RTI FORM

Name

Phone Number

Date

Month

Year

Address

Particulars of information required:

Subject matter of information

The period to which the information relates

Description of the information required

Whether information is required by post or via email or in person

In case by post (Ordinary, Registered or Speed)

Whether the applicant is below poverty line

*Appeal against the PIO - to be made to his immediate superior

Name

Phone Number

Date

Month

Year

Address

Particulars of the State Public

Information Office

Date of receipt of the order
appealed against

Date

Month

Year

Last date for filling the appeal

Date

Month

Year

The grounds for appeal

Particulars of information
Nature & Subject matter of information required

Name of the Officer or Department to
which the information relates:

*Appeal against the PIO - to be made to his immediate superior - the Appellate Officer - within 30 days from the date of receipt of communication from the PIO or within 30 days from the expiry of such period .

Name

Phone Number

Date

Month

Year

Address

Particulars of the State Public

Information Office

Date of receipt of the order
appealed against

Date

Month

Year

Last date for filling the appeal

Date

Month

Year

The grounds for appeal

Particulars of information
Nature & Subject matter of information required

Name of the Officer or Department to
which the information relates:

*The applicant, if not satisfied with the action taken by the Appellate Officer, can prefer second appeal to the State / Central Information Commission within 90 days.

RTI FORM

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