BEFORE THE PRESIDENT DISTRICT CONSUMER DISPUTES  REDRESSAL FORUM, _____
_____ son of _____, resident of _____.
COMPLAINANT
VERSUS
1-    _____ son of _____, resident of _____.
2-    _____, _____ through its _____.
…..RESPONDENTS
Complaint Under Section _____ of the Consumer Protection Act _____ Amended up to date
Sir,
The complainant respectfully submits as under: –
1-    That the complainant purchased _____ drinks marked as _____ on _____ from the shop of the respondent No.1 and out of the said _____ bottles one bottle was drinked by the _____ of the complainant
2-    That the respondent No.1 is the retailer /seller of the products of the respondent No.2 and the complainant purchased _____ bottles _____. Each from the respondent No.1 so both the respondents being the seller and manufacturer of the _____ Drinks respectively. Thus the complainant is the consumer of both the respondents as defined under the various relevant provisions of the consumer Protection Act.
3-    That the _____ of the complainant after _____.
4-    That the complainant sent a legal notice dated _____ to the respondent No.1 calling upon him to release the bills regarding the purchase of bottle and the respondent No.1 gave the said Bill that was as Bill No. _____ dated _____ in favour of the respondent No.1, by _____ Drinks. (Copy of the same is enclosed herewith the complaint).
5-    That due to the deficient and wrong service of the respondents the health of the complainant’s _____ was effected and the complainant was mentally and monetarily shocked.  The complainant is entitled to receive _____/- as treatment charges of his _____from both the respondents jointly and severally
6-    That the complainant is residing at _____  and the Respondent No.1 is doing his business at _____ and the respondent No. 2 is supplying the drinks at _____ at the shop of the respondent No.1 within the territorial jurisdiction of this Hon’ble Forum, therefore, this Hon’ble Forum has got the jurisdiction to entertain and try the present complaint.
PRAYER:
It is, therefore, prayed that in view of the forgoing facts and circumstances this hon’ble court may kindly be pleased to:
i)    Pass an order directing the respondents to pay _____/- to the complainant jointly and severally on account of mental tension, agony and harassment suffered by the complainant due to the ill health of his _____.
ii)    It is further prayed that the respondents may also kindly be directed to pay _____/- as charges of treatment spent by the complainant on the treatment of his _____.
iii)    Costs of this petition may kindly be awarded in favour of the complainant and against the respondents.
iv)    Any other relief, which this Hon’ble Forum may deem fit and proper, be passed in favour of the complainant and against the respondents.
Dated______
COMPLAINANT
_____ son of _____, resident of _____
THROUGH COUNSEL:
_____ Advocate, _____