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FORM-A ( section 6(1) and 7(1) of the RTI Act, 2005)
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1 Full Name of the Applicant

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2 Address
PÉÆÃjzÀ zÁR¯É/ ¥Àj²Ã®£É/ ªÀiÁzÀj
3 «ªÀgÀ.
Details of the document/ Inspection/ Samples
required
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4 Year to which the above pertains
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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 of Rs.10/-I.P.O/ D.D./ Cash with the application.
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Place:
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Date: Signature of the Applicant