You are on page 1of 3

Application fee: Rs.

10

Application form for seeking information under The Right to Information Act, 2005

Date DD MM YY
The Public Information Officer,
Address: ______________________________________________
______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________

Sir,
I hereby request you to provide following information under Right to Information Act, 2005
in respect of your center.

Particulars of information required (All fields are mandatory):

(i) Subject matter of information: (ii) The period to which the


information relates:
From (DD/MM/YY)
To (DD/MM/YY)

(iii) Description of the information required:


(Details may be attached separately on A4 size paper, if required)

(iv) Whether information is required by:


Post (The actual postal charges shall be included in additional fees) In Person
□ Ordinary □ Registered □ Speed

(v) Purpose for which the information is required:

I hereby declare and confirm that I am an Indian citizen and as such I am entitled to seek information
under RTI Act, 2005. I have attached copy of my PAN card/ Voter's card/ Passport/ Ration card/
Driving license in support of my citizenship. If any information /declaration turns out to be incorrect or
false, I shall be liable for consequences apart from losing right to receive information.

Signature of the applicant


Place: Date:

Full name of the applicant (Fill in Block letters):


Surname First Name Second Name

Address:
House No./ Bldg. Name
Street Name/Area
City & Pin Code
Telephone
E-mail
(For Office Use)
Reference: Received by:
DD MM YY
C-DAC/Centre name/RTI/ □ Post □ E-mail

Sign and Name of receiving officer

(For Office Use Only)

Follow Up Status

Application forwarded to: Name:


Designation:

Signatures of Receiving Officer Time DD MM YY

Information Received on
Time DD MM YY

1st Reply 2nd Reply 3rd Reply 4th Reply


Information sent (DD/MM/YY) (DD/MM/YY) (DD/MM/YY) (DD/MM/YY)
to applicant on

Information has to be sent to applicant on /before Date:


DD MM YY

Signatures (when the information was sent)


Addresses:

Bangalore (Electronic City) Bangalore (Knowledge Park)


APIO- Shri. K.S.Krishnakumar, PIO- Dr. Subrata Chattopadhyay
C-DAC, 61, Electronics City, Bangalore C-DAC, Bangalore, Knowledge Park, Opp.
561 229 HAL Aero Engine Division, 1, Old Madras
Tel:080-28523300 Road, Byappanahalli, Bangalore 560038
Fax 91-80-28522590 Phone : +91-80-25343153
E-Mail:krishna@ncb.ernet.in E-MAIL: subratac@cdac.in

Pune HQ Delhi

PIO- Corporate- Mr. R.Y.Deshapnde A-335, Shivalik Enclave, Near Malaviya


C-DAC, Pune Univ Campus, Pune – Nagar, New Delhi 110 017
411007.
Phone : (020) 25704343,
E-MAIL: ryd@cdac.in Mohali

APIO- Dr. N.R. Ramdasi, Knowledge PIO- Ms. Suneet Kheterpal


Management Cell, C-DAC, Pune C-DAC, A-34, Industrial Area, Phase-VIII,
Phone: (020)25704000/1/2 (Extn 343) Mohali (Near Chandigarh) 160071
E-MAIL: ramdasi@cdac.in Phone: (0172) 2237052-56 (Extn. 212)
Fax: (0172) 2237050-51
Email: suneetk@cedtm.stpm.soft.net

Hyderabad Kolkata
PIO- Mr. M. V. Nageswara Rao, PIO-Shri C.N.Ajit
C-DAC, Hyderabad, 2nd Floor, Delta Phone : (033)23574764(O) 9433012047(M),
Chambers, Ameerpath, Hyderabad 500016 E-MAIL: cna@cdackolkata.com
040-23401331/2, Fax No: 040-23401531
E-MAIL: mvnrao@cdac.in APIO- Mr.P.K.Sengupta,
Phone : (033)2357-9846/5989/3581
Plot E-2/1, Block GP, Sector Vbidhannagar,
Salt Lake, Kolkata 700 091

Mumbai Noida

APIO- P.R.Chandrasekharan, PIO- Mr. C.K.Joseph,


C-DAC, Juhu, Gulmohor Cross Road, C-DAC Noida,
Mumbai -400 049. Anusandhan Bhavan, C-56/1, Sector 62,
Tel:022-26201606/26201488 Noida 201307 (UP)
E-MAIL:chandra@ncst.ernet.in Phone : (0120) 2402551 (Extn 206)
E-MAIL: ckjoseph@cdacnoida.in
APIO- Shri Subhash Chand

Chennai Thiruvanthapuram

PIO-Shri. R. Nagesh, PIO- Mr. Rajendrakumar


Centre for Development of Advanced
P.B. No. 6520, Vellayambalam,
Computing
Thiruvananthapuram 695 033
(C-DAC), Block-II,6/13, Park
Phone: (0471) 2720961
Avenue,Keshava Perumal Puram,
Chennai- 600 028 E-MAIL : - rajan@cdactvm.in
Phone: (044)2461 0880 / 2461 0898
Fax - : (044)2461 0898