Fatal Accident Complaint

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Step 1: Contact Information
>
Step 2: Complaint Information
>
Step 3: Summary

Step 1: Contact Information

I would like to file a Fatal Accident Complaint and my contact information is provided below. I understand that my contact information is for use by DGMS only and will be kept strictly confidential.

First Name

Middle Name

Last Name

Contact Phone

Email ID

Note : To submit a formal Fatal Accident Complaint, a valid email address is required. DGMS uses this email address to confirm your intention to "sign" the complaint electronically.

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Step 1: Contact Information
>
Step 2: Complaint Information
>
Step 3: Summary

Step 2: Complaint Information

Name Of Mines

Name Of Owner

Name Of Mineral

Village

* District

* State

Pincode

* Complaint Detail

Other Information

Cancel and return to menu

Step 1: Contact Information
>
Step 2: Complaint Information
>
Step 3: Summary

Step 3: Summary

Contact Information

First Name

Middle Name

Last Name

Contact No

Email ID

Complaint Information

Name Of Mines

Name Of Owner

Name Of Mineral

Village

District

State

Pincode

Complaint Detail

Other Information

Cancel and return to menu