अनलाइन उजुरी

Full name *

Mother's name *

Father's name *

Permanent address *

Phone number *0/10

Temporary address

Email address

Marital statusLet us know if you are married or not.

Do you have sons or daughters?AreAre not

Details of son and daughter

Have you given birth to a son or a daughter?IsNo

Have a relationship with PIDAC (abuser)?IsNo

Details of relationship with PIDAC

What kind of abuse did you experience?Not allowed to exercise women's rightsViolence is a social evilChoose one

Brief description of the incident mentioned

Date of event

Time of event

Location of the incident

Is the abuser an employee or official of public office or related bodies?YesNo

Name of the office

Office address

The position of that person

Location/ address at the time of application

Have you applied to any other bodies regarding the incident?IsNo

Details of other bodies that have applied

Details of the petitioner in case the case is pending in the court or the case is pending

Documentary evidence and witness details confirming the conduct of the application

Details of treatment sought from the petition

निवेदन सँग केहि अन्य कागजात पनि बुझाउन चाहन्नुहुन्छ?I wantDon't wantSuch as a photograph or any other document that can be used as evidence

Upload documents

Full name

Address

Contact address

Age

Phone number

Consent *The description in the petition is true. If I am found to have lied, I will accept the punishment as is in the law.

National Women Commission