[SSIMS] SC/ST/OBC/MINORITY CASTE, WOMEN, PHYSICALLY CHALLENGED, RACIAL DISCRIMINATION OR RAGGING INCIDENT COMPLAINT REGISTRATION FORM

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All the data provided here will be maintained confidential. One Complaint per incident should be logged.

Points to Remember

The UGC Helpline: You can anytime call on the National Anti-ragging Helpline 1800 180 5522 (24X7 Toll free). You can also send an E-mail on helpline@antiragging.in. For any other information regarding ragging please visit the UGC website i.e. www.antiragging.in.

The University Administration is there to help – Please do not hesitate to ask for help. We will definitely help you. The local police and local administration are also there to help.

Anybody can register a complaint of Ragging. It does not have to be only the victim. If you notice an incidence of Ragging you must inform the call center. It is your duty to do so. You can also register a complaint of Ragging - Anonymously. You must, however, avoid this option because without knowing details it becomes difficult to take any action. We can assure you of confidentiality.

Ragging Related Circulars by UGC

NAME OF THE COMPLAINANT

GENDER *

Female

Male

Transgender

CATEGORY

OBC

MINORITY

WOMEN

PHYSICALLY CHALLENGED

OTHERS CASTES

NOT TO SPECIFY

Clear selection

STATUS OF COMPLAINANT *

Student

Teaching Faculty

Non-Teaching Faculty

Research Scholar

External Visitor / Delegates

Administration Staff

Others

DEPARTMENT / SECTION / WING *

UNIVERSITY REGISTRATION NO. IF STUDENT

MOBILE NUMBER *

EMAIL ID

NATURE OF COMPLAINT *

CASTE DISCRIMINATION

RAGGING INCIDENT

GOONING / BULLYING

RACIAL DISCRIMINATION

SEXUAL HARASSMENT

EVE TEASING WITH-IN CAMPUS / OUTSIDE CAMPUS

OTHERS

SHORT DESCRIPTION ABOUT INCIDENT HAPPENED *

DATE OF INCIDENT *

YYYY

HAVE YOU ALREADY INFORMED TO COLLEGE AUTHORITY? *

Yes

Tried to Inform but Concern Person was not Reachable

ANY SUGGESTIONS YOU WISH TO INCLUDE?

Declaration:

I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it. I hereby authorize sharing of the information furnished on this form with the SRI SIDDHARTHA INSTITUTE OF MANAGEMENT STUDIES, TUMKUR.

Acceptance *

Yes

Required

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