SAMPLE RTI APPLICATION FORM

SAMPLE RTI APPLICATION FORM 

To



          The Public information Officer  
          ______________________
          ______________________
          ______________________
          PIN: __________________




Sir, 


Subject:  Request for Information under Right to Information Act 2005. 

I  Sri / Smt /Ms. _____________________Son/Daughter/wife of Shri/Smt/Ms._______

______________________________________________________________, 

telephone number (with STD Code) ____- _________________________ and/or mobile 

number: ______________________________ wish to seek information as under 

__________________________________________________________________

I hereby inform that following formalities have been completed by me: 

1. That I have deposited the requisite fee of Rs. ____________/- by way of Cash / banker 

cheque / Draft / Postal Order/ others ______________________________ ) favoring 

___________________________________________ dated ________________. 

2. I need the photocopy of the documents and I had deposited the cost of the 

photocopy of Rs. __________/- for _________________________ (Number of Pages) 

or 

3. I had deposited sum of Rs. ___________/- for the charges of CD. (strike out which ever 

is not applicable) 

4. That I belong to Category of below Poverty Line (BPL): Yes / No (Strike whichever is not applicable). If yes, I am attaching the valid photocopy of 

the certificate. Yes / No 

5. That I am ‘Citizen’ of India and I am asking the information as ‘Citizen’. 

6. I assure that I shall not allow/ cause to use/ pass/share/display/ or circulate the information received in any case and under any circumstances, with any person or in any manner which would be detrimental to the Unity and Sovereignty or against the Interest of India. 

Signature of the Applicant 

                                                                                      Dated:

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