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SAMPLE APPLICATION FORM (BLANK)

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ANNEXURE “A”
(See rule 3)


Format of Application for obtaining information under
The Right to Information Act 2005
To: The State Public Information Officer
(Name of the office with address)
Affix court fee
stamp of Rs.10

 

1. FULL NAME OF APPLICANT :

2. ADDRESS :

3. PARTICULARS OF INFORMATION REQUIRED :

(i) Subject matter of information :

 

(ii) Period to which the information relates :

(iii) Description of information required :
(Details may be attached on additional A4 size paper if required)

 

 

 

(iv) Whether information is required by post or in person :

(v) In case by post (Ordinary, Registered or Speed) :


4. WHETHER THE APPLICANT IS BELOW POVERTY LINE :
(If yes, attach a photocopy of the proof thereof)

 

 

 

Place :

Date :

 

 

 

Signature of the applicant