FORM No.I (Complaint) (See Rule 3 (1) ) Before the Lokayukta/ Upa-Lokayukta for Andhra Pradesh. 1. Name and address of the Complainant for : all correspondence in respect of the complaint 2. Name and address of the Public Servant : complained against 3. Brief facts relating to the action complained : Of (Complainant's affidavit in the prescribed Form to be enclosed) 4. If the complainant or the person for whom : he is acting is aggrieved, the nature of the grievance should be specifically mentioned 5. Names and address of the witnesses whom : the complainant desires to examine in support of the allegations (Affidavit, if any, of the witnesses may be produced) 6. Particulars of the documents relied upon by : the complainant in support of the allegations 7. If the documents relied upon or their true : copies are available with the complainant, they should be enclosed and details thereof should be furnished 8. If the documents relied upon are not in the : custody of or cannot be produced by the complainant, the office or other place or individual from whom they may be secured, should be specified 9. Did the complainant make a complaint : previously to the Lokayukta or the Upa-Lokayukta or any other authority for redressal of his grievance, in respect of the action now complained of and against the public servant mentioned in Column (3) (Particulars to be furnished together with the result of the previous complaint) 10. Remarks, if any : Note :-Copied of affidavits and documents shall be enclosed in duplicates for office use and in as many sets as there are public servants complained against. Place : Signature of thumb mark of the Dated : Complainant.
