APPLICATION FOR INFORMATION UNDER RTI ACT 2005

APPLICATION FOR INFORMATION UNDER RTI ACT 2005

To

Asstt. Public Information Officer

Integral coach factory,

Perambur, Chennai - 38

1. Full Name of the Applicant (in capital letters) _______________________________

2. Father’s/Husband Name (in capital letters) _______________________________

3. Complete address                                               _____________________________                                                                                                

                                                                                    _____________________________

Pin code                                                                    _____________________________

4. Telephone No. Office ________               Res.____________            Mobile ______________

5. Whether belong to BPL category (if yes, please

attach a copy of the BPL/Antyodaya ration card (please tick) Yes ___           No____

to claim waiver of the application fee)

6. Details of Application Fee/Addl. Fee:-

, by Cash, DD/BC/IPO to be drawn ‘.’ payable at the office where application is submitted)

Cash Receipt/ DD/ IPO No

.Date Name of the issuing

Bank/Authority

Amount (Rs.)

7.Particulars of information required (please enclose separate sheet, if required, indicating specific

details of information required and the preferred medium i.e. inspection, photocopy, softcopy, etc.)

_____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

DECLARATION

I state that the information sought does not fall within the restriction contained in Section 8

& 9 of the RTI Act and to the best of my knowledge it pertains to your office.

Place:_________

Date :___________