RTI Application Form
The Public Information Officer
Sub:-Request for information under RTI Act
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.
- The information needed is in the form of ___________ Documents / Clarification.
(Please. Tick whichever applicable)
- The Information sought pertains to your head office __________________________, ______.
- The Required Information is for the period – ___________ to ______________.
- The information sought is related to ——– Myself / Third Party
- The particular / details of Information / Documents asked for are given below:-
- 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) favoring ‘_____________, __________’ 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):- _______________________
E-mail Address, if any _________________________