FORM - B
(See Rule 5)
Appeal under section 19(1) of the Right to Information Act, 2005
The Appellate Authority ,
Andhra Pradesh Legislature Secretariat
Velagapudi, Amaravathi, Guntur Dist .
1. Full Name of the applicant
2. Full Address
3. Particulars of the Public Information Officer
4. Date of receipt of the order appealed against (if order passed)
5. Last date for filing the appeal.
6. The grounds for appeal.
7. Particulars of Information
i) Nature and subject matter of the information required.
ii) Name of the Office to which the information relates.
Date: Signature of the Applicant