UNDER THE RIGHT TO INFORMATION ACT-2005
Application ID No. : (For official use)
To --Department name and address---
The Public Information Officer
1. Name of the Applicant: ____________________
2. Address _____________________
_____________________
3. Particulars of information:
(a) Concerned Office/Department:
(b) Particulars of information required
(i) Details of information required:
(ii) Period for which information asked for:
(iii) Other details:
4. Format in which information is required:
5. Mode of delivery expected:
(ordinary post, speed post, by courier, by hand, through internet or e-mail, by fax etc.).Additional fee may be charged to cover the cost of delivery.
6. The information can be furnished (Please delete the inapplicable portion).
a) Within 30 days as prescribed under Section 6 (1)
b) The information sought for concerns my life and liberty, therefore the information
may be furnished to me within 48 hours
7 I state that the information sought does not fall within the restrictions
contained in section 8 and 9 of the Act and to the best of my
knowledge it pertains to your office.
8. I also state that I am a citizen of India and I am eligible to seek information under the
Right to Information Act 2005.
9. (i) A Postal Order/Bank Draft No. _______ dated _____is enclosed, or
(ii) The applicant is not liable to pay any fee because he/she is below the
&nbs p; poverty line (proof is attached).
(Please tick one and delete the remaining two options)
Place:
Date :
(Name & Signature)
Postal Address :
Tel No :
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