Second appeal/Complaint to CIC:format
by , 05-01-2008 at 08:26 PM (5707 Views)
[CENTER]The Right to Information Act, 2005[/CENTER]
Appeal/Complaint before
CENTRAL INFORMATION COMMISSION
August Kranti Bhavan, Bhikaji Kama Place,
NEW DELHI 110066
Appeal / Complaint No. ________dated__________
[For office use only]
As I am aggrieved by decision/no decision of Central Public
Information Officer and/or First Appellate Authority, I hereby
file this appeal/complaint for your kind decision.
1. Details of appellant/complainant
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 First Appellate Authority [FAA]:
3.1 Name/Designation of the FAA:
3.2 Full Address of FAA:
4. Dates of RTI application/first appeal:
4.1 To CPIO: ________ & mailed on: _________
4.2 To FAA: ________ & mailed on: _________
5. Particulars of Decisions:
5.1 Reference No & Date of CPIO’s Decision:
5.2 Reference No & Date of FAA’s Decision:
5.3 Date/s of personal hearing by FAA:
6. Dates of receipt of replies by appellant/complainant from:
6.1 CPIO:
6.2 FAA:
7. Details of information sought:
8. Brief facts of the case:
9. Reasons/grounds for this appeal / complaint:
10. Any other information in support of appeal/complaint:
11. Prayer/relief sought for:
12. Grounds for prayer/relief sought for:
13. Personal Presence at hearing: YES / NO
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 this commission nor is pending with any Court or tribunal or authority.
Place: Date: Signature of appellant/complainant
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