⚖️RTI
Application Form
Date:
To,
The Public Information Officer
__________________
__________________
Sub:-Request for information under RTI Act
Dear Sir,
I __________________________ Son/ Daughter / Wife of
____________________ resident of
_________________________________________________________ Telephone No. (with
STD Code) / Mobile No. – (______) __________________ wish to seek information,
under the RTI Act, _____ from _____________, ______. 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
__________________________, ______.
3. The Required Information is for the period - ___________ to
______________.
4. The information sought is related to -------- Myself / Third
Party
5. The particular / details of Information / Documents asked for
are given below:-
___________________________________________________
___________________________________________________
6. I have deposited the required RTI Fee amount of Rs. __/-
(Rupees ___ Only) towards application fee through Cash (Receipt enclosed) /
Demand Draft / Banker’s Cheque / Indian Postal Order (Strike Out Whichever not
Applicable) favouring ‘_____________, __________’ 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, _____.
(Name and
Signature of the Applicant)
Address: - ______________________________
Telephone No. (Office):- _______________________
(Res.):- _______________________
E-mail Address, if any _________________________