To

               First Appellate Authority

               ……………..……………………….

               ……………..……………………….

A. Contact details:

1.  Name of the Applicant

2. Address

B.  Details about RTI request:

1. Particulars of the SPIO against whose order appeal is preferred

(a) Name

(b) Address

2. Date of submission of application (Pease attach a copy)

3. Brief facts leading to appeal

(a) No response received within 30 days of submission of Form I

(b) Aggrieved by the response received within the prescribed period (a copy of the order received be attached)

Grounds for appeal  ………………………………….

………………………………………………………………………………………………………………

4. Prayer or relief sought

5. Last date for filing the appeal

6. If appeal is being filed after 30 days, the reasons which prevented from filing appeal in time

……………………………………………………

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