Permit Denial Appeal Form

Purpose: This form is used to formally appeal against the denial of a government-issued permit. Please provide complete and accurate information to ensure your appeal is reviewed appropriately.

Applicant Information

Full Name: {fullName}

Contact Number: {contactNumber}

Email Address: {email}

Mailing Address:
{mailingAddress}

Permit Application Details

Permit Type: {permitType}

Application Number: {applicationNumber}

Date of Application: {applicationDate}

Date of Denial: {denialDate}

Reason for Denial

{denialReason}

Grounds for Appeal

Please describe your reasons for appealing the denial:

{appealReasons}

Supporting Documents Submitted:

{#supportingDocuments}

• {documentName}

{/supportingDocuments}

Additional Representatives

If you are represented by someone (e.g. lawyer or authorized representative), please provide the details below:

Declaration

I, {fullName}, declare that the information provided in this appeal is true and complete to the best of my knowledge. I understand that providing false or misleading information during an appeal process may result in penalties or legal action.

Date of Submission: {submissionDate}

Signature: {signature}

Office Use Only