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