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Municipal and government · Form

Sample Form: ثبت شکایت شهروندی

شکایت از خدمت یا کارمند با کد رهگیری و پیگیری تا پاسخ.

10 questions · Free up to 50 responses a month

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About this template

“ثبت شکایت شهروندی” has 10 questions; 5 are required and 5 optional. Question types: Short text (2), Mobile number (1), National ID (1), Dropdown (1), Single choice (1), Date (1), Long text (1), File upload (1), Yes / No (1). 12 ready-made options across 2 choice questions, all editable in the online version.

In the online version of this template

  • National IDs are checked instantly with the check-digit algorithm.
  • Mobile numbers are validated against the Iranian number format.
  • Dates are picked and stored on the Jalali (Persian) calendar.
  • Attached files are stored with the response.
Related:Online form builderIranian national ID validator

Questions in this template

  1. 1.

    نام و نام خانوادگی *

    (Short text)
  2. 2.

    شماره موبایل *

    (Mobile number)
  3. 3.

    کد ملی

    (National ID)
  4. 4.

    اداره/سازمان *

    (Dropdown)
    • شهرداری
    • آب و فاضلاب
    • برق
    • گاز
    • ثبت احوال
    • بهزیستی
    • سایر
  5. 5.

    موضوع *

    (Single choice)
    • تأخیر در خدمت
    • رفتار کارمند
    • دریافت وجه غیرقانونی
    • کیفیت خدمت
    • سایر
  6. 6.

    تاریخ مراجعه

    (Date)
  7. 7.

    شماره‌ی پرونده/درخواست قبلی

    (Short text)
  8. 8.

    شرح شکایت *

    (Long text)
  9. 9.

    مدارک

    (File upload)
  10. 10.

    نامم محرمانه بماند

    (Yes / No)

Printable or online?

Printable version (Word & PDF)

  • For filling in on paper, signing and filing by hand
  • Edit the Word file any way you like
  • Collecting and typing up the answers is up to you
Download WordDownload PDF

Online version on Porsino

  • Answers are collected and organised automatically — no retyping
  • National ID, mobile number and dates are validated instantly
  • Ready-made reports and charts, plus Excel export in one click
  • Share a link or QR code — it works on mobile too
Build the online version for free

How do I use this template?

  1. Sign up for Porsino for free; no bank card needed.
  2. In the panel, open “Templates” and choose “ثبت شکایت شهروندی”.
  3. Change the questions as you like, publish the form and send the link.

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