IN THE STATE CONSUMER DISPUTES REDRESSAL COMMISSION AT………………..
Appeal No………………… of 19………………..
Appeal under Section 19 of the Consumer Protection Act against the order of District Forum………………..
(mention place)
A. B. (add description and residence)………………………………… Appellant/Appellants

versus

C. D. (add description and residence)…………………………… Respondent/Respondents
To
The Hon’ble President and his companion members of National Commission.
Sirs,
The Appellant/Appellants most respectfully showeth:
1. This is in appeal under Section 19 against the Order of the State Commission……………….. (name of
place) dated……………….. in Appeal No. ……………….. of 19………………..
2. That the appeal is being filed within a period of 30 days from the date of Order as per the provisions of
Section 19 of the Consumer Protection Act.

OR

That this appeal is being filed after the expiry of period of 30 days as it could not be filed within the
prescribed period for the reasons mentioned in the application filed along with this appeal for
condonation of delay. The said application is being disputed by an Affidavit.
3. Grounds of objections to the order appealed against may be set forth concisely and under distinct
heads without any argument or narrative; such grounds are to be numbered consecutively.
4. Prayer clause with details of relief/reliefs being claimed are to be stated.
Place………………..

Appellant/Appellants

Date…………………

In person or through Counsel