Form-A
[See Rule 3(1)]
To[See Rule 3(1)]
The Public Information Officer
O/o .......................................
..............................................
.............................................
Sub :- Application under RTI Act. to get information.
1. Name of the applicant : ..................................................
2. Parmanent Address : .................................................................... .....................................................................
.....................................................................
3. Particulars of information required :
(i) Subject Matter of Information : Information about ..............
(ii) The period to which the information relates : w.e.f. ................
(iii) Description of the information required :
1. (Write your questions here)
2. (Write your questions here)
vi) Whether information is required by Post or in Person : By post
(v) In case by Post (Ordinary/Registered/Speed) : Registered Post
A sum of Rs. 10/- on account of fee as mandatory under Right to information Act for the supply of information has been sent by applicant with this application vide Cash Receipt No/Postal Order No - ............ Dated ............................ So please provide above information as soon as possible.
Place : ................................
Date : .................................. Signature of Applicant
Note : I, State that the information sought does not fall within the restrictions contained in
Section 8 of the Act and to the best of my knowledge it pertains to your office.
Received your application Dated ................ vide Diary No. .................Dated .................
1. Name of the applicant : ..................................................
2. Parmanent Address : .................................................................... .....................................................................
.....................................................................
3. Particulars of information required :
(i) Subject Matter of Information : Information about ..............
(ii) The period to which the information relates : w.e.f. ................
(iii) Description of the information required :
1. (Write your questions here)
2. (Write your questions here)
vi) Whether information is required by Post or in Person : By post
(v) In case by Post (Ordinary/Registered/Speed) : Registered Post
A sum of Rs. 10/- on account of fee as mandatory under Right to information Act for the supply of information has been sent by applicant with this application vide Cash Receipt No/Postal Order No - ............ Dated ............................ So please provide above information as soon as possible.
Place : ................................
Date : .................................. Signature of Applicant
Note : I, State that the information sought does not fall within the restrictions contained in
Section 8 of the Act and to the best of my knowledge it pertains to your office.
ACKNOWLEDGEMENT
Received your application Dated ................ vide Diary No. .................Dated .................
(Signature)
The Public Information Officer
O/o .......................................
The Public Information Officer
O/o .......................................
..............................................
..............................................