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Schedule - A
Application to Forum for Redressal of
(a) I/ We, the consumer/s herein declare that:
(i) the information furnished herein above is true and
(ii)I/ We have not concealed or misrepresented any fact
stated hereinabove and the documents submitted herewith.
(b) The subject matter of the present Grievance has never
been submitted to the Forum by me/ or by any one of us or by any
of the parties concerned with the subject matter to the best of
my/ our knowledge.
(c) The subject matter of my/ our Grievance has not been
settled through the Forum in any previous proceedings.
(d) The subject matter of my/ our Grievance has not been
decided by any competent authority/court/arbitrator, and is not
pending before any such authority/ court/ arbitrator.
(Consumer's name in block letters)
NOMINATION - (If the consumer wants to nominate his
representative to appear and make submissions on his behalf before
the Forum, the following declaration should be submitted.)
I/We the above named consumer hereby Nominate
Shri/Smt. ,who is
not an Advocate and whose address
my/our REPRESENTATIVE in the proceedings and confirm that any
statement, acceptance or rejection made by him/her shall be
binding on me/us. He/She has signed below in my presence.
(Signature of Representative)
(Signature of Consumer)
Declaration as per Regulation 8.10 of MERC (CGRF & EO), Regulation 2020
I/We hereby nominate consumer representative with following details
Email ID :
Mobile No :
Relationship with complainant :
Further, We also declare as under that he,
1) is not an Advocate (within the meaning of the Advocates Act,1961)
2) is appearing on an individual case basis;
3) has a pre-existing relationship with the Complainant (such as: a relative, neighbour, business associate or personal friend);
4) is not receiving any form of, direct or indirect, remuneration for appearing before the Forum and files a written declaration to that effect;
5) he will demonstrates to the Forum that he is competent to represent the party.