RTIApplicationForm

FORMA
SeeRule3(1)
I.D.No..
(ForOfficeUseOnly)
To
ThePublicInformationOfficer/
AssistantPublicInformationOfficer
1.FullNameofTheApplicant
2.FatherName/SpouseName
3.PermanentAddress

4.CorrespondenceAddress

5.ParticularsofTheInformationSolicited
a) SubjectMatterofInformation(*)

:____________________________
:____________________________
:____________________________
:____________________________
:____________________________
:____________________________
:____________________________
:____________________________
:____________________________

b) Theperiodtowhichinformationrelates(**):____________________________
c) SpecificDetailsofInformationrequired(***):____________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
d) WhetherinformationisrequiredbyPost
:____________________________
orinperson(theactualpostalfeesshallbe :____________________________
includedinadditionalfeeinprovidingtheinformation)
e) IncasebyPost(ordinary/registered
:____________________________
orspeedpost)
6.Isthisinformationnotmadeavailableby
publicauthorityundervoluntarydisclosure?
:____________________________
7.Doyouagreetopaytherequiredfee?
:____________________________
8.Haveyoudepositedapplicationfee?
:____________________________
(IfYes,Detailsofsuchdeposit)
:____________________________
9.WhetherbelongstobelowPovertyLinecategory?:____________________________
(Ifyes,youfurnishedtheproofofthesamewith
application?)
Place:
Date:

SignatureofApplicant

(*)BroadCategoryofthesubjecttobeindicated(suchasgrantofgovernmentservice
matters/Licensesetc.)
(**)Relevantperiodforwhichinformationisrequiredtobeindicated.
(***)Specificdetailsoftheinformationarerequiredtobeindicated.

NameoftheDepartmentorPublicAuthority

FORMB
[Seerule3(2)]
Acknowledgement
OfficeoftheStatePublicInformation Officer

Receivedtheapplicationformfrom
Mr/Ms

:____________________________

Address

:____________________________
:____________________________
:____________________________
:____________________________
:____________________________
:____________________________

Seekinginformationon(Subjecttobespecified)

VideDiaryNo.:____________________________Dated:_________________________

Place
Date

FullNameofStatePublicInformationOfficer/
StateAssistantPublicInformationOfficer
DesignationandSeal