Full Name * Name is required.
Mobile Number * Mobile Number is required. Enter a valid 10-digit mobile number.
Alternative Contact Number (Optional) Enter a valid 10-digit number if provided.
* Anchal / Block Select Anchal सतगावां कोडरमा सदर डोमचांच जयनगर चन्दवारा मरकच्चो नगर पंचायत कोडरमा नगर पंचायत झुमरी तिलैया नगर पंचायत डोमचांच Please select Anchal/Block
Select Panchayat * Select Panchayat Please select Panchayat
Village/Locality * Village/Locality is required.
Water Resource Type * Select Resource Type Handpump Tube-well Open Well Water Supply Pipeline Overhead Tank Irrigation Canal Pond/Water Body Public Standpost Other Please select water resource type
Type of Issue * Select Issue Type Mechanical Failure No Water Supply Water Quality Problem Pipeline Leakage/Breakage Infrastructure Damage Electrical Issue Maintenance Required Other Please select issue type
Date Issue Observed * Please select issue observation date
Detailed Description of Issue * Please provide detailed description of the issue.
Approximately how many households are affected?
Upload Photograph of the Issue * Please upload an image of the issue. (Max file size: 5MB. Allowed formats: JPG, PNG, JPEG)

Previous Complaint Reference No. (if any)