FORM -1
Form of application for seeking information
under the Right to Information Act,2005.
I.D. No
(For official use)
To
The Public Information Officer,
Tukkuguda Mu
……………………………………
……………………………………
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. A fee of Rs 10/- (Rupees ten only) has been deposited in the office of the Public
Information Officer vide receipt No…………. dated………………..
Place : ……………………
Date : ……………………..
Signature of Applicant
E-mail address, if any
Tel. No. (Office)
(Residence)
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Note :- (i) Reasonable assistance can be provided by the Public Information Officer in
filling up the Form 1.