The format to be filled in by the Candidate / Applicant

UÉ, / To,

£ÀªÀÄÆ£É-J (ªÀiÁ.ºÀ.¥À. D¢ü¤AiÀĪÀÄ 2005gÀ 6(1) ªÀÄvÀÄÛ 7(1) £Éà ¥ÀæPÀgÀt)

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

01. CfðzÁgÀ£À ¥ÀÆtð ºÉ¸ÀgÀÄ

Full Name of the Applicant

02. «¼Á¸À ªÀÄvÀÄÛ zÀÆgÀªÁt ¸ÀASÉå

Address and Phone Number

03. PÉÆÃjzÀ zÁR¯É/¥Àj²Ã®£É/ªÀiÁzÀj

«ªÀgÀ
Details of the
Document/Inspection/samples
required

04. ªÉÄð£ÀªÀÅ AiÀiÁªÀ ªÀµÀðPÉÌ

¸ÀA§¢ü¹ªÉ.
Year to which the above pertains
 05. ªÀiÁ»wAiÀÄ£ÀÄß AiÀiÁªÀ ¸ÁªÀðd¤PÀ
ªÀiÁ»w C¢üPÁj¬ÄAzÀ PÉÆÃjzÉAiÉÆÃ
D C¢üPÁjAiÀÄ ¥ÀzÀ£ÁªÀÄ ªÀÄvÀÄÛ
«¼Á¸À
Designation and Address of the
Public Information Officer from
whom the information is required.

¸ÀÆZÀ£É: CfðAiÉÆqÀ£É gÀÆ. 10/- gÀ CAZÉ CfðAiÀÄ£ÀÄß ®UÀwÛ¸À¨ÉÃPÀÄ.

Note: Enclose of Rs. 10/- Postal Order with the application.

¸ÀܼÀ:
Place:

¢£ÁAPÀ: CfðzÁgÀ£À ¸À»

Date:
Signature of the Applicant