1.            Please use Internet Explorer browser with popup allowed in browser settings.

2.            Fill details in english language only.




1.            Name                                                                    Mention Complete Name.

2.            Sex                                                                       Select Gender from list.

3.            Address                                                               Mention Complete address for


4.      State                                                                     Select name of your State from the list.

5.      District                                                                  Select name of your District from the list.

6.      PIN CODE of your locality, email-id and mobile no., if available


VICTIMS DETAILS                                                     


7.      Name                                                                    Mention complete name of the victim

8.      Address                                                               Mention Complete address of the victim

9.      State                                                                     Select name of State from the list, from

                                                                                       where the victim belongs to

10.    District                                                                  Select name of District from the list, from

                                                                                       where the victim belongs to

11.    Sex                                                                       Select Gender of the victim from the list,

                                                                                       If the number of victims are more than one

                                                                                       then Select ‘Group’ option.

12.PIN CODE of locality, if available.

13.    Disability                                                              Select the disability status of the victim

                                                                                       from the list.

14.    Age                                                                       Mention age of the victim in years.

15.    Religion                                                                Select Religion of the victim the list.

16.    Caste                                                                    Select Caste of the victim from list.


INCIDENT DETAILS                                                   


17.    Place                                                                    Mention exact place of incident i.e.


                                                                                       Village, Town, City

18.    State                                                                     Select Name of State from the list,

                                                                                       where incident occurred

19.    District                                                                  Select Name of District from the list,

                                                                                       where incident occurred

20.    Incident Date                                                       Mention incident date (Date/Month/Year)

21.    Incident Category                                                Select incident category from the list

                                                                                       with whom the incident relates to

22.    Incident Sub-Category                                        Select incident sub- category from the

                                                                                       list which specifically shows the nature

                                                                                       of incident

23.    Write complaint                                                   Brief summary of facts/allegations of the


24.    Is it filed before any Court/State                        Select the option whether the complaint

         Human Rights Commission                               of same incident is filed before any

                                                                                       Court OR State Human Rights




25.    Name, designation & address of the                Mention full details of Public Servant/

         Public Servant                                                     Authority against whom the complaint is

                                                                                       being made.

26.    Relief sought for                                                  Mention full details of relief, which is

                                                                                       sought against the human rights