RTI Application Form
Applicant I.D. No. ______
Date:
To,
__________________
__________________
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 __________________________, ______.
(Please. Tick whichever applicable)
3. The Required Information is for the period - ___________ to ______________.
4. The information sought is related to -------- Myself / Third Party
(Please. Tick whichever applicable)
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 _________________________
P.S. 1. ____ shall send the information at the address as given by the applicant. Return of Letter due to incomplete/ incorrect address shall not be the responsibility of the _____.
2. Separate form has to be filled up for each query.
