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FORMS:-

 

 

 

B.                 VARIOUS FORMS:

 

 

i)          Form-A           [See rule-3(1)]

            APPLICATION FOR INFORMATION UNDER

            THE GIGHT TO INFORMATION ACT 2005.

                                                                                                                                                                                                                        .

ii)         Form-B           [See rule 3(3)]

 

iii)        Form-C           [See rule 3(3)&6(i)]

            .

iv)        Form-D           [See rule-4(1)]

            APPLICATION FOR INSPECTION

            UNDER THE RIGHT TO INFORMATION ACT.2005

            .

v)         Form-E            .          

 

 

Form ‘A’

[See rule -3(1) ]

 

                        APPLICATION FOR INFORMATION UNDER

                        THE RIGHT TO INFORMATION ACT 2005

 

To

 

 

                        The Public Information Officer/Assistant Public

                        Information Officer

 

                        (Name of the Department  from which the information

                        is sought)

 

(a)  Subject matter of the information

 

                        (b)   Period to which the information  relates.

                                Month & year

 

                        (c)   Description of the information required

 

(d)    File No. if available

(e)    Whether the applicant claims exemption

As below poverty line family, if yes, attach proof

 

(f)      Original Treasury  Challan No

Amount and date of depositing

Application fee under rule 4 be attached.

 

 

 

 

                                                               Applicant 

 

 

                                                     Name_________

 

 

                                          Address_______________

 

                              Telephone No._______________________

 

 

 

 

         FORM ‘B’

     [See rule 3(3) ]

 

 

From

 

Designation of the

                                Public Information Officer/Assistant Public

                                Information Officer

(Department-------------)

 

 

To

 

                                (Name of the applicant)

Address of the applicant.

 

 

Reference:             Application No.--------------Dated_____________

 

 

Subject:

 

 

Sir,

 

Please refer to your application dated____________ referred to above.  The information  required by you consists of __________ pages and printed publication cost Rs.___________. The additional fee for supplying this information to you is  Rs.__________.  In case you desire the information to be sent to you by post, an additional amount of Rs.___________ will need to be deposited.

 

2.                                 You are required to deposit the aforesaid amount of the additional fee in a Government Treasury under Head_________ through challan and send a copy thereof to the undersigned.

 

3.                                If you are not satisfied with the amount of additional fee levied, you have a right to prefer appeal to ____________________ within a period of 30 days.

 

 

 

Public Information Officer/Assistant

Public Information Officer

Tel. No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form ‘C’

[See rule 3(3) & 6(i)]

 

 

From

 

                        Designation of the

Public Information Officer/Assistant Public

Information Officer

[Department-______________ ]

 

 

To

 

                        (Name of the applicant)

Address of the applicant.

 

 

Reference:        Application No.______________________ dated___________

 

 

Subject:           

 

Sir,

 

                        Please refer to  your application  dated ______________referred to above.

 

 

2.                         The information required by you is ready .  You are directed to collect the information from the office of the undersigned on any working day of the week during 12.00 to 3.30p.m.

 

 

                                                                        Public Information  Officer /Assistant

                                                                        Public Information Officer

                                                                        Telephone  No.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Form ‘D’

[See rule-4(1)]

 

                                                APPLICATION FOR INSPECTION

 

                                UNDER THE RIGHT TO INFORMATION ACT 2005

 

 

 

 

 

To

 

 

                        The Public Information Officer/Assistant Public

                        Information Officer

 

                        (Name of the Department from which the inspection

                        is sought)

 

 

(a)  Subject matter of the information

(b)   Period to which the information relates.

        Month & year

 

 

                        (c)   Description of the information required

 

(d)   File No. if available

 

(e)   Whether the applicant claims exemption

       as below poverty line family, if yes, attach proof

 

(f)   Original Treasury Challan No.

                   amount and date of depositing

       application fee under rule 4 be attached     

 

 

 

                                     Applicant

 

                         Name_____________

 

 

            Address_______________

 

 

Telephone No.__________________

 

 

                                                                                                                                Appendix-I

 

 REGISTER OF APPLICATIONS FOR INFORMATION

UNDER THE RIGHT TO INFORMATION ACT 2005

 

                                    PART-I

 

SSl

NNo

Name &

full postal

address

of the

applicant

Whether

below

poverty

line

(BPL)

Date of

receipt of

application

Tentative

date on

which

the record

would be

ready

Mode by

which the information

is sent

Treasury

challan

No. and

date

Signature

of

PIO/APIO

 

 1

       2

     3

      4

     5

       6

     7

        8

 

 

 

 

 

 

 

 

 

 

                                    PART-II

 

Actual date

when the

information is

ready

Number of

actual

pages

Amount of

additional fee

Signature of applicant

with

date in token of receipt

if the

information is delivered

in person

or if the information is

sent by

post its particulars and

date

Signature of

PIO/APIO

              9

          10

         11

                  12

            13

 

 

 

 

 

 

 

 

                                                                        Appendix-II

 

INSPECTION REGISTER

UNDER THE RIGHT TO INFORMATION ACT.2005

 

 

Sl

No

Name & full

     postal

address of

     the

applicant

Whether

below

poverty

line(BPL)

Subject

matter

of

information

Particulars of

record

to be

inspected

Time

taken

From__

to____

 

Amount of

Fee charged

Signature of

applicant

Particulars of

challan

deposited in

treasury

     By

PIO/APIO

Signature

       of

PIO/APIO

   1

       2  

     3

     4  

       5

     6

      7

      8

       9

       10

 

 

 

 

 

 

 

 

 

 

 


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