1.

Name of the Applicant

:

……………………………………..

2.

Address

:

………………………………………..

3.

Particulars of information.

(a) Concerned department

(b) Particulars of information required.

:

:

…………………………………….

…………………………………….

i)Details of information required

:

……………………………………….

ii)Period for which information asked for

:

……………………………………….

iii)Other details

:

………………………………………

4. I state that the information sought does not fall within the restrictions contained in the Right to Information Act, 2005 and to the best of my knowledge it pertains to your office.

5. A fee of Rs.____________ has been deposited in the office of the Competent authority vide No_______________________dated________________.