ANNEXURE  "A"
(See rule 3)	


Format of Application for obtaining information under
The Right to Information Act 2005



To: The State Public Information Officer,
(Name of the office with address)



1. FULL NAME OF APPLICANT  :       	


2. ADDRESS	:       	


3. PARTICULARS OF INFORMATION REQUIRED : 		


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(i) Subject matter of information :





(ii) Period to which the information relates :



(iii) Description of information required : 
(Details may be attached on additional A4 size paper if required)









(iv) Whether information is required by post or in person :

(v) In case by post (Ordinary, Registered or Speed) :





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3. WHETHER THE APPLICANT IS BELOW POVERTY LINE :  
(If yes, attach a photocopy of the proof thereof) 

	





Place	: 

Date	: 					Signature of the applicant