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FORMAT OF APPLICATION FOR SEEKING INFORMATION
UNDER THE RIGHT TO INFORMATION ACT-2005
Application ID No. : IITR/MS/RTI-
(For official use)
To
Shri L. C. Patel
District Collector Office
(Valsad)
----------------------------------------------
The Public Information Officer/ Asstt. Public Information Officer,
1. Name of the Applicant : RANA GEETA JAYDEEP
2. Address A/1M.R.C SOCIETY, P.O GORWA VADODARA390016
3. Particulars of information
(a) Concerned Office/Department :SHRI MAMLTDAR SHRI JILLA PURVTHA ADHIKARI Shri Collector VALSAD
(b) Particulars of information required RATIONCARD Information on departmental records
(i) Details of information required : _AS PER HARD COPY REG.POST RECIVED YOUR OFFICE DT.06/01/2012
(ii) Period for which information asked for:
(iii) Other details __ AS PER MY APPLICATIONS RS.3+3+3COURT FEESTAMP&RS20POSTAL ODER 92F-111328&92F-111329&92F-111330
4. Format in which information is required:
5. Mode of delivery expected (ordinary post, speed post, by courier, by
hand, through internet or e-mail, by fax etc.). Additional fee may
be charged to cover the cost of delivery.
6. The information can be furnished within 30 days as prescribed
under Section 6 (1)/ the information sought for concerns my life
and liberty, therefore the information may be furnished to me
within 48 hours (Please delete the inapplicable portion).
P.T.O. -2-
7. Without prejudice to my rights under the RTI Act 2005, to facilitate
faster retrieval of information, I would like to state that the
information could be available in………………………(please indicate
the name of concerned Office/Department of the Institute).
8. I state that the information sought does not fall within the
restrictions contained in section 8 and 9 of the Act and to the best
of my knowledge it pertains to your office.
9. I also state that I am a citizen of India and I am eligible to seek
information under the Right to Information Act 2005.
10. (i) A fee of Rs.__________________ has been deposited in the
Finance & Accounts Office of the Institute vide Receipt
No.________________ dated_______________, or
(ii) A Postal Order No. 92F-111328&92F-111329&92F-111330
dated 05/01/2012 is enclosed, or
(iii) The applicant is not liable to pay any fee because he/she is
below the poverty line (proof is attached).
(Please tick one and delete the remaining two options)
Place:VADODARA
Date :05/01/2012
(Name & Signature) GEETA JAYDEEP RANA
Postal Address:A/1M.R.C SOCIETY ,PO.GORWA ,VADODARA390016
E-mail address :-geetajaydeeprana@gmail.com &JAYPRANA1@GMAIL.COM
Tel No.9429190303