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[See Rule 7(3)]
Second Appeal under Section 19 (3) of the Act
   * Applicant's Name
The Orissa Information Commission.
*1. Full Name of the Appellant :
*2. Address :
* (a) State :
* (b) District  :
(c) City/Town/Village :
(d) E-Mail ID :
*3. Paticulars of the First Appellate Authority :
*4. Date of Receipt of the order
appealed against :
(Attach soft copy if required).  
  (.pdf,.jpg,.gif file only)
*5. Last date for filing the appeal :
6. Particulars of Information
*  (a) Nature of the subject matter of the     information required :
* (b) Name of the Department to which the 
information relates
* Name of the Office to which the
information relates
7. The grounds for appeal :
8. Signature of the Appellant : (.jpg,.gif,.png,.bmp file only)
 Supporting Documents
Document Name Date Upload Soft Copy

Copy of Receipt in Support of payment of fees for Submission of Form A application*



Copy of an index of the document referred to in the appeal*  

Copy of Self- addressed duly stamped envelope for intimation of defects in case the memorandum of appeal is sent by registered post*

Copy of Self attested copy of Form ā€œDā€ application (if any). Copy of receipt in support of payment of fees for filing of Form ā€œDā€ application

I,   (Name of the appellant) of
hereby declare that paticulars 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.
Please Enter The code
NOTE :- (*) marked fields are mandatory.Please upload images maximum size (250*50) and document upto (1 MB).
         , Orissa State Portal, National Portal for India Link to Disclamier Link to FAQs Link to Important Links Link to Section 4 Disclosure