Rti Application Form printable pdf download

RTI Application Form

Applicant I.D. No. _________

File No. - _________________

(For Official use)

Dated:

To ,

The Central Public Information Officer ,

The New India Assurance Company Limited,

Head Office / Regional Office - I / II,

( Strike Out Whichever not Applicable )

___________________________

PIN - ______________________

Sub:- Request for information under RTI-Act 2005

Dear Sir,

I ____________________________ Son / Daughter / Wife of ______________________

Resident of ____________________________________________________________

Telephone No. (with STD Code ) / Mobile No. – (______)_______________ wish to

seek information, under the RTI Act, 2005 from The Oriental Insurance Company

Limited. I, here by, declare that I am a Citizen of India and the information sought in

this application will be used in the best of the Public Inte rest . I further assure you that,

I shall not allow/ cause to use / Pass /share / display / or circulate the information

received in any case and under any circumstances, with any person or in any manner

which would be detrimental to the Unity / Sovereignty or against the Interest of India.

1. The information needed is in the form of --------- Documents / Clarification.

(Plz. Tick whichever applicable)

2. The Information sought pertains to your

BRANCH / DIVISION / REGIONAL OFFICE - ______________

( Strike` Out Whichever not Applicable )

( BO / DO/ RO Code / Place)

3.The Information sought pertains to your HEAD OFFICE - _________________Deptt..

4. The Required Information is for the period - ______________ to _______________.

5. The information sought is related to the

POLICY No . ______________________________ Dated ______________________

CLAIM No. _______________________________ Dated ______________________

6. The information sought is re lated to ------- Myself / Third Party

(Plz. Tick whichever applicable).

7. The particular / details of Information / Documents asked for is given below:-

________________________________________________________________________

8. I have deposited the required RTI Fee amount of Rs.10/-(Rupees Ten only) towards

application fee through CASH (Receipt enclosed) / Demand Draft / Banker’s Cheque /

favoring ‘ THE NEW INDIA

Indian Postal Order

( Strike Out Whichever not Applicable )

ASSURANCE COMPANY LIMITED’ Payable at ______________

( the place where

and the instrument bearing No. -___________ Dated __________.

application is deposited )

Rti Application Form

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