Form X Form of Appeal Before The Food Safety Appellate Tribunal

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FORM X

(Refer Rule (i) of 3.3.1 (2))

FORM OF APPEAL

BEFORE THE FOOD SAFETY APPELLATE TRIBUNAL


(PLACE OF THE TRIBUNAL)

In the matter of Food Safety and Standards Act, 2006 (34 of 2006)
AND
In the matter of appeal against the order dated passed by the Adjudicating Officer, (Place)
APPEAL NO. OF
A.B. .. Appellant
Vs
C.D ... Respondent

For use in Appellate Tribunal’s


office Date of presentation in the
registry Date of receipt by post
Registration No.

Signature
(Registrar)

INDEX
(Specimen Index)

Sl No. EXHIBIT PARTICULARS Page


No.

1. Memorandum of Appeal
2. A Copy of the Show Cause Notice dated issued by the Adjudicating Officer
3. B Copy of the Reply dated sent by the Appellant to the Show Cause Notice.
4. C Copy of the letter dated sent by the Appellant to the Adjudicating Officer
5. D Copy of the impugned order dated

MEMORANDUM OF APPEAL

1. Particulars of the Appellant


(i) Name of the Appellant: AB
(ii) Address of the Appellant:
(iii) Address for service of all notices
(iv) Telephone/Fax No.
E-mail address, if any
2. Particulars of the Respondent
(i) Name of the Respondent : C.D.
(ii) Address of the Respondent:
(iii) Address for service of all notices
(iv) Telephone/Fax No.
e-mail address, if any
3. Jurisdiction of the Appellate Tribunal
The Appellant declares that the matter of appeal falls within the jurisdiction of the Appellate Tribunal.
4. Limitation
The Appellant further declares that the appeal is within the limitation as prescribed in Rule 3.3.1 (2)
5. Facts of the case
Here give a concise statement of facts of the case and grounds of appeal against the specified order, in a
chronological order, each paragraph containing as neatly as possible as separate issue, fact or otherwise)
6. Relief(s) sought
In view of the facts mentioned in paragraph 5 and the grounds on which the impugned order is challenged,
the Appellant prays for the following relief(s)
(Here specify the relief(s) sought and the legal provision, if any, relied upon)
7. Interim relief(s) sought (if prayed for)
Pending the final decision in the appeal, the Appellant seeks the following interim relief (s).
(Here specify the interim relief(s) prayed for and the reasons therefore)
8. Matters not pending with any other court
The Appellant further declares that the matter regarding which this appeal has been filed, is not pending
before any court of law or any other authority or any other Tribunal.
9. Particulars of fee paid
(i) Amount of fee Rs.
(ii) Name of the bank on which
the Demand Draft is drawn Bank
(iii) Demand draft No. and date
10. Details of Index
An index containing the details of the documents relied upon is enclosed.
11. List of enclosures

(Signature of the Appellant)


VERIFICATION

I, son /wife/daughter of Mr. being the Appellant do hereby verify that the
contents of paragraphs 1 to 11 are true to my personal knowledge and belief and that I have not suppressed any
material fact.

(Signature of the Appellant)


Place:
Date:

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