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Grievance Status
SGI Reference Number
IRDA Token Number
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Current Status
Entity Complain Refno
Status Changed Date
Reported By
Reported Date
Reported For
Relation
IRDA State Name
IRDA District Name
Additonal Info
Severity
Greivance Description
Previous Status
IRDA Token No
Grievance Source
Grievance Sub Source
Last Updated By
Greivance Summary
Basic Information
Severity Type
Grievance
Identification Details
Mobile No
Are you an Individual/Corporate
Organization Name
Designation
Complaint Against
TPA
Agent Name
Agent License Number
Broker Name
Broker License Code Number
Surveyor Name
Surveyor License Number
Agent Name
Address
Phone No
Description
Type of Service Obtained
Contact Person Name
Contact Person Address
Contact Person Phone Number
Contact Person Email
Type of Policy
Type of Complaint
Complaint Description
Policy holder/ Claimant Name
Claim No
Date of intimation
Claim Amount
Claim Received Amount
Proposal Details
-----Select Proposal-----
B.O.C No./collection No.
Cheque No. for proposal
Receipt No.
Number
Premium Payment Ref. Number
Cover Note/ Policy/ Claim Number
Identifier Type
Certificate No. ( in case of group insurance)
Other Ref. Number
Document Type
Branch
Person Assigned
Designation
TAT
Source By
Is Senior Citizen
--select--
Yes
No
More Information
State
District
Summary
Description
Additional Information
Customer Details
First Name
Middle Name
Last Name
Gender
--select--
Male
Female
Date Of Birth
Mobile Number
E-Mail ID
Address
File Upload
File
UploadFile
Document type
File name
Action
DocFileExtn
DocFileName
File name
DocumentCategory
DocumentCategoryId
Depreciation
FKID
PKUploadID
Path
Document type
File Name
File Type
File Status
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