Govt. ITI Nagaon

Address:- S.M. Road, Panigaon, PO- Itachali, PS- Sadar, Dist.-Nagaon, Assam,

PIN- 782003

STRIVE GRIEVANCE REDRESSAL FORM

Complaint Date
Name of the Complainant
Address of the complainant	PO: District: Phone No.: E-mail:
Category of procurement	(Please tick) Goods Work Consultancy Non-Consulting Services IT Infrastructure
Method of Procurement	(Please tick) Government E-Marketplace (GeM) Open Tender/ RFQ/ RFP Direct Selection Single Source Selection Shopping Other (Specify_________________________________)
Nature of Complaint	(Please tick) Transparency Issue Technical Specifications Conflict of Interest Eligibility Irregularities in issuing of bidding document/RFQ/RFP Proposal submission Irregularities in Bid/Technical Evaluation / Financial Proposal Evaluation Contract Negotiations Contract Award Disqualification of Bid/Proposal Qualification of other Firm Payment Others (Specify_________________________________)
Procurement Reference No. (Tender/ RFQ/ RFP No./ Procurement Package No./ Procurement File No.)
Brief description of the Compliant
Name of the individual/ department where grievance assigned (Redressing Officer)	Sri Padma Kt. Borah
Designation & Office Address	Supervisor O/O Senior Principal Industrial Training Institute, Nagaon Mobile No. –7002585243 Email- principal@itinagaon.com

Date:	Signature of Complainant

N.B.

Please attach all the relevant documents for records

Please submit the grievance redressal form to the Redressing Officer mentioned above