SAMPLE RTI APPLICATION FORM |
To, |
The Public Information Officer |
______________________________ |
______________________________ |
PIN:__________________________ |
Sir, |
Subject: Request for information under Right to Information Act 2005. |
I Sri / Smt / Ms. |
__________________________________________________________________________ |
Son/Daughter/Wife of Shri/Smt/Ms. |
__________________________________________________________________________ |
resident of |
__________________________________________________________________________ |
telephone number (with STD Code)_____ - ____________________ and/mobile |
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I hereby inform that following formalities have been completed by me: |
1. That I have deposited the requisite fee of Rs.______ /- by way of Cash/Banker |
cheque/Draft/Postal Order/ others____________________ ) favoring |
_______________________________________ dated ___________________________. |
2. I need the photocopy of the documents and I had deposited the cost of the |
photocopy of Rs.______ /- for the charges of CD. (strike out which ever is not applicable) |
or |
3. I had deposited sum of Rs.______ /- for the charges of CD. (strike out which ever is not |
applicable) |
4. That I belong to Category of below Poverty Line (BPL): Yes/No |
(Strike whichever is not applicable). If yes, I am attaching the valid photocopy of the |
certificate. Yes / No |
5. That I am 'Citizen' of India and I am asking the information as 'Citizen'. |
6. I assure 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 and Sovereignty or against the against the Interest of India. |
Signature of the Applicant, |
Dated: |