Application Form for
RTI 
-Central
Format of application for obtaining
information under the Right to
Information Act, 2005
To,
The Central
Public information Officer ,
(Name of the Office with Address)
(1) Full name of Applicant: Mr./Mrs./Ms.
(2) Address:
(3) Particulars of the
information required
(i) Subject matter of
Information :
(ii) The period to which the
information relates:
(iii) Description of the
information required:
(iv) Whether the
information is required by post or in person:
(the actual postal charges shall be included in additional fees)
(v) In case by post (Ordinary, Registered or Speed):
(4) Whether the applicant is below poverty line
(if yes, attach the photocopy of the proof thereof.)
Place: Signature of the Applicant
Date: Fee of Rs.10/- sent in cash/by moneyorder/
by payorder no.…………………….
ANNEXURE “B” Affix here Court Fee Stamp
[See rule
5(1) of Maharashtra Right to
Information Rules,2005] Fee Stamp of Rs. 20/-
Appeal under
section 19 (1) of the Right to
Information Act, 2005.
From : Mr./Mrs./Ms.
(Appellant’s name and address)
To : The
Appellate Authority &
(Name/designation/address of the
Appellate authority )
(1) Full name of the Appellant : Mr./Mrs./Ms.
(2) Address :
(3) Particulars of the State
Public Information Officer :
(4) Date of receipt of the order appealed against :
(if order passed)
(5) Last date for filing the appeal :
(6) The grounds for appeal
(7) Particulars of
information --
(i) Nature and subject matter of the
information required :
(ii) Name of the office or Department
to which the
information relates :
Place :
Date : Signature of Appellant.
ANNEXURE “C” Fee Affix here Court Stamp Rs.20
[See rule
5(2) of Maharashtra Right to
Information Rules,2005]
Second Appeal under
section 19 (3) of the Right to
Information Act, 2005.
From : Mr./Mrs./Ms.
(Appellant’s name and address)
To : The State
Information Commission,
13th Floor, New Administrative Bldg.,
M. Cama Marg, opp. Mantralaya,
Mumbai 400032.
(1) Full name of the Appellant : Mr./Mrs./Ms.
(2) Address :
(3) Particulars of State Public
Information Officer :
(4) Particulars of the First
Appellate Authority :
(5) Date of receipt of the order appealed against :
(6) Last date for filing the appeal :
(6) The grounds for appeal :
(7) Particulars of
information --
(i) Nature and subject matter of the
information required :
(ii) Name of the office or Department
to which the
information relates :
Place :
Date : Signature of Appellant.
FORM OF APPEAL TO CENTRAL
INFORMATION COMMISSION
Second Appeal under
section 19 (3) of the Right to
Information Act, 2005.
From : Mr./Mrs./Ms.
(Appellant’s name and address)
To : The Central
Information Commission,
Block No 4 (5th floor), Old JNU Campus,
New Delhi 110067
(1) Full name of the Appellant : Mr./Mrs./Ms.
(2) Address :
(3) Particulars of Central Public
Information Officer :
(4) Particulars of the First
Appellate Authority :
(5) Date of receipt of the order appealed against :
( If order passed)
(6) Last date for filing the appeal :
(7) The grounds for appeal :
(8) Particulars of
information --
(i) Nature and subject matter of the
information required :
(ii) Name of the office or Department
to which the
information relates :
(9) True copies of the following documents are enclosed:
Place :
Date : Signature of Appellant.
HEMA SAMPAT