FORM-D
[See Rule-7(1)]
Form of Memorandum of Appeal to the first 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 :
3. Particulars of Public Information Officer :
4. Date of recept of the order appealed against :
5. Last date for filling the appeal :
6. Particulars of information :
(a) Nature and subject matter of the information required :
(b) Name of the office or department to which the
information relates :
7. 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 tje best of my knowledge and belife, 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