Information & Public Relations Department Page 9
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14I, _____________________________________Name of the appellant, son of / daughter
of / wife of ____________________________________hereby declare that the particulars
furnished in the appeal are to the best of my knowledge and belief, 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
-9-
FORM – E
[See Rule 7 (3)]
Second Appeal under Section 19 (3) of the Act
From
_______________________
(Applicant’s Name & address)
To
The State Information Commission
1.
Full name of the Appellant
:
2.
Address
:
3.
Particulars of the first Appellate Authority
:
4.
Date of receipt of the order appealed against
:
5.
Last date for filing the appeal
:
6.
Particulars of information
(a) Nature of subject matter of the information required
:
(b) Name of the office or Department to which the
:
information relates
7.
The grounds for appeal
:
(Details items to be enclosed in separate sheet)
Verification
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