RTI
Application Form
To, Date:
The
Public Information Officer,
(Name
of Govt. Department/ organization)
(Full
address of the Govt. Department/organization)
Sub:-Request
for information under RTI Act,2005
Dear
Sir/Madam,
I ______________________________
Son/Daughter/Wife of ____________________ resident of
______________________________________________________________ Telephone No.
(with STD Code) / Mobile No. – (______) __________________ wish to seek
information, under the RTI Act, 2005 from (Name of the Govt. Department/ Govt. Organization).
I, hereby, declare that I am a Citizen of India and information sought in
this application will be used in the best of the Public Interest. I further
assure you that, I shall not allow/cause to use/Pass/share/display/or circulate
the information received in any case and under any circumstances, with any
person or in any manner which would be detrimental to the Unity/Sovereignty or
against the Interest of India.
1. The
information needed is in the form of Documents /Clarification.
(Please tick whichever applicable)
2. The
Information sought pertains to your Head Office/Branch office
(Please tick
whichever applicable)
3. The Required
Information is for the period - ___________ to ______________.
4. The
information sought is related to -------- Myself / Third Party
(Please tick
whichever applicable)
5. The
particular/details of Information /Documents asked for is given below:-
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
6. I have
deposited the required RTI Fee amount of `____/- (Rupees _______ Only) towards application fee through Cash
(Receipt enclosed)/Demand Draft/Banker’s Cheque/Indian Postal Order (Strike Out
Whichever not Applicable) favouring (name of addressee) Payable at ___________ (the place where application is
deposited). Further, I also undertake to pay any additional fees/charges (if
applicable) as prescribed under the RTI Act.
Kindly
provide the information as soon as possible & within time frame as stipulated
under RTI Act, 2005.
(Name and Signature of the Applicant)
Address: - ______________________________
Tel. No. (Office):- _______________________
(Res.):- _______________________
E-mail Address, if any _________________________
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