Right To Information Application

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ANNEXURE “A”

(See rule 3)
Affix Court
fee stamp of
Format of Application for obtaining information under Rs.10/-
The Right to Information Act 2005

To: The State Public Information Officer,


(Name of the office with address)

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


Affix 20 rupees Court fee stamps. Annexure “C”
See Rule 5 (2)
Second appeal under Section 19 (3) of the Right To Information Act, 2005
From :
To,
The Chief Information Commissioner,
New Administrative Building, 13th Floor,
Opp. Mantralaya, Mumbai 400032.

1. Full name of the Appellant:


2. Address:
.
3. Particulars of the State Public Information Officer.:
4.Particulars of the First Appellate Authority:
5. Date of Receipt of order appealed against:
6. Last date for filing appeal:
7. The grounds of appeal: Remedies sought:
1. Please ask the PIO to provide the information.
2. Please penalize PIO as per the provisions of the Act.
3. Also please reprimand the Public authority for such blatant disrespect for the law.
8.Particulars of information-
(i) Nature and subject matter of the information required:
(ii) Name of the office or Department to which the information relates :
.
Place:
Date:

Signature of Appellant
Encl.: Copies of :
1. Annexure A.
2. Annexure B.
3. Copy of acknowledgements

Note: In italics, my suggestion of what you could write. The rest is the format.
For Central government bodies there are no fees for appeals.

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