Complaint Form in English/Hindi

Hindi Version

FORM I

[See rule 3]

FORM OF COMPL AINT

BEFORE THE LOKAYUKTA, HARYANA

Complainant …..………………. s on of, daughter of/wife of ……………… ………

……………………………… (add description of profession, residen ce etc.)

In the matter of allegation against ………… ………… ……………… ……… son of / daughter of / wife of ……… ……… ……………… ………………. ..…………… holding the office of ………… …………… ………… ……………… ……………… ..... at ……… …… ……… ………… ………

The above named complainant is satisfied that the aforesaid public servant, --

(i) has knowingly and intentionally abused his posit ion as such to obtain any undue ga in …… ………… or favour to h imself or to any other person or to cause un due harm to any other pers on; and / or

(ii) was act uated in t he di scharge of his functions as such public servant by corrupt motives, and / or

(iii)is guilty of corrupt ion; and / or

(iv) is in possession of pecuniary resources of property dis-proportionate to his known source of income and such pecuniary resources of property is held by the public servant personally or by any member of his family or by some other person on his behalf.

(Strike out the clause or clauses not relevant to the complaint.)

To support the allegations the complainant relies on the following facts and is also filing an affidavit:-

(1) (2) (3) (4)

The complainant has/has not for the same matter resorted to a remedy by way of proceeding before a tribunal/ a court of law/ an authority empowered to decide the matter particulars of which are as under:-

(give particulars and result, if any)

The necessary deposit of Rs. 1000/- has been made by affixing Judicial stamps of that value on the complaint.

PRAYER

It is, therefore, prayed that an inquiry be made against the public servant.

..… ……… ……… …………………

Signature/ thumb mark of the applicant

VERIFICATION:

I …… ……… …son of /daughter of/wife of Shri ………… ……… resident of

…… ……… ... hereby verify that the facts stated by me in paras …… …… … ……

……… ……. to …… …………… ………… …… in t he complaint are true to my personal knowledge and/ or the facts stated by me in paras … …… ……… ……… to

…… …………… are based on information received from ……………… (give the name) and / or documents, and the same are believed by me to be true.

..……… …………… …………… ……… …….

.

Signature/ thumb mark of the applicant

FORM II

[See rule 3]

Note:- This affidavit should be got prepared on a non-judicial stamp paper worth Rs. 3/- and then it should be got attested from a notary or an Oath Commissioner or Magistrate 1st Class.

F ORM OF AFF IDAV IT

I ……… ………… ……… …… ………… ……………… Son of /daughter of/ wife of

Shri …… ………… ……… ……… Professi on ………… …….……… ……..., resident of

……… ………… tehsil ……… …… District … …… …… ……… do hereby solemnly affirm and state as follows:-

(1) that I am the complainant in this case;

(2) that the statements of this complaint have been read by / read over to me and understood

/heard by me and these are true to the best of my knowledge and belief;

(3) that the facts stated by me in paras ………… …… to ……… ………… are true to the best of my knowledge and belief stated in paras ………… …………… ……… ……… are based on the information given to me by Shri …… ……… ………... and/ or documents which, I believe to be true.

Place ………………………….. Dated …………… ……… …….

.. ………… …… …… ……………… …………..

Signature/ thumb mark of the deponent

Affidavit sworn before me.

Certified that the above averment was declared b efore me on oath / affirmation this …………… ……………… day of …… ………… …… .200 at … …… in the District of …………………… by Shri/ Smt./ Miss ……… …… w ho was identified by Shri/ Smt ./Miss …… …………… …………… ……… who is personally known to me. The contents of the above affidavit have been read over a nd explained to the deponent who admitted the same to be correct and true.

… ……… ……… ……… ……… …… ……… …..

Des ignat ion of the aut hor ity be fore wh om affi davit is sw orn

Place …………………………….. Dated …………… ……… ……….

FORM III

[See Rule 8(1)AND (2) ]

FORM OF CERTIFICATE TO BE GIVEN BY THE OFFICE OF THE LOKAYUKTA, TO A PERSON FOR RECORDING EVIDENCE BEFORE LOKAYUKTA

1. Certified that … …… ………… …………… …… was summoned to give evidence before the Loyaukta in his public/private capacity in case of

…… ……………… …………… and was required to attend for a period of

………………………………………… days i.e. from …………….……..……………

…………………………………….. to ………………………………….

2. Further certified that he has been paid the following amounts in accordance with the rules for attending the office of the Lokayukta for the purpose:

(i) Travell ing Allowance Rs. . (ii) Subsistence Allowan ce Rs.

Place … ……… …… ………… ….. Da te ………… …… ………… ……

for: L okayukta, Ha ryana.

 

FORM NO. IV

{See Rule 6(2)}

Office of the Lo kayu kta, H ar ya na, C handigarh.

Proc eed ings No …… ……… .. Da ted:… ………….

To

Shri/Shrimat i……… …….

Ref:- Your C om plaint da te d… ……………

Your complaint dated..... against Shri/Shrimat i....... Is found to be deficient in the following particulars. You are hereby re quested to supply the omissions and rectify the defects mentioned be low with in ten days after receipt of this communication, failing which your complaint will be disposed of on the basis of the available material.

Particu lars:-

1. Form No. 1 not filled.

2. P rescr ib ed fee of Rs. 1 00 0/- to be pa id.

3. Comp laint is not s igned by the com pla inant.

4. Affidavit of the compla inant in the p rescribed f orm and /or of the witnesses not en clo sed.

5. Name, desi gnation and address of t he public servant compla ined against not furnished.

6. Documents relief on or true cop ies thereof in t he cus tody and control of t he complainant not enc lo sed.

7. Particulars of doc uments relied on not in the c ustody or control of the complainant not furnished.

8. Required sets of copies of affidavits and documents not e nclosed.

9. Oth er rea son s.

You rs faithfully, Reg istrar,

for Lokayukta of Haryana.

FORM NO. V

{See Rule 6(4)}

Office of the Lo kayukta, Har ya na, C handi garh.

Proc eed ings No …… ……… .. Da ted:… …………. To

Sh ri /Shrimat i…… ……….

Your c om plaint, dated… ……. …. .conta ining certain allegatio ns aga inst Shr i/Shrim ati……… ……… …… ………… .is re jected for the reasons m entioned below:-

Reasons for reject ion of the comp laint:

1. The de fects and /or om issio ns p oin ted out in p roc eed ings No… …… ………

dated …… ………… have not been rectified and /or supplied.

2. The comp la int does not disc lose an all egation which can be invest igated by the

Lo kayukta.

3. There are no sufficient grounds for investigating the complaint.

4. Other remedies are available to the complainant and in the circumstances of the case it would be more proper for the complainant to avail of such remedies.

5. The public servant against whom the complaint is made is not one in respect of whom a complaint can be entertained by the Lokayukta.

6. The complaint is made after the expiry of six years from the date on which the action complained against is alleged to have taken place.

7. An earlier complaint based on the same allegation as those made in the present complaint was previously disposed of by the Lokayukta or any other authority through proceedings No ……… …… ……dated… …..

8. The prescribed fee of Rs. 1000/- has not been paid.

Lokayukta, Haryana

 

 

FORM NO. VI

{See Rule 14(1) (a)}

Proceedi ngs of the Lo ka yu kta, Hary ana, Chand igarh.

No ……… …… .. Dated:…………….

To

Sh ri /Shrimat i…… ……….

Ref:- Complaint No……… …of……… ….2 00….

After cond ucting a p rel imi nary v erif ication into the a bove com plaint the H on ourable Lokayukta pro po ses to cond uct an investigation in to i t. So, you are hereby afforded an oppor tunity to offer your c ommen ts on:

(i) the compla in t, date d… ……… ……………… …... sent against you by Shri / Shrim ati ………….. …………………A copy of which is herewith enc lo sed al ong with copies of aff idavits pr oduced by the c om pla inant;

(ii) the enclosed statement con taining an allegation aga inst you, which the H on ’ble L okayukta has on his own motion proposed to investigate for t he g ro unds mentio ned therein;

(iii) the action in respect of which H is Excel len cy, the Go vernor of Haryana has re quired the H on’ble Lo kayukta to conduct an i nvestigati on as per the enc lo sed c opy.

You ma y, therefore, submit your c om ments as afore said on … ………… … … at 10. 30 A. M. be fore t he H on’ble Lo kayukta at h is o ffice t oge th er with su ch af fid avi ts of witnesses and doc uments in t he or iginal and three sets of cop ies thereof, as you may desire to be examined and c ons idered b efo re furt her st eps in the inv est iga tion are or dered.

You may engage ano ther publ ic servant or a legal practitioner to r ep resent you. If you fail to appear in the afore said m anner and su bmit your comm ents as aforesa id, f urther in vest igati on m ay be pr oceeded with on the bas is of t he mater ial avai lable.

Reg istrar,

for Lokayukta, Haryana.