APPEAL
(submitted to Kela, which forwards it to the Social Security Appeal
Board)

Appellant:
[FIRST NAME LAST NAME]
[PERSONAL IDENTITY CODE]
[ADDRESS]
[PHONE NUMBER]

Decision appealed:
Kela decision, benefit: [NAME OF THE BENEFIT, e.g. general benefit,
housing allowance, sickness allowance]
Decision number: [NUMBER]
Date of the decision: [DATE]
Date of notification: [DATE]

My claim:
I request that the Kela decision be [revoked / amended] so that [WHAT YOU
CONCRETELY DEMAND].

Grounds:
[EXPLAIN CONCRETELY WHAT IS WRONG IN THE DECISION AND WHY. E.g.:

In the decision, [WHICH CIRCUMSTANCE] has been assessed incorrectly,
because [GROUND AND REFERENCE TO ATTACHMENT].

OR: The decision did not take [WHAT] into account, although [GROUND].]

Attachments:
1. Kela decision [DATE]
[2. OTHER ATTACHMENTS — e.g. medical statement, bank statement, payslip]

[DATE]
[SIGNATURE AND NAME IN PRINT]