7/25/2019 APPLICATION FOR INFORMATION UNDER RTI_new.pdf

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Department Administrative Reform s and training Department

APPLICATION FOR INFORMATION UNDER RTI

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(Marked Fields are mandatory)

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Application for() RTI Application Appeal

Applicants Details(

)*ApplicantsName () ..

*Applicants Gender

() Male Female

*Mobile Number () ..

Permanent Address ()

Adderess Line 1( ) .

Address Line 2 ( ) .

*State () .*District () .

*Sub-Division () ..

*Circle Office ( ) .

*Village/Town (/) ..

*Post Office () ..

*Pin Code ( ) .. (e.g 78xxxx)

Email ID () ..

Other Details ( )

*Do you belong to BPL ()? Yes No

Fee Paid () By Cash Draft Stamp IPO

Draft /IPO No (/ ) .

Draft/ IPO date (/ ) .

Drawn on () .

*Preferred Language( ) .

*Will you Collect Personally? ( ) Yes No

Delivery Mode () Ordinary post Registered post Speed post

Supporting Documents ( )

1. RTI Queries ( )

2. Any other documents. () Signature of the applicant

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