To The Public Information Officer
……………………(Name of public authority/unit)
……………(Full address)
PIN Code………….

Sub: Request for information under Section-6(1) of RTI Act.

Sir,

Please supply me the following information in respect of my application dated ……….. regarding …………………….

Details of pending grievance

Application date. ……………………….
Name of applicant ……………………..
Address of applicant …………………
Subject matter of Grievance application…………

Particulars of information required

[1] certified copy of note sheet indicating notings by various officials and decision of competent authority on my application dated ……….. regarding ………..

[2] Certified copy of investigation report or feedback obtained with respect to my application dated ……………

[3] Certified copy of the note sheet indicating notings by various officials and decision of competent authority on the investigation report/feedback received.

[4] Certified copy of letter, directions and/or instructions issued to concerned authority / subordinate office as a follow up action based on my application dated ………

[5] In case no action is taken on my application dated ………., please inform me the name of officer(s) and staff responsible, but failed to take action on my application dated …………

[6] Certified copy of your rules or citizens charter or any other document stipulating the time frame in number of days by which such a application for relief should have been dealt with and resolved by your public authority. Application Fee of Rs….. is remitted as under (strike out which is not applicable):

[a] Paid by Challan and copy attached.
[b] Pasted Court Fee Stamp for Rs……
[c] Attached IPO for Rs.10/- payable to the Accounts Officer, ………..

Please send the information to my below address by Registered post.

Yours faithfully,

Signature
Name ………………
Address ……………
Pin Code ………

Date: