FORM A

See Rule 3 (1)

To
I.D.No. ......................
(For office use only)
The Public Information Officer/
Assistamt Public Information Officer

1. Full name of applicant

:___________________________________________________

2. Father names/ Spouses name

:___________________________________________________

3. Parmanent address

:___________________________________________________

4. Correspondence address

:___________________________________________________

5. Particulars of information solicited

(a) Subject matter of Information*

:___________________________________________________

(b) The period to which the information related** : ___________________________________________________

(c) Specific details of information required***

:____________________________________________________

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(d)Whether Information is required by post or in

:_________________________________________________
person the actual postal charges shall be included
in additional fee in providing information.
(e) In case by post (Ordinary, Registered or
Speed Post)

:_________________________________________________

6. Is this information not made available by

:_________________________________________________
the Public Authority under voluntary disclosure.
7. Do you agree to pay the required fee?

:_________________________________________________

8. Have you deposited application fee?

(if yes, details of such deposit)

:_________________________________________________

9. Whether belongs to below Poverty line category ?:_________________________________________________

If year you furnished the proof of the same
Will applicant?

:_________________________________________________

Place:
Date:
Signature of Applicant