Information & Public Relations Department Page 5
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14[ No.- 27163 – I & P.R.]
By Order of Governor
Sd/-
(Digambar Mohanty)
Commissioner-cum-Secretary to Government
-5-
FORM – A
See Rule – 4 (I)
Application for Information under section 6 (1) of the Act
To
The Public Information Officer
(Name of the office with address)
1. Full name of the applicant
2. Father / Spouse name
3. Permanent address
4. Particulars in respect of Identity of the applicant
5. Particulars of information solicited
(a) Subject matter of information
(b) The period to which the information relates
(c) Specific details of information required
(d) Whether information is required by post or in person
(The actual postal charges shall be included in providing information)
(e) In case by post (ordinary, registered or speed)
6. Address to which information will be sent & in which form
7. Has the information provided earlier
8. Is this information not made available by the Public authority
9. Do you agree to pay the required fee
10. Have you deposited application fee
(If yes details of such deposit)
11. Whether belongs to BPL category, have you furnished the proof of the same
Place
Date
Full Signature of the applicant
Address
Office of the Public Information Officer
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business