RTI First Appeal Form

I.D. No: ___________________ [For office use]

Date:

To,
The First Appellate Authority under RTI Act,
Dept/Office:

Sir,

As I am aggrieved by decision/no decision of Central/State Public Information Officer, I hereby file this appeal for your kind decision.

1. Details of appellant

1.1 Full Name:

1.2 Full Address:

1.3 Phone/Cell No.:

1.4 Email ID:

2. Details of Central/State Public Information Officer (CPIO/SPIO)

2.1 Name/Designation:

2.2 Full Address:

2.3 Name of Public Authority:

3. Details of RTI application to CPIO/SPIO

Date of Application:

Mailed on by registered/speed post No. / hand delivery.

Date of receipt by CPIO/SPIO:

4. Particulars of payment of filing fee

Paid Rs. 10/- by bank draft/pay slip/IPO No. Dated of Bank/Post office OR deposited cash on against receipt No. with office/department.

5. Details of information sought

6. Particulars of Decision of CPIO/SPIO

Letter reference No:

Date of CPIO/SPIO's Decision:

Date of receipt of decision:

7. Brief facts of the case

8. Reasons/grounds for this appeal

9. Any other information in support of appeal

10. Prayer/relief sought for

11. Grounds for prayer/relief sought for

12. Personal Presence at hearing

YES NO

13. Enclosures

Photocopies of original RTI application with its enclosures, postal proof of mailing, acknowledgement of CPIO/SPIO, decision letter of CPIO/SPIO.

14. Declaration

I hereby state that the information and particulars given above are true to the best of my knowledge and belief.

I also declare that this matter is not previously filed with any information commission nor is pending with any Court or tribunal or authority.

Place: Date:

Signature of appellant