Duruva

Customer Escalation Form

Loan Account Number* :

* If you are an existing customer please enter your Loan A/C Number

Service Request Number / Ticket Number From Step 1 *

(Complaint number provided while raising the complaint – Step 1)

Customer First Name *

Customer Middle Name

Customer Last Name *

Mobile Number registered with DURUVA *

Alternative Mobile Number

Email ID with registered DURUVA *

PAN Card No *

Voter ID *

Date of Birth *

City *

Product *

Subject *

Issue / Complaint *

Please describe your issue in at least 250 characters (maximum 1500 characters).

Contacted Person

If you have visited any branch and met any specific person in connection with your issue

Attachment *

You can attach file if any (Allowed: jpg, jpeg, png, pdf. Max size 2 MB)