the above affidavit
are true and correct to the best of my knowledge and belief.

Deponent
Note:
1. The Affidavit has to be sworn before the Notary, on a Rs. 5/- non-judicial stamp paper.
2. The details of Place, State, Month, Year are to be filled as per actual.
3. Complainant or Appellant is the Deponent.
TOP

FORMAT FOR AUTHORISATION

BEFORE THE NATIONAL COMMISSION, NEW DELHI /

BEFORE THE STATE COMMISSION, <STATE> /
BEFORE THE DISTRICT FORUM, <DISTRICT>.

Consumer Dispute Case/First Appeal/

Revision Petition No. ________ of <Year>

BETWEEN
______________________________________________<Complainant>
And
__________________________________ <Opp. Party/Respondent>

AUTHORISATION

I _______________________________________________ , of
<Address>________________________________________________,
Complainant/Appellant in the above case do hereby appont and retain
_______________________________________________________ to appear for me in the above case and to
conduct and prosecute the above mentioned Respondent and in all proceedings that may be taken in respect of any
application connected with the same or any decree or order passed therein. I authorise the aforesaid
Representative to admit any compromise lawfully entered in the said case.

Dated the : (Signature of the Complainant)

Sample Complaint Petitions ...

 MODEL SPECIMEN OF NOTICE, COMPLAINT

AFFIDAVIT AND REPLY

NOTICE BEFORE FILLING THE COMPLAINT

Name and address

.....

(of the trader, dealer, firm, company, etc)

..

(Complete address)

IN RE: (Mention the goods/ services complained of giving details)

Dear Sir,

This is to bring to your kind notice that I had purchased ..... from your . For a
consideration of Rs..paid in cash vide your cash memo/ Receipt/ Invoice
No.(or through cheque No...) dateddrawn on
..bank for a sum of Rs..

The said goods are suffering form the following defects:-

(i).

(ii)etc.

I have reported the above matter to you several times (give reference of earlier letters, if any) but despite all my
pleadings you have not made good the defect in the goods (or deficiency in services) which is indeed regrettable and
highly unbusiness like. On account of your aforesaid dereliction of duty and failure and neglect to rectify the same I
have suffered losses/ incurred expenses

(give details)

which you are liable to compensate to me.

You are hereby finally called upon to

remove the said defects in the goods

and /or
 replace the goods with new goods

and /or

return the price / charges paid

(iv) pay compensation for financial loss/ injury/interest suffered due to your negligence..

(give details)

in the sum of Rs..with interest @.% per annum within

days of the receipt of this notice failing which I shall be constrained to initiate against you for
redressal of my aforesaid grievances and recovery of the aforesaid amount such proceedings, both civil and criminal
as are warranted by law, besides filing a complaint under the statutory provisions of The Consumer Protection Act,
1986 exclusively at your own risk, cost, responsibility and consequences which please note.

Place .

Dated. (Signature)

THE COMPLAINT

BEFORE THE HON'BLE DISTRICT CONSUMER DISPUTES

REDRESSAL FORUM AT.

OR

BEFORE THE HON'BLE STATE CONSUMER DISPUTES

REDRESSAL COMMISSION AT.

OR

BEFORE THE HON'BLE NATIONAL CONSUMER DISPUTES REDRESSAL COMMISSION AT NEW DELHI

IN RE : COMPLAINT NO..OF 20.IN THE MATTER OF

(FULL NAME) (DESCRIPTION) (COMPLETE ADDRESS)

.complainant

VERSUS

(FULL NAME) (DESCRIPTION) (COMPLETE ADDRESS)

.Opposite Party/ Parties

COMPLAINT UNDER SECTION 12 / SECTION 17 SECTION 21 OF

THE CONSUMER PROTECTION ACT, 1986

RESPECTFULLY SHOWETH:

INTRODUCTION

(In this opening paragraph the complainant should give his introduction as well as that of the opposite party/parties.)

TRANSACTION

(In this paragraph complainant should describe the transaction complained of, i.e., particulars and details of
goods/services availed : items of goods/kind and nature of service: date of purchased of goods/availing of service:
amount paid as price/ consideration, full or in part towards the goods/service; Photocopies of the bill/ cash memo/
voucher or receipt should be attached and properly marked as Annexure A,B,C and so forth or 1,2,3 and so forth.)

DEFECT/ DEFICIENCY

(In this paragraph complainant should explain the grievance, i.e.,whether the loss or damage has been caused by
some unfair trade practice or restrictive trade practice adopted by any trader or there is some defect in the goods or
there has been deficiency in service or the trader has charged excessive price for the goods. One should elucidate
the nature of unfair trade practice adopted by the trader, i.e., relating to the quality of goods/ services: sponsorship:
warranty or guarantee for such period promised. The nature and extent of defects in goods should be explainted and
so should the deficiency in service. In case of excessive price one should specify the details of actual price fixed by or
under any law for the time being in force or as set out on goods and their packing vis-a-vis the price charged by the
trader. Complaint can also be filed against offer for sale

of goods hazardous to life and safety when used. You should narrate your grievance and rest assured it is being
read/heard by compassionate and pragmatic judges. Photocopies of relevant documents must be attached.)

RECTIFICATION

(In this paragraph complainant should highlight what attempts were made by him to set things right, i.e., personal
visits or negotiations, communication in writing if any: whether any legal notice was got served and/ or whether he
has approached any other agency for redressal like M.R.T.P. Commission, Civil or Criminal Court of competent
jurisdiction; the stage of its proceedings, its outcome, if any, alongwith copies (certified preferably) of such
proceedings. The nature of response got from the trader when irregularities were brought to his notice, should also be
disclosed here).

OTHER PROVISIONS

(In this paragraph reference may be made to any other law or rules or regulations of particular procedure which is
applicable to the case and /or which has been violated by the trader and consumer's rights under the same. There
are incidental statutory obligations, which traders must fullful and in case of their failure to do so the case in prima
facie made out and Forum would take cognizance).

EVIDENCE
(In this paragraph complainant should give details of documents and/or witnesses he will reply upon to substantiate
his case.The documents attached as Annexures as stated above may be incorporated in a proper list and a list of
witnesses (if any) may be filed similarly). The annexures should be attested as True Copy.

JURISDICTION

(In this paragraph complainant should liquidate the claim in the complaint i.e., upto 20 lacs; 20 lacs to 1 crore; or
above and set out the pecuniary jurisdiction of the Forum / State Commission/ National Commission, as the case may
be. The territorial Jurisdiction should be highlighted to obviate any formal objection).

LIMITATION

That the present complaint is being filed within the period prescribed under section 24A of the Act.

RELIEF CLAIMED

(In this paragraph complainant should describe the nature of relief he wants to claim, i.e, for removal of defects in
goods or deficiency in service; replacement with new goods; return of the price or charges, etc., paid and/or
compensation on account of financial loss or injury or detriment to his interest occasioned by negligence of the
opposite party and elucidate how you have calculated the amount of compensation claimed).

(10) PRAYER CLAUSE

It is, therefore, most respectfully prayed that this Hon,ble Forum/ Commission may kindly be pleased to
.

(Details of reliefs which complainant wants the Court to grant)

Place .

Dated. Complainant

Through

(Advocate or Consumer Association, Etc.)

Verification:

I .. the complainant above named. Do hereby solemnly verify that contents of my above complaint are
true and correct to my knowledge, no part of it is false and nothing material has been concealed therein.

Verified this .. day of 20.at...

Complainant

Note:- Although it is not compulsory, complainant may file an affidavit in support of the complaint which adds to the
truth and veracity of allegations and gives credibility to the cause. It need not be on a Stamp paper but one should get
it attested from an Oath Commissioner appointed by a High Court. The format is just as simple.
AFFIDAVIT IN SUPPORT OF THE COMPLAINT

BEFORE THE HON'BLE ..IN RE: COMPLAINT NO.OF 20

IN THE MATTER OF:

....Complainant

Versus

.Opposite Party

AFFIDAVIT

Affidavit of Shris/o. Shri aged

years, resident of .

I, the above named deponent do hereby solemnly affirm and declare as under:-

That I am complainant in the above case, thoroughly conversant with the facts and circumstances of the present
case and am competent to swear this affidavit.

That the facts contained in my accompanying complaint, the contents of which have not been repeated herein for
the sake of brevity may be read as an integral part of this affidavit and are true and correct to my knowledge.

Deponent

Verification

I, the above named deponent do hereby solemnly verify that the contents of my above affidavit are true and correct to
my knowledge, no part of it is false and nothing material has been concealed therein.

Verified this day of .20at.

Deponent

Points to be taken care before filing a case

In all cases the burden of proof is always on the complainant to prove his case. Generally consumers believe that
filing a complaint with Consumer Forum is enough, it is not so consumer/complainant. It should not be presumed that
if a doctor/clinic/hospital has done something wrong than just filing a care in consumer court is sufficient. Consumer
has to produce medical opinion and decided cases before the consumer court to prove his case.

As the complainant is required to produce strict evidence of the negligence on the part of opposite party. That is
why most of the consumers/complainant lose their case.
 Generally fighting a case in consumer forum is not so easy, the delay adopted by the advocates of opposite party
cause a lot harassment to the complainant. So if your case is more than Rs. 50,000 don't hesitate to engage an
Advocate otherwise it is risky to stand against the highly experienced Advocates of the opposite party.