Rti Application Form (Page 2 of 2) in pdf

Rti Application Form Page 2

Further, I also undertake to pay any additional fees/charges (if applicable) as prescribed

under the RTI Act.

9. It is certified that I do fall under the category Below Poverty Line (BPL), and an

attested copy of the relevant certificate (issued by the competent authority) is enclosed

herewith for your kind perusal. ( Please strike out if not belonging to the BPL category)

Kindly provide the information as soon as possible & within time frame as stipulated

under RTI Act,2005.

(Signature of the Applicant)

Fax No. :

E-mail Address :

P. S.- 1. Please fill the application form in CAPITAL letters

2. The above

Application form is Optional & NOT Compulsory .

FOR OFFICE USE : -

A. THE Application Has been

Y Y

1. Received on ---

2. Received through –

POST / E-MAIL / In PERSON

( Strike Out Whichever not Applicable )

3. Received By ( Name of Person )-

________________________

B. Designation of Person Receiving Application ________________________________

C. Office particulars where Application was received ___________________________

D. The Application has been Forwarded to ( Name of Person concerned / Office

Particulars ) –

____________________________________________________________

E. Signature & Stamp of the Person Receiving RTI Application –

Rti Application Form Page 2