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RTI Application Form: Sl. No. Particulars Information

This document is an application form for filing a request for information under India's Right to Information (RTI) Act. The form collects information such as the applicant's name, address, contact details, citizenship and financial status. It also requests details of the information being sought, whether it pertains to a third party, and if it concerns someone's life or liberty. The applicant must declare that they will only use the information for public interest and not share it in a way that could harm national unity or security. The form is used to record the application details for processing by the relevant public information officer.

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sanjay singh yadav
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599 views2 pages

RTI Application Form: Sl. No. Particulars Information

This document is an application form for filing a request for information under India's Right to Information (RTI) Act. The form collects information such as the applicant's name, address, contact details, citizenship and financial status. It also requests details of the information being sought, whether it pertains to a third party, and if it concerns someone's life or liberty. The applicant must declare that they will only use the information for public interest and not share it in a way that could harm national unity or security. The form is used to record the application details for processing by the relevant public information officer.

Uploaded by

sanjay singh yadav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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RTI Application Form

Sl. no. Particulars Information


1. File no. (For Office User)

2. Address of Public Information


Officer

3. Applicant’s Reference no.

4. Date of Application

5. Name of Applicant

6. Gender

7. Complete Postal
Address of Applicant
8. State

9. Country

10. PIN Code

11. Citizenship Status

12. Phone No.

13. E-Mail

14. Is Requester Below Poverty YES / NO


Line?
15. RTI Fees Paid ₹.

16. Mode of Payment of fees

17. Does it concern the Life or


Liberty of a Person? (If YES,
enclose proof)

Page 1 of 2
18. Information Sought

19. Whether Information sought


pertains to third party?

I hereby declare that:


1) I am a citizen of India.
2) The information sought shall be used for Public Interest.
3) I shall not allow / cause to use / pass / share / display or circulate the information received
in any case and under any circumstances, with any person or in any manner which would be
detrimental to the unity / sovereignty or against the interest of India
4) I undertake to pay any additional fees / charges (if applicable) as per prescribed under the
RTI Act.

(SIGNATURE OF THE APPLICANT)

FOR OFFICE USE

Sl. no. Particulars Information


a) Date of Receipt of application

b) Received through Post / Courier / E-Mail / In Person

c) Received by

d) Name of CPIO to whom the application


pertains
e) Date of Transfer / Reply

Page 2 of 2

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