Independent Non-governmental No fee is payable at any stage.1
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नागरिक शिकायत ब्यूरो Citizen Grievance Bureau Independent grievance redressal desk for the citizens of India
Case Registrycase@cgb.org.in
Register a grievance
प्राधिकार पत्र

Letter of Authority

Form CGB-2. Without it the Bureau writes to no one. With it, the Bureau corresponds on your behalf in one registered matter, under limits fixed in the letter itself, until the matter closes or you revoke it.

Form
CGB-2
Signed by
The citizen
Scope
One matter
Revocable
At any time
Part 1

Complete the letter

पत्र भरें

Enter your particulars on the left. The letter on the right is completed as you type, and may be printed or saved as a PDF for signature. Nothing you enter leaves this page.4

Particulars for Form CGB-2Fields marked optional may be left blank and completed by hand.

THE CITIZEN

THE MATTER

EXECUTION

Citizen Grievance Bureauनागरिक शिकायत ब्यूरो
FORM CGB-2Registry No.

LETTER OF AUTHORITY

प्राधिकार पत्र

To,
The Registrar, Case Registry
Citizen Grievance Bureau, case@cgb.org.in

I, , , residing at , District , , having the email address , being the in respect of No. with , hereby authorise the Citizen Grievance Bureau, acting through its Case Registry, in the matter of :

  1. to correspond in writing with the said institution, its grievance redressal officer, Nodal Officer and Principal Nodal Officer, on my behalf in the said matter;
  2. to receive from the said institution information, statements and copies of documents relating to the said matter, to the disclosure of which I hereby consent;
  3. to lodge and pursue the said matter as my authorised representative before the RBI Ombudsman, the Insurance Ombudsman, CPGRAMS, a State grievance portal or the National Consumer Helpline, where the governing scheme permits;3
  4. to keep me in copy on all correspondence issued and to forward to me each reply received.

This authority does not permit the Bureau to receive or hold any money on my behalf; to accept, reject or negotiate any settlement or waiver on my behalf; to sign any document creating a financial obligation for me; or to appear on my behalf before any court or tribunal.

I declare that the particulars given by me in Form CGB-1 are true. I understand that no fee is payable to the Bureau at any stage, and that I may revoke this authority at any time by writing to case@cgb.org.in. This authority remains in force until the matter is closed or the authority is revoked, whichever is earlier.1

Place:
Date:
Name in capitals:
Signature or thumb impression of the citizen

Enclosure: proof of identity, with the Aadhaar number masked except the last four digits.

Part 2

Scope of the authority

प्राधिकार की सीमा

The limits below are written into the letter itself, so that every institution reading it knows what the Bureau may and may not do.

The authority permits the Bureau to

  • Correspond in writing with the institution, its grievance redressal officer, Nodal Officer and Principal Nodal Officer, in this matter alone.
  • Receive from the institution information, statements and copies of documents relating to this matter.
  • Lodge and pursue the matter as authorised representative before an Ombudsman, CPGRAMS, a State portal or the National Consumer Helpline, where the scheme permits.
  • Keep you in copy on all correspondence and forward each reply received.

The authority does not permit the Bureau to

  • Receive, hold or handle any money on your behalf.
  • Accept, reject or negotiate any settlement, waiver or offer on your behalf.
  • Sign any document that creates a financial obligation for you.
  • Appear on your behalf before any court or tribunal.
  • Act in any other matter, or with any other institution.
Part 3

Signing and sending

हस्ताक्षर और प्रेषण
  1. CompleteFill the particulars above, or print the blank form and complete it by hand.
  2. PrintPrint the letter, or copy it by hand on plain paper in the same words.
  3. SignSign, or affix your thumb impression, in the box provided. Date it.
  4. PhotographPhotograph or scan the signed letter and your masked identity proof.
  5. SendEmail both to case@cgb.org.in with the subject "Form CGB-2: [Registry No.]".
If you cannot sign. A citizen who cannot write may affix a left thumb impression. The person who completes the form for the citizen writes the citizen's name beside the impression and adds their own name below it. The authority must remain the citizen's own: no family member may sign in the citizen's place.
Part 4

Revocation

प्राधिकार वापस लेना

You may withdraw the authority at any time, without giving reasons. The institution is informed within one working day, and the complete file is handed to you within three.

To the Registrar, Case Registry
Citizen Grievance Bureau

Registry No.: [Registry No.]

I revoke, with immediate effect, the Letter of Authority (Form CGB-2) executed by me in the above matter.

I request that the institution be informed of the revocation, and that the complete record of the matter be supplied to me at this email address.

Name: [Your name]
Date: [Date]
Send revocation by email

Case Registry

A grievance left unanswered is a grievance not yet registered.

Register a grievance case@cgb.org.in