To BY SPEED POST
The Public Information Officer
[ Name of Public Authority]
[ Full Address ]
[Pin Code]
Sub: Request for information under Section-6(1) of RTI Act.
Sir,
Please supply me the following information with respect to my complaint detailed
below:
Details of complaint:
Name of Govt Office :
Date of Complaint :
Complaint Number :
Subject of Complaint :
Particulars of Information sought:
[1] certified copy of note sheet indicating notings by various officials and decision of
competent authority on my complaint/grievance dated ……….. regarding …………
[2] Certified copy of investigation report or feedback obtained with respect to the
grievances raised in my complaint dated ……………
[3] Certified copy of letter, directions and/or instructions issued to concerned
authority / subordinate office as a follow up action based on my complaint dated
………
[4] In case no action is taken on my complaint dated ………., please inform me the
name of officer(s) and staff responsible, but failed to take action on my complaint
dated …………
[5] Certified copy of your rules or citizens charter or any other document stipulating
the time frame in number of days by which such a complaint/matter should have
been dealt with and resolved by your public authority.
I am affixing Rs.10/- Court Fee Stamp on this application towards RTI application fee
OR I am attaching IPO for Rs.10/- payable to the Accounts Officer, ………….
payable at ……….. towards RTI Application Fee. [ Check Application Format and
mode of payment of RTI Application Fee from State RTI Rules as applicable to the
public authority ]
Please send the information to my below address by Registered post.
Yours faithfully,
Signature
Name ………………
Address ……………
Date: