The Right to Information Act, 2005
First Appeal for Central Govt.
I.D. No_________ Date: _________ [For office use]
The First Appellate Authority under RTI Act
Dept/Office___________________ REGD AD
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:
2.2 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. _________
OR deposited cash on ____________against receipt No________
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.
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.