WBIC
Registration of Second Appeal / Complaint
R
ead the following instructions before filling up the form:
Fill in all the fields that are indicate a star (*) in Red marked as required.
File format should be in pdf or jpg.
The maximum file size allowed for upload is 200KB.
Appeal / Complaint
*
Appeal/Complaint:
Appeal
Complaint
Details of Applicant :
*
Applicant Name:
Name cannot include special characters
*
Applicant's Address:
Complete Address cannot include special characters.
*
Pin Code:
Pin/Zip/Area Code cannot include special characters or alphabets.
Landline:
+91
Landline Number cannot include special characters or alphabets.
Mobile:
+91
Mobile Number cannot include special characters or alphabets.
Email:
E-mail ID cannot include special characters.
*
Citizenship Status:
India
NRI/Persons of Indian Origin
Country of Residence
(File format should be in pdf or jpg.)
*
Gender:
Male
Female
*
Are you a Senior Citizen? (above 60 years ):
Yes
No
Age Category:
-Select-
60-69 Years
70-79 Years
80-89 Years
90 Years above
Age proof document:
(File format should be in pdf or jpg.)
*
Are you Physically Handicapped?
Yes
No
Details of Handicap:
Disability certificate:
(File format should be in pdf or jpg.)
*
If BPL:
Yes
No
Details of BPL Certificate/Proof:
BPL Certificate/Proof:
(File format should be in pdf or jpg.)
Department Details
*
Department:
District:
Public Authority:
-Select-
*
Rural/Urban:
-Select-
RURAL
URBAN
*
Do you have Appeal / Registration Number of First Application?
Yes
No
*
Enter Appeal / Registration Number of First Application:
SPIO Particulars
SPIO Name:
SPIO Name cannot include special characters
*
SPIO Designation:
SPIO Designation cannot include special characters
*
SPIO Address:
SPIO Address cannot include special characters
*
SPIO Pin Code:
Pin/Zip/Area Code cannot include special characters or alphabets.
SPIO LL/Mobile:
+91
SPIO Contact No cannot include special characters or alphabets.
*
Nature of Response of SPIO:
-Select-
*
Do you have Appeal / Registration Number of First Appeal?
Yes
No
*
Enter Appeal / Registration Number of First Appeal:
FAA Particulars
FAA Name:
FAA Name cannot include special characters
*
FAA Designation:
FAA Designation cannot include special characters
*
FAA Address:
FAA Address cannot include special characters
*
FAA Pin Code:
Pin/Zip/Area Code cannot include special characters or alphabets.
FAA LL/Mobile:
+91
FAA Contact No cannot include special characters or alphabets.
*
Nature of Response of FAA:
-Select-
Appeal / Complaint Details
*
Subject:
Subject cannot include special characters and max length 100 Characters
*
Please enter the Appeal / Complaint Description
(if you have text in electronic form simply copy and paste here) (Max length 500 Characters)
Appeal / Complaint Description cannot include special characters and max length 100 Characters
*
Does it pertain to the Life or Liberty of a Citizen?
(This information is required to make the provision of Section 7(1) applicable)
Yes
NO
Supporting Documents
RTI Application Document:
*
Details:
*
Upload:
(File format should be in pdf or jpg.)
First Appeal Document
*
Details:
*
Upload:
(File format should be in pdf or jpg.)
Other Document
Details:
Upload:
(File format should be in pdf or jpg.)
Captcha
Type the Letters
*
Designed and Developed by
Centre for Good Governance
