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£ÀªÀÄÆ£É-J (ªÀiÁ.¥À.ºÀ.

C¢ü¤AiÀĪÀÄ 2005gÀ ¸ÉPÀë£ï 6(1) £Éà ¥ÀæPÀgÀt)


FORM-A (section 6(1) of the RTI Act, 2005)
CfðzÁgÀ£À ¥ÀÆtð ºÉ¸ÀgÀÄ
1 Full Name of the Applicant

«¼Á¸À:
2 Address

PÉÆÃjzÀ zÁR¯É/¥Àj²Ã®£É/ªÀiÁzÀj
3 «ªÀgÀ
Details of the document/ Inspection/
Samples
required

ªÉÄð£ÀªÀÅ AiÀiÁªÀ ªÀµÀðPÉÌ ¸ÀA§A¢ü¹ªÉ.


4 Year to which the above pertains

ªÀiÁ»wAiÀÄ£ÀÄß AiÀiÁªÀ ¸ÁªÀðd¤PÀ ªÀiÁ»w


5 C¢üPÁj¬ÄAzÀ
PÉÆÃjzÉAiÉÆà D C¢üPÁjAiÀÄ ¥ÀzÀ£ÁªÀÄ ªÀÄvÀÄÛ
«¼Á¸À.
Designation and Address of the Public
Information Officer from whom the
information is required.

Note: Enclose Rs. 10/-I.P.O/D.D./Cash with the application.

¸ÀܼÀ:
Place:

¢£ÁAPÀ: CfðzÁgÀ£À ¸À»


Date: Signature of the Applicant

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