FORM A [See rule 3(1) ] Application for obtaining information __________________________________________________ Date: ___________ Place _______ By regd/speed post

ad. To, Public Information Officer (Name of Public Authority / Department / Office) Address: Sir, I want to obtain following information from you under the Right to Information Act, 2005. The details are as under. 1. Applicant's Name: 2. Address of the applicant [with phone/mobile No. if any]: 3. Information required [with duration/period]: 4. I enclose herewith crossed Indian Postal Order for application fees. The details are as under: Number: ________Date: ______Issuing post office: _____ Drawn in favour of: ______________ Amount: Rs.20/OR Non-judicial stamp / court fee stamp / revenue stamp of Rs.20/-. is affixed on this application. OR I hereby declare that I belong to B.P.L. family as on date of application and I enclose herewith certified copy / true copy of B.P.L card or certified copy / true copy of certificate for B.P.L. Therefore I have not paid application fee. 5. I hereby declare that I am a Citizen of India. Self attested photocopy of voter card/ ration card/ driving licence/pass port/PAN card is attached for citizenship proof. 6. I hereby declare that above details are true to the best of my knowledge and belief. Signature of applicant: __________________________________________________