Rti Application Form 'A printable pdf download

RTI APPLICATION FORM ‘A’

To,

The Public information Officer

____________________________

PIN: _______________________

1. Full Name of the applicant.

: _______________________________________

2. Father Name/Spouse Name : _______________________________________

3. Permanent Address

_______________________________________

4. Correspondence Address

: _______________________________________

5. Particulars of the information Solicited; ___________________________________

(a) Subject Matter of Information :_________________________________________

(b) The period to which information relates: ___________________________________

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6. It is certified that I am a bona fide citizen of India.

7. “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 enclose herewith for your information.

(*Please strike out if not belonging to the BPL category).

8. A copy of _______________________ as Identity /Address Proof is enclosed.

9. (i) A fee of Rs. _________ has been deposited in the Finance & Accounts Office of the STPI vide

Receipt No. ___________ dated _______________, or

(ii) A Postal Order/Bank Draft No. _____________ dated ____________ is enclosed, or

(iii) The applicant is not liable to pay any fee because he/she is below the poverty line (proof is

attached)

(Please tick one and delete the remaining two options)

Place:

Date:

(Name & Signature)

Telephone No

Fax No.:

E-mail Address:

Rti Application Form 'A