pragati KARNATAKA

Please try to give as much information as possible.

The information you may give may be could be based on what you heard your from your close relative or friend

Bribe paid form

Give details of bribe paid by you or your relative or your friend . Give as much details as possible

Name of the office which demanded the bribe

Give Name of the office
Location

Give the address or location
Place

Give name of the village/town/city in which the office is situated
How you came to know bribe has to be paid (Press Shift Key for multiple Selection)

you can seect more than one
Who asked the bribe first time

Who asked the bribe
Bribe money Demanded

Give bribe demanded details
Bribe Paid

Give bribe paid
Who are the people who received bribe (multiple selection by holding the Shift Key)

Give details of all persons who received bribe
Where bribe was demanded for the first time

Give details of where bribe was demanded(multiple)
Which are the places where bribe was paid

Give details of places were bribe was paid
To whom you complained(Multiple Selection by holding the Shift Key)

To whom you complained against demanding bribe(multiple selection can be done by holding the Shift Key)
Other details which you think are relevant

Give other details including bribe demanded in kind , harassment suffered, number of times you had to visit the office and ANY OTHER THING WHICH YOU FELL IS RELEVANT
Contact Phone(OPTIONAL)

OPTIONAL
email(OPTIONAL)