Complaint filed before the Tamil Nadu Local Bodies Ombudsman constituted under Nadu Local Bodies Ombudsman Act, 2014 shall be in writing in the Form given below with supporting documents, if any, and shall be filed either in person section 3 of Tami before the Secretary to the Ombudsman or sent to him/her by Registered Post by affixing Court Fee stamp to the value of Rupees Ten on each complaint towards fee FORMI ‘Ten Rupees Court Fee Stamp Affix Here 1. Name and Address of Complainant 2. Address for Communication a) Residential Address b) Mobile No. ©) Landline Number : ) E-mail ID ‘Name and Address of Respondent(s) 4, Nature of complaint and details (In separate sheets, if needed) ‘Name and Address of witness, if any 6. Description of documents produced with the complaint DECLARATION . hereby declare that the facts given above are true and correct to the best of my knowledge and belief. Place: Date: Signature of the Complainant