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1)
Details
of the Applicant:
Application for seeking information
under the Right to Information Act, 2005
To
The Public Information officer / Asst Public
Information officer,
…………………………………………………………………………
…………………………………………………………………………
…………………………………………………………………………
Name of the
Applicant:…………………………………………………………
Father’s
Name:……………………………………………………………………
2) Address :…………………………………………………………
………………………………………………………………………
………………………………………………………………………
Phone/Cell No:……………………………… E-mail
ID: ………………………………
3)
Particulars
of Information required u/s 6 of RTI Act, 2005:
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4) Language
in which information is required:-----------------------------------------------
5) Mode of Delivery expected:
(by speed / Regd post,
courier or by mail)
6)
Fee Details:
Mode
of Payment:…………………………………………
Date
of Payment:…………………………………………
Note: The Application Fee may be paid in the form of D.D /
Postal Order / Court Fee Stamp be affixed on the pplication. If the applicant is below poverty line, he/she is not
liable to pay Application Fee.
DECLARATION
I also state that I am a citizen of
India and I am eligible to seek information under the Right to Information Act,
2005. I state that the information sought does not fall within the restrictions
contained in Section 8 of the Act to the best of my knowledge.
Place:
Date: Signature
of the applicant
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FORMAT / APPLICATION FOR APPEAL IS AS FOLLOWING
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FIRST
APPEAL UNDER THE RIGHT TO INFORMATION ACT, 2005
To
The
First Appellate Authority,
…………………………………………….
…………………………………………….
…………………………………………….
…………………………………………….
Sir,
As I
am aggrieved by decision / no decision of Public Information Officer / Asst
Public Information Officer, I hereby file this appeal for your kind decision.
1) Name of the Applicant:……………………………………………………..
Father’s
Name:……………………………………………………………………
2) Address :…………………………………………………………
………………………………………………………………………
………………………………………………………………………
Phone/Cell No:……………………………… E-mail
ID: ………………………………
3)
Details
of Public Information officer / Asst Public Information officer:
Designation:……………………………………………………
Address :…………………………………………………………
………………………………………………………………………
………………………………………………………………………
4)
Details
of RTI Application to the PIO:
Date of Application:…………………………
Mailed on:………………………by hand
delivery/ registered /speed post No………..
Date of receipt of the application
by PIO:…………………………
5)
Particulars
of payment of filing fee:
Paid Rs…….by band draft / IPO
No:……………………. Dated……………………………… of …………………………….Bank/ Post office or deposited
cash on ………………….against receipt No……………………..with ……………………office / department or
affixed court fee stamp on the application.
6)
Particulars of information sought:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………………..
7)
Particulars
of Decision of PIO:
Letter reference No:…………………………..
Date of PIO’s Decision:……………………….
Date of receipt of decision by the
appellant:………………………………..
8)
Brief
facts of the case:
……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………………………………………………
………………………………..
9) Reasons
/ Grounds for this appeal:
………………………………………………………………………………………………………
……………………………………………………………………………………
10) Any
other information in support of appeal:
……………………………………………………………………………………………………… ……………………………………………………………………………………………………… ………………………………………………………………………………………………
11) Prayer
/ Relief sought for:
……………………………………………………………………………………………………… ………………………………………………………………………………………………………
……………………………………………………………………………………………
12) Grounds
for prayer / relief sought for:
………………………………………………………………………………………………………
………………………………………………………………………………………………………
…………………………………………………………………………………………….
13) Personal
presence at hearing: YES / NO……………………………
Enclosures:
Xerox copies of original RTI application with its enclosures, Postal proof of
mailing, acknowledgement of PIO/ Asst PIO / CPIO / SPIO, decision letter of
PIO/ Asst PIO / CPIO / SPIO.
DECLARATION
I hereby state that the information
and particulars given above are true to the best of my knowledge and belief. I
also declare that this matter is not previously filed with any information
commission nor is pending with any court or tribunal or authority.
Place:………………
Date:………………… Signature
of the appellant
