Form for making Complaint to Complaints Officer

Inthinhrikna/Inthliarhranna thlen ni (Date of incident)
Inthinhrikna/Inthliarhranna thlenna hmun (Place of incident)
Inthinhrikna/Inthliarhranna thlen dan (Description of incident)
Inthinhrikna/Inthliarhranna thlen tu (Person/Institution responsible for the incident)
Complaint theh lut tu hming
Phone / Mobile Number
Email Id
Fax
Ni (Date)
Veng (Address)
Office chhung atan bik (For official use only)
Complaint Number

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MSACS Office, Directorate of Health Services, Dinthar, Aizawl, Mizoram – 796001
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