Appendix 29

Proforma for Submission of Grievance Representation

1.	Name of the Applicant	:...............................................
2.	Address:	:...............................................
3.	Grievance subject:	Details may be mentioned (use additional sheets, if required)
4.	Particulars of file/ correspondence Ref No./date of DGFT or its regional office, if any:	:...............................................
5.	Whether the head of the concerned regional licensing office has been approached if so, furnish particulars/ decision, if any, taken.	Yes [ ] No. [ ] :...............................................
6.	Any other remarks	:...............................................

Signature of the Applicant		:	................................
Name in Block Letters		:	................................
Designation		:	................................
Place: …………………	Tel. No.	:	................................
Date: …………………	E-mail Address	:	................................