The Odisha Land Rights to Slum Dwellers Rules, 2017

Form - II

[See rule 8 (1)]

Form for Appeal

To,

The Appellate Authority
............................. (Name & Address)

1. Name and Address of the Appellant (including phone No.): ___________________________

2. Name of the Committee / Authorised Officer against the decision of whom the appeal is preferred: _____________________________________________________________

3. Details of order of the Committee / Authorised Officer: No. _________________________ dated ________________________

4. Date of receipt of the order by the Appellant: _______________________

5. Brief facts leading to the appeal: ______________________________________________________

6. Relief Sought: ____________________________________________________________

7. Grounds for the Relief: __________________________________________________________

8. Any other information necessary for deciding the appeal: _______________________________ ___________________________________________________________________________

9. List of enclosures, if any:

Declaration

I .............................. son of ................................................... residing at ....................................................... verify that the contents of the above appeal filed by me are true to the best of my knowledge and belief.

Name of the appellant:

Signature:

Date:
Place:

[No. 21429-HUD-13-LEGIS-67-POLICY-15-34/2017/HUD.] By Order of the Governor G. MATHI VATHANAN Commissioner-cum-Secretary to Government

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