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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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