Sample RTI Application Form

Sample RTI Application Form :

Do you know that the Government of India has enacted a law known as the Right to Information Act (RTI) in the year 2005? Under this act, every Indian citizen has the right to know any information regarding the actions and functioning of public offices. Find out from elders, teachers, your local panchayat president, members of the panchayat or municipality how one can file an RTI application.

To :

The Public Information Officer,
PIN : ____________________


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

I, Sri / Smt /Ms. ________________________________________________ Son/ Daughter/ wife of Shri/ Smt/ Ms. _____________________________________ resident of _________________________________________________________, telephone number (with STD Code) _________________________ and/or mobile number ______________________________ wish to seek information as under -- --------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------

I hereby inform that the following formalities have been completed by me.

That I have deposited the requisite fee of Rs. _____ by way of (Cash / banker cheque / Draft / Postal Order / others) _______________ favouring _____________________dated ________________.

2. I need the photocopy of the documents and I had deposited the cost of the photocopy of Rs. ____for _____ (number of pages).

3. I had deposited a sum of Rs. _____ for the charges of the CD. (strike out whichever 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 a 'Citizen' of India and I am asking for the information as a 'Citizen'.

6. I assure you 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


Sample RTI Application Form :

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