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Case Lodgement Form

Reference number
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Case number
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Date
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CLAIMANT(S) (PLAINTIFF(S))
Name
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Contact address
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Residential / Office Address
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Mobile Number
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Email Address
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Nature Of The Case
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RESPONDENT(S)
Name
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Contact Address
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Residential / Office address
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Mobile Number
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Email Address
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SUMMARY OF THE CASE
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REMEDIES SOUGHT
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ACTION TAKEN BY CENTRE
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SIGNATURE OF OFFICER AT POST
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NAME OF OFFICER AT POST
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SUBMIT