To

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 above mentioned complaint/grievance dated ……….

[2] Certified copy of investigation report or feedback obtained with respect to the grievances raised in my above mentioned 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 above mentioned complaint dated ………

[4] Certified copy of the note sheet indicating notings by various officials and decision of competent authority on investigation report or feedback obtained with respect to the issues raised in my above mentioned complaint dated ……………

[5] 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 above mentioned complaint 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 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: