RTI Application Form

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. ___________________________________________________
  7. ___________________________________________________
  8.  
  9. 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):- _______________________

(Res.):- _______________________

E-mail Address, if any _________________________

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