Grievance registration number: [number]
Date the grievance was closed: [DD-MM-YYYY]

Why the reply does not resolve my grievance:
1. [What the reply said]
2. [What is still not done, with dates]
3. [Any point the reply did not answer]

What I am asking the appellate authority to do:
[direct the office to ____ / give a reasoned reply on ____]

I attach: [the reply received and any new papers].

Name: [your name]
Mobile: [registered mobile number]