RTI

CONTACT INFO

NamePhNoDesignation
PRINCIPAL99483548568INFORMATION OFFICER
Dr.H.L MALLESH GOWDA94487793177ASST.INFORMATION OFFICER

Information Officer Will Receive Appeals, Under The ACT RTI 2015
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: