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10
Application form for seeking information under The Right to Information Act, 2005
Date DD MM YY
The Public Information Officer,
Address: ______________________________________________
______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
Sir,
I hereby request you to provide following information under Right to Information Act, 2005
in respect of your center.
I hereby declare and confirm that I am an Indian citizen and as such I am entitled to seek information
under RTI Act, 2005. I have attached copy of my PAN card/ Voter's card/ Passport/ Ration card/
Driving license in support of my citizenship. If any information /declaration turns out to be incorrect or
false, I shall be liable for consequences apart from losing right to receive information.
Address:
House No./ Bldg. Name
Street Name/Area
City & Pin Code
Telephone
E-mail
(For Office Use)
Reference: Received by:
DD MM YY
C-DAC/Centre name/RTI/ □ Post □ E-mail
Follow Up Status
Information Received on
Time DD MM YY
Pune HQ Delhi
Hyderabad Kolkata
PIO- Mr. M. V. Nageswara Rao, PIO-Shri C.N.Ajit
C-DAC, Hyderabad, 2nd Floor, Delta Phone : (033)23574764(O) 9433012047(M),
Chambers, Ameerpath, Hyderabad 500016 E-MAIL: cna@cdackolkata.com
040-23401331/2, Fax No: 040-23401531
E-MAIL: mvnrao@cdac.in APIO- Mr.P.K.Sengupta,
Phone : (033)2357-9846/5989/3581
Plot E-2/1, Block GP, Sector Vbidhannagar,
Salt Lake, Kolkata 700 091
Mumbai Noida
Chennai Thiruvanthapuram