FORM OF APPLICATION

PIO from which information is required

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A. Contact Details

1. Name of the Applicant __________________________

2. a) Mailing Address ____________________________
    b) Tel. No __________________________________
    c) E-mail __________________________________

3. Whether a citizen of India Yes ______  No ______
B. Details of information sought
1. Nature of information sought (Please v Mark)
(a) Life & liberty of the person * ______
(b) Other than (a) ______
2. Type of information required
(a) Copy of documents      Yes ______  No ______
(b) Inspection of records   Yes ______  No ______
(c) Sample of material       Yes ______  No ______
(d) Other information        Yes ______  No ______

3. (a) Whether information sought relates to third party? Yes ______  No ______
    
    (b) If yes his/her name & address _____________________________________
_____________________ _____________________ _____________________

4. Specify the particulars of information required
(i) _______________________________
(ii) ______________________________
(iii) ______________________________
(iv) ______________________________
(v) _______________________________
5. Time period for which information is required _______________________________
6. Whether applicant belongs to BPL category: Yes ______  No ______
Proof of BPL attached                                  Yes ______  No ______
7. Details of fee paid Rs._______________________________
Signature of the applicant
Place ..................................
Date ..................................
 
* Application may preferably be submitted directly to the Public Information Officer concerned to avoid delay.