First appeal under section 6(1) of the Bihar Right to Public Services Act, 2011

To: The Sub-Divisional Officer, [Sub-Division name], [district]

1. Name and address of the appellant: [your full name and address, mobile number]
2. Name and address of the designated public servant: Circle Officer, [circle name], [district]
3. Service applied for: [Caste / Income / Residence] certificate, application reference number [number], submitted on [date]
4. Order appealed against: [the rejection order dated (date), in short] OR [no decision within 10 working days; the time limit ended on (date)]
5. Grounds of appeal: [why the rejection is wrong, or that no certificate was issued within the time limit]
6. Relief sought: Direct the designated public servant to issue the certificate, and take action under section 7 of the Act.
7. Other information: [anything else that helps]

Documents attached:
(a) List of documents
(b) Self attested copy of the rejection order or the acknowledgement
(c) Copies of the documents referred to above

Place: [place]
Date: [date]
Signature: [your signature]