Form for submission of Monthly issues to PIB

To

PIB DAVP Code No.

Subject: Submission of issues for the month _______________ and year 2017.
Sir/Maam,
With reference to above, I hereby submit the issues of my newspaper ________________ published from
________________ language ____________ periodicity ______________.

Details of Newspaper

1. Issues submitted for the month __________year _________.

2. Total number of issues__________
3. Number of pages in each issue __
4. Issues printed in color or B/W ______________

Kindly acknowledge.

Yours faithfully,

Signature ____________
Name _______________________________
Designation / Position held in Newspaper _______________
Address _________________________________________________
Contact No. _______________________________