The official seal and emblem of the Appellate Tribunal shall be such as the Central Government may specify.
Form 1
(See Rule 4)
Memorandum of appeal
For use in Appellate Tribunal's office
Date of presentation in the registry
Date of receipt by post
Registration number
Signature
Registrar
Before the Securities Appellate Tribunal
In the matter of the Insurance Act, 1938 (4 of 1938)
and
In the matter of appeal against the order made on . by .
In the matter of appeal against the order made
on
by .. A.B. Appellant
C.D. and other Respondent(s)
Details of appeal:
1. Particulars of the appellant:
(i) Name of the appellant
(ii) Address of registered office of the appellant
(iii) Address of service of all notices
(iv) Telephone/Fax Number and e-mail address, if any
2. Particulars of the respondent(s):
(i) Name of the respondent(s)
(ii) Office address of the respondent(s)
(iii) Address of respondent(s) for service of all notices
(iv) Telephone/Fax Number and 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 period, as specified in the Act, from the date on which a copy of the order against which the appeal is filed, is received by the appellant.
5. Facts of the case and the details of the order against which appeal is filed:
The facts of the case are given below
(Give here a concise statement of facts 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 above, the appellant prays for the following relief(s) [Specify below the relief(s) sought, explain the grounds for relief(s) and the legal provisions, if any, relied upon].
7. Interim order, if prayed for: Pending final decision of the appeal, the appellant seeks issue of the following interim order:
(Give here the nature of the interim order prayed for with reasons).
8. Matter not pending with any other court etc.: The appellant further declares that the matter regarding which this appeal has been made is not pending before any court of law or any other authority or any other Tribunal.
9. Particulars in respect of the fee paid in terms of Rule 9 of these rules
(1) Amount of fees
(2) Name of the Bank on which Demand Draft is drawn
(3) Demand draft Number
10. Details of Index: An index containing the details of the documents to be relied upon is enclosed.
11. List of enclosures
(Signature of the appellant/Authorised Representative)
Form 2
[See Rules 4(3) and 11(2)]
Verification
I son/daughter/wife of Shri .being the (status of party/)/authorised representative of . (status of party) do hereby verify that the contents of Paras 1 to 11 are true to my personal knowledge and belief and that I have not suppressed any material facts.
Signature of the party/Authorised Representative
Place:
Date:
To
The Registrar
..
..