12. Declaration

(a) I/ We, the Complainant/s herein declare that:
(i) The information furnished herein above is true and correct; and
(ii) I/ We have not concealed or misrepresented any fact stated hereinabove and the documents submitted herewith.
(b) The subject matter of the present representation has never been brought before the Office of the Ombudsman by me/ or by any one of us or by any of the parties concerned with the subject matter to the best of my/ our knowledge.
(c) The subject matter of my/ our representation has not been settled through the Office of the Ombudsman in any previous proceedings.
(d) The subject matter of the present representation has not been decided by any competent authority/court/arbitrator, and is not pending before any such authority/ court / arbitrator.
Yours faithfully
(Signature)
(Complainant's name in block letters)
Nomination.
Accepted
(Signature of Representative)
(Signature of Complainant)
Annexure-III
Annexure-III
Annexure III: Quarterly Reporting By Forum/ombudsman
Annexure III: Quarterly Reporting By Forum/ombudsman
Quarter: _____________ Financial Year: _____________