I.D. No._______
To,
The Competent Authority,
_____________________
_____________________
1. Name of the Applicant: _____________
2. Address: _____________
3. Particulars of information: _____________
Concerned department: _____________
Particulars of information required: _____________
i. Details of information required: _____________
ii. Period for which information asked for: _____________
iii. Other details: _____________
4. I state that the information sought does not fall within the restrictions contained in Section __ of the Act and to the best of my knowledge it pertains to your office.
5. A fee of Rs. _______/- has been deposited in the office of the Competent authority vide No.________ dated ________.
Place: _________
Date: __________