Application Form for obtaining information under RTI

ANNEXURE “A”

Affix Court fee stamp of Rs.10/-

(See rule 3)

Format of Application for obtaining information under

The Right to Information Act 2005

To: The State Public Information Officer,

(Name of the office with address)

1. FULL NAME OF APPLICANT :

2. ADDRESS :

3. PARTICULARS OF INFORMATION REQUIRED

(i) Subject matter of information :

(ii) Period to which the information relates :

(iii) Description of information required : (Details may be attached on additional A4 size paper if required)

(iv) Whether information is required by post or in person :

(v) In case by post (Ordinary, Registered or Speed) :

4. WHETHER THE APPLICANT IS BELOW POVERTY LINE :
(If yes, attach a photocopy of the proof thereof)

Place :

Date : Signature of the applicant

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