ANNEXURE - A

RTI APPLICATION FORM

(RIGHT OT INFORMATION ACT – 2005)

To
The Public information Officer Affix
Court Fee
________________________ Stamp of
Rs.10
____________________________

____________________________

Respected Sir,

Subject: Request for Information under Right to Information Act 2005.

I Sri / Smt /Ms. ______________________________________________

Son/Daughter/wife of _________________________________________

resident of ___________________________________________________

_____________________________________________________________

wish to seek information as under

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Whether information is required by post or in person:
In case by post (Ordinary, Registered, Speed):

Whether applicant belong to Category of Poverty Line (BPL):

(If yes, attach a photo copy of certificate)

Signature of the Applicant

Date:
Place: