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J.P.Shah

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First Appeal For Central Govt:format


jps50

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The Right to Information Act, 2005

 

 

 

First Appeal for Central Govt.

 

 

I.D. No_________ Date: _________ [For office use]

 

 

To,

 

The First Appellate Authority under RTI Act

Dept/Office___________________ REGD AD

_______________________

 

 

 

 

Sir,

 

 

 

As I am aggrieved by decision/no decision of Central 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 CPIO:

 

2.1 Name/Designation:

 

2.2 Full Address :

 

 

2.3 Name of Public Authority:

 

 

 

3. Details of RTI application to CPIO:

 

Date of Application________

 

Mailed on: _________

 

by registered/speed post No.________/hand delivery.

 

Date of receipt by CPIO______________

 

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/dept

 

5. Details of information sought:

 

 

 

 

 

6. Particulars of Decision of CPIO:

 

Letter reference No__________________

 

Date of CPIO’s Decision:_____________

 

Date of receipt of decision by the appellant:___________

 

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, decision letter of CPIO.

 

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

 

P.S. Please refer office memorandum dated 09-07-2007 issued by DoPT, Govt. of India.

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