ANNEXUREB Receipt Diary No. & Date
DD
MM
YYYY
(For official use only) FORMAT FOR APPLICATION To The Central Public Information Officer,
Sl 1 2 3 (i) (ii) (iii ) 4
Particulars Name of the Applicant Name of the Father/Husband (as the case may be) Contact Details Postal Address Telephone Numbers / FAX Number EMail Address Name of the public authority from whom the information is being requested (tick the appropriate column) Department of Posts Ministry of Company Affairs Ministry of Personnel, Public Grievances and Pension
5
Nature and details of the information requested
6
Mode of fee payment, Details thereof
Cash / ACG67 Receipt No. with Date
Demand Draft / Bank Draft / Bankers Cheque
Exempted under BPL
7
Desired mode of receipt of information
Post
EMail
In Person
Date
Signature of the applicant R E C E I P T
Received the application form from Sri ______________________________________ on dated _____________________ seeking information addressed to ______________________ _____________________________________________________________________________ .