Dated : ____/____/________To, Public Information Officer ____________________________ ____________________________ ____________________________ PIN: ________________________

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

I would like to know the details of required details for project mentioned below: Project Name – ___________________________________________________________________ Project Location/Address: ___________________________________________________________

Information Required as below: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

If requested information does not pertain to your department, then please follow the provisions of Section 6(3) of the RTI Act 2005.

As per RTI Act, please provide details (name & Designation) of the first appellate authority w.r.t. above request.

Attachments (If Any) :

I would like to receive this Information – BY POST IN PERSON

I hereby inform that following formalities have been completed by me: 1. That I have deposited the requisite fee of Rs. 10 by Court fee stamp as pasted on top of this form. 2. That I belong to Category of below Poverty Line (BPL): No/Yes3. That I am ‘Citizen’ of India and I am asking the information as ‘Citizen’. 4. I assure that I shall not allow/ cause to use/ pass/share/display/ or circulate the information received in any

manner which would be detrimental to the Unity and Sovereignty or against the Interest of India.

Regards,

Name of Applicant: Signature of applicant: Date:

Communication Address –Mobile No. –Email –

Affix here court fee stamp of Rs. 10 /-