Site Map || Contact Us
 
  RTI Acts and Rules RTI Act & Rules
   
  Section 4(1)(b) Disclosure Section 4(1)(b) Disclosure
  PIOs PIOs & FAAs
   
  Web Directory Web Directory
   
  Cause List Weekly Cause List
   
  Complaint Status Complaint Status
   
  Orders/Decisions Orders/Decisions
   
  IEC Activities IEC Activities
   
  News & Events News & Events
   
  Video Gallery Photo Gallery
   
  Video Gallery Video Gallery
FORM-A
See Rule 4(I)
Application for Information under Section 6(1) of the Act
To
The Public Information Officer
Orissa Information Commision
B-1 Block, Toshali Plaza,
Satya Nagar, Bhubaneswar-751007
*1. Full Name of the Appellant :
*2. Permanent Address :
* (a) State :
* (b) District  :
(c) Name of the City/Town/Village :
(d) PIN/ZIP/Area Code :
(e) Contact No. :
*3. Name of the Father/Husband :
*4. Particulars in respect of identity of the applicant :
(.pdf,.jpg,.gif file only)
5. Particulars of Information solicited:
* (a) Subject Mater of Information :
* (b) The period to which the information relates :
 
* (c) Specific details of information required :
(d) Information to be sent by post or recieved person :
(e) Incase of post :
*6. Address to which the information will be sent and in which form :
7.  Has the information been provided earlier :
8. Is this information not made available by the Public Authority ?
9. Do you agree to pay required fee ?
10. Have you deposited application fee?
(If yes, please indicate details of such deposit)
11. Wheather belong to BPL category, have you furnished the proof of the same ?
(Attach soft copy only .pdf type)
12. Signature of the applicant :
(.jpg,.gif,.png,.bmp file only)
 

NOTE :- (*) marked fields are mandatory.Please upload images maximum size (250*50) and document upto (1 MB).
Orissa.gov.in, Orissa State Portal India.gov.in, National Portal for India Link to Disclamier Link to FAQs Link to Important Links Link to Section 4 Disclosure