________________
5.
Particulars of the order under appeal : (i) Order Number (ii) Date of the order (iii) Name of the authority, whose order has been challenged in the appeal
6.
Limitation : The appellant further declares that the appeal is within the limitation prescribed under the Act.
7. Facts of the case and orders passed by the competent authority : The facts of the case are given below :
(Give herein a concise statement of facts and grounds of appeal against the order passed by the competent authority)
8. Matter not pending with any other Commission, etc : The appellant further declares
that the matter regarding which this appeal has been made is not pending before any Commission of law or any other authority or any other Tribunal.
9.
Relief sought : In view of the facts mentioned in paragraph eight above, the appellant prays for the following reliefs; (specify below the reliefs sought by the appellant)
11. Details of index : An index in duplicate containing the details of the documents to
be relied upon is enclosed.
12. List of enclosures :
VERIFICATION
1.
........... (name in full in block letters) son/daughter/wife of Shri.........
....... do hereby verify that the contents of paras 1 to 12 are true to personal knowledge and belief and that I have not suppressed any material facts.
Signature of the Appellant
Place : Date :
Ilarity Benefits
