SAMPLE OF RTI APPLICATION FORMAT

From:
Name:-.
C/O
Vill. - ...
P.O.- .
Dist. (Assam)
PIN.
Date..
To,
The State Public Information Officer/CPIO/PIO
Office of the .
Subject:- Seeking information under section 3 of RTI Act 2005.
Subject matter of information:-
The period to which the information relates:-
Mode of delivery expected:- By post/By hand delivery/By courier service.
Concerned Department:- ..
Preferred language of the said information is:- Hindi/ English/Assamese or others
which is necessary.

Sir/Madam,
I am undersigned applicant, citizen of India seeking the following the pieces of
information by enclosing a ten rupees IPO/Bankers cheque/demand draft/court fee stamp
or cash as an application fee for your kind consideration under section 6(1) of RTI Act
2005. I expect you will furnish the information as per the RTI Act.
or
The undersigned hereby submit an RTI petition under section 7(5) of RTI Act
2005 for the following pieces of information. I expect you will furnish the information as
per the RTI Act. (If BPL card Holder then it necesssry)

Details of Required Information:1.

2.
3.
N.B.:- (i) Please communicate on my address under section 5(3) of RTI Act 2005.
(ii) Please transfer of my RTI petition under section 6(3)(ii), if my seeking
information are related to an another public authority.
This is for favour of your kind information and necessary
action, Sir.

Yours faithfully
Enclosed: As stated above.
(SRI/SMT.)
Ph. No
E mail ID