[ The first nine fields marked with a ' # ' are mandatory.] # Name: # Date: # E-Mail: # OTC Investor registration No.: # Broker dealt through: # Script name: # Qty.: # CR No.: # DNR: Nature of complaint: ( Tick wherever applicable) (i) Listed Securities Non receipt of :   Shares/ debentures sent for transfer:   Duplicate share certificates   Allotment letter / Refund order   Intrest / dividend - (Period)   Rights / Bonus   Redemption Ammount   Rights / Preferential Offer   Annual Report   Amount due from broker(transaction details)   Others (ii) Permitted Securities     Non-receipt of ammount due from broker - (Transaction Details) Please Note: Please fill all details pertaining to the complaint. Every complaint should be stated separately.