Date of complaint (उजुरी मिति)
Complain (उजुरी)Feedback (सल्लाह/सुझाव)
Date of the reported incident (घटनाको मिति)
Incident location (घटना स्थान)
Complaint details (गुनासो विवरण)
Desired Outcomes (इच्छित परिणामहरू)
