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The document is an application form for requesting information from a Public Information Officer (PIO). It includes sections for the applicant's contact details, the nature and type of information sought, and whether the applicant belongs to the Below Poverty Line (BPL) category. The form also requires details about any fees paid and encourages direct submission to the PIO to avoid delays.

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Ramesh M
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4 views

appn1

The document is an application form for requesting information from a Public Information Officer (PIO). It includes sections for the applicant's contact details, the nature and type of information sought, and whether the applicant belongs to the Below Poverty Line (BPL) category. The form also requires details about any fees paid and encourages direct submission to the PIO to avoid delays.

Uploaded by

Ramesh M
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Form of application

PIO from which information is required

---- ----------------------------------
---------------------------------------
---------------------------------------

A. Contact Details
1. Name of the Applicant __________________________
2. a) Mailing Address ____________________________
b) Tel. No __________________________________
c) E-mail __________________________________
3. Whether a citizen of India Yes No
B. Details of information sought
1. Nature of information sought (a) Life & liberty of the person *
(Please √ Mark)
(b) Other than (a)

2. Type of information required (a) Copy of documents Yes No


(b) Inspection of records
Yes No
(c) Sample of material
Yes No
(d) Other information
Yes No

3. (a) Whether information sought relates to third


party?
Yes No

(b) If yes his/her name & address


_____________________
_____________________
_____________________
4. Specify the particulars of information required

(i) _______________________________
(ii) ______________________________
(iii) ______________________________
(iv) ______________________________
(v) _______________________________
5. Time period for which information is required ……………………………………………

6. Whether applicant belongs to BPL category: Yes No

Proof of BPL attached Yes No

7. Details of fee paid Rs.______________

Signature of the applicant

* Application may preferably be submitted directly to the Public Information Officer concerned
to avoid delay.

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