(1) At the end of each year list of officers or service providers who have not defaulted under the Act in that year shall be published and be issued letter of appreciation as per Form F by head of the Public Authority. The same shall also be noted in the ACR of the concerned officer/employee. The names of such officers shall be recommended to State Government for reward.
(2) The State Government may give a reward to officers or service providers against whom no default is reported in that year, so as {0 cincowrage and enhance the cfficiency of the State Government scrvants. For this, the competent authority shall recommend such names to the State Government at the end of each year. Appropriate reward for such officers may be fixed by the State Government.
GUJARAT GOVERNMENT GAZETTE EX. 26-2-2014 Name of the Office:
Name of Village/Taluka/ District:
Scheduled Services:
FORM A (See Rule 4) DISPLAY BOARD The Gujarat (Right of Citizens to Public Services) Act, 2013.
(State Emblem) [PART IV-B Sr. List List of Name of | Timelimit | Name and | Time limit | Address of | Time limit for No of documents | Designated for Address of for Designated | disposal by the services | (Checklist) Officer Designated | Grievance disposal Authority Designated Officer Redressal by the and State Authority and Officer Grievance | Appellate | State Appellate Redressal | Authority Authority Officer 1 2 3 4 5 6 7 8 9 Name and designation of the authorized person to give and receive the application :
Instructions to Citizens :- > To get the acknowledgement receipt compulsorily.
» If services are delayed / not delivered, contact Grievance Redressal Officer along with acknowledgment receipt.
Website :
Email id :
Contact number of call centre/ Help desk number :
go re I I A A i s a n a b a n
PART-IV-B] ’ GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 83-7 FORM B ( See rule 5(2) or Rule 8(2)) Acknowledgement by the Designated Officer/ Grievance Redressal Officer
1. Name of the Applicant/Complainant with address
2. Date of application/complaint
3. Unique Acknowledgement Number
4. Name of the Designated Officer/Grievance Redressal Officer with designation and address
5. Details of services sought/complaint
6. Accept (Yes/No)
7. Proposed date of Delivery of services/Time frame of Redressal : 8. Rejection (with reasons) Place : Signature and Stamp of the Designated Officer/ Grievance Redressal Officer Date :
83-8 GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 [PART IV-B FORM C ( See Rule 8(1) ) Format for filing Complaint with Grievances Redressal Officer To The Grievance Redressal Officer, Name of the concerned Public Authority Address :- I want to complain against non-delivery/ delayed delivery of service (Details of requested notified service) by Shri / Smt. / Kum ( Name and Designation of Designated Officer ).
I had applied for services on (Date). However, the services were not delivered/ not delivered within prescribed time limit of days.
%» I hereby declare that I am a Citizen of India.
> 1 hereby declare that above details are true to the best of my knowledge and belief.
Name & Signature of the Complainant :
Address :
Telephone No./Mobile No.
Place :
Date :
Mode of delivery of complaint :- Encl :- 1. Copy of Acknowledgement issued by Designated Officer.
PART-IV-B] GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 83-9 FORM-D (See rule-13(1) or rule 15(1) ) Format for filing Appeal before Designated Authority or State Appellate Authority.
To The Designated Authority/ State Appellate Authority, Address I want to file an appeal against decision of Grievances Redressal Officer / Designated Authority (Name & Address) dated I find the said decision/order to be unjustified and unreasonable owing to following reason(s) :- The authority may be pleased to strike down the decision / order of Grievances Reddressal Officer / Designated Authority and pass any such further order and directions as it may consider just.
» Thereby declare that I am a Citizen of India.
» Thereby declare that above details are true to the best of my knowledge and belief.
Signature of the Appellant Address :
Telephone No./Mobile No.
Place :
Date :
Mode of Delivery of Appeal :- Enclosure :
1. Copy of Acknowledgement issued by Designated Officer
2. Copy of Acknowledgement issued by Grievance Redressal Officer.
3. Copy of decision of Grievance Redressal Officer. (in case of Appeal against Grievance Redressal Officer),
4. Copy of Acknowledgement issued by Designated Authority (in case of Appeal against Designated Authority)
5. Copy of decision of Designated Authority (in case of Appeal against Designated Authority) 83-10 GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 [PART IV-B FORM E (See rule 13(3) or rule 15(2)) Acknowledgement by the Designated Authority’ State Appellate Authority:-
1. | Name of the Appellant with address
2. | Name and Address of concerned Public Authority 3 | Name of the Defendant and designation/address
4. | Date of Appeal
5. | Unique Acknowledgement Number
6. | Details of services sought/complaint Place : Signature and Stamp of the Designated Authority/ State Appellate Authority
PART-IV-B] GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 83-11 Form E-1 (see rule 17) Register to be maintained by the Designated Officer Name and designation:
Address:
Sr. Name of the Details of | Reasons for Date of Reasons if | No. of days No. applicant with services rejecting the Services services delayed ) address and sought application delivered denied acknowledgement if any No.
1 2 3 4 5 6 7 83-12 GUJARAT GOVERNMENT GAZETTE EX. 26-2-2014 Register to be maintained by Grievance Redressal Officer Name and designation:
Form E-2 (seerule 17) [PART IV-B Address:
Sr. Name and Date of Details | Name and Reasons | Basis for | Relief Date of | Re- N Addressof | Complaint of | designation for complaint | asked | disposal of marks o- the with services of the rejecting Complaint Complainant | Acknowled | sought Officer the gement. Complained | application No. against if any 1 2 3 4 5 6 7 8 9 10
PART-1V-B] GUJARAT GOVERNMENT GAZETTE EX. 26-2-2014 83-13 Form E-3 (seerule 17) Register to be maintained by Designated Appeal Authority Name and designation:
Address:
Sr, Name and Date of Details Reasons Basis Name and Name and | Date of | Remarks No Address of Appeal of for for designation | designation | disposal : the with services | rejecting | appeal of the of the GRO of Appellant | Acknowled | sought the designated appeal gement complaint, officer No. if any 1 2 3 4 5 6 7 8 9 10 83-14 GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 Name and designation :
Form E-4 (seerule 17) Register to be maintained by State Appellate Authority [PART IV-B Address :
Sr. | Name and Date of |Details of | Reasons Basis Name. and| Name and | Name and | Date of [Remarks N Address of final services for for designation | designation | designation | disposal o the application | sought rejecting | appeal ofthe |ofthe GRO| of the of Appellant with the Appeal, designated Designated | appeal Acknowle if any officer Authority dgement No.
1 2 3 4 5 6 7 8 9 10 11 is 3 as " R T E C S .
fa
PART-IV-B] GUJARAT GOVERNMENT GAZETTE EX,. 26-2-2014 83-15 FORM-F (see rule 20) (Draft Appreciation letter) To, Name and Designation of the officer It is matter of pride that you have delivered the services under the Gujarat (Right of Citizens to Public Services) Act, 2013 in time to the citizens throughout the year. Owing to excellent and timely services rendered by you, the Department and the Government have earned good name and has resulted in promoting good faith in the citizens towards the Act and the administrative reforms measures taken by the Government. It is assumed that the employees will get encouragement and enthusiasm from your model service. I would like to place on record the Government appreciation for the outstanding (default free) service rendered by you in the year...........
Wishing you many more success in future.
Signature and Stamp of Head of Public Authority.
By order and in the name of the Governor of Gujarat.
BHARAT B. PATEL, Deputy Secretary to Government.
Government Central press, Gandhinagar.