APPLICATION
FORMAT FOR INFORMATION UNDER RTI ACT 2005
To
The Chief Public
Information Officer/ Public Information Officer
PSP Division/
Regional Passport Officer/ Passport Officer
_________________________________
1. Full Name of the
Applicant (in capital letters)
_______________________________
2. Father's/Husband
Name (in capital letters) _______________________________
3. Complete address
_____________________________
_____________________________
Pin
code_____________________________
4. Telephone No.
Office ________ Res.____________ Mobile ______________
5. Whether belong
to BPL category (if yes, please attach a copy of the BPL/Antyodaya
ration card (please tick) Yes ___No____ to claim waiver of the
application fee)
6. Details of
Application Fee/Addl. Fee:- (Application Fee - Rs.10/-; Addl. Fee -
@Rs.2/- per page for A-4 size paper created or copied, by Cash,
DD/BC/IPO to be drawn in favour of 'Accounts Officer, Ministry of
External Affairs, if the application is submitted at the PSP
Division, Patiala House, New Delhi or Passport Officer ' payable at
local office where the application is submitted
Cash Receipt/
DD/Bankers
Cheque / IPO No
Date Name of the
issuing
Bank/Authority
Amount (Rs.)
7. Particulars of
information required (please enclose separate sheet, if required,
indicating specific details of information required and the
preferred medium i.e. inspection, photocopy, softcopy, etc.)
________________________________________________________________________
DECLARATION
I state that the
information sought does not fall within the restriction contained in
Section 8 & 9 of the RTI Act and to the best of my knowledge it
pertains to your office.
Place:_________
Date:___________
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