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APPLICATION FOR INFORMATION
UNDER THE RIGHT TO INFORMATION ACT, 2005
(Form-A — See Rule 3(1) of the Right to Information Rules, 2012)
Registration / I.D. No.: ________
(For office use only)
Dated: ________
To,
The Central Public Information Officer / State Public Information Officer (PIO),
________
(________)
________,
________,
________,
________, India.
Re: Request for information under Section 6(1) of the Right to Information Act, 2005.
Sir / Madam,
§1. Applicant Particulars. I, ________, son/daughter/spouse of ________, aged ________ years, being a citizen of India and competent to seek information under the Right to Information Act, 2005 (Act No. 22 of 2005), do hereby submit this application before the Public Information Officer of the aforesaid public authority.
§2. Information Sought. Pursuant to Section 6(1) of the Right to Information Act, 2005, I request that the following information be furnished to me:
________.
§3. Period of Information. Kindly limit the search of the aforesaid information to the period from ________ to ________.
§4. Enclosures. The following documents are annexed to this application for your reference:
________
§5. Mode of Supply. I request that the said information be furnished to me by way of ________, and where applicable dispatched by post (________) to the address mentioned at the foot of this application. Where the information is voluminous or maintained in a particular medium, I request, in the alternative, an opportunity to inspect the relevant records or take samples in person at a date and time conveniently fixed by your office, in accordance with Section 2(j) of the Act.
§6. Fees. I undertake to pay the prescribed application and additional fees as may be chargeable under the Right to Information (Regulation of Fee and Cost) Rules, 2005 and the rules framed thereunder, after deduction of any concession to which I may be entitled in law.
§8. BPL Declaration (if applicable). I am a person belonging to the Below Poverty Line (BPL) category and accordingly claim exemption from payment of fees under the applicable rules. A self-attested copy of my BPL card bearing No. ________ is enclosed herewith.
Date: ________
Place: ________
Yours faithfully,
________________________
(Signature of Applicant)
________
Permanent / Postal Address for correspondence:
________
________
________
________, India
Telephone / Mobile: ________
E-mail: ________
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