Feedback Resolve

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Feedback Type

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User Details

User Name*

User Email ID*

Mobile Number (10 digits)*

Office Phone

Home Phone

City

Address

Best Contact Method

Details of Feedback

Detailed Description*

Nearest known landmark or location of issue

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I declare that the information provided in the application is true to the best of my knowledge and shall be liable for any action for wrong information provided by me under the rules and regulations of the Government..

Action Planner (UCI - )

#	Description of action taken	Planned Action Completion Date	Action status	By whom	Attachments

Tentative Resolve Date :

Do you want to add action

Planned Start Date

Planned Completion Date

Action

Key Project Personnel to be informed Selected personnel will be informed through email.
No Project is Associted with this Request.

Respondents to be informed Selected respondents will be informed through email.

If respondent is not registered please give email address below.

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TO :

CC :

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Activity log (UCI - )

Date Received :
Requester :
Feedback Type : New has been raised
Description :
Created By (In case created by other user) :

Date	Activity	Description of action taken	Assigned To	Action Event sent to	Action Taken by	Status
	Reassign the respondent
	Reassign the respondent
	Reassign the respondent
	Reassign the respondent
	Reassign the respondent