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FORM ‘D’

Form of Memorandum of Appeal to the First or

Departmental Appellate Authority under Section 19(1) of the Act

From

_________________________

(Applicant’s Name & Address)

 

Before

 

The First Appellate Authority

 

  1. Full Name of the Appellant                            :
  2. Address with contact Nos.                             :
  3. Particulars of Public Information Officer       :
  4. Date of receipt of the order appealed  against            :
  5. Last date of filing the appeal                          :
  6. Particulars of information.                              :

 

  1. Nature and subject matter of the              :

Information required

  1. Name of the Office or Department to      :

 which the information relates

  1. The grounds for appeal

(Details if any to be enclosed in separate sheet)

 

Verification

 

                        I ………………………….. (Name of the appellant), son of/daughter of/ wife of ………............. hereby declare that the particulars furnished in the appeal are to the best of my knowledge and belief, true and correct and that I have not suppressed any material fact.

 

                                                                                    Signature of the appellant

                                                                                    Place:

                                                                                    Date:

 

To

 

__________________________________

Name and address of Appellate Authority