BEFORE THE DISTRICT CONSUMER DISPUTES REDRESSAL COMMISSION, [DISTRICT], [STATE]

Consumer Complaint No. ____ of [year]

In the matter of:
[Your full name], [age], [address], [mobile], [email]  ... Complainant
Versus
[Company legal name], through its [Managing Director / Branch Manager], [registered or branch office address]  ... Opposite Party

COMPLAINT UNDER SECTION 35 OF THE CONSUMER PROTECTION ACT, 2019

1. The Complainant is a consumer. On [date] the Complainant [bought / hired] [goods or service] from the Opposite Party for Rs. [amount paid], not for resale or any commercial purpose. (Annexure 1: invoice or policy)
2. Facts: [what went wrong, in date order, 5 to 10 short lines].
3. Complaint to the company: on [date] the Complainant complained to the Opposite Party (reference no. [____]). [It replied on [date] refusing / It did not reply.] (Annexure 2)
4. Deficiency in service / defect / unfair trade practice: [say which, and why].
5. Cause of action: arose on [date] when [event], and continues. This complaint is filed within two years of that date (section 69).
6. Jurisdiction: the value of goods or services paid is Rs. [____], within this Commission's limit. The Complainant [resides / works] in [district], and/or the Opposite Party has a branch at [place] (section 34(2)).
7. The same matter is not pending before, or decided by, any other court, forum, ombudsman or authority.
8. Relief sought:
   (a) refund / replacement / payment of Rs. [____];
   (b) compensation of Rs. [____] for loss and harassment;
   (c) costs of this complaint;
   (d) any other relief the Commission thinks fit.

List of annexures: 1. Invoice / policy  2. Complaint and reply  3. [Photos, emails, bank statement]  4. ID proof

Place: [____]   Date: [DD-MM-YYYY]
[Signature]
[Name], Complainant

VERIFICATION
I, [name], verify that the contents of paragraphs 1 to 8 are true to my knowledge and belief.