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 Name of the office or Department to which the information relates
Department Name*
Office / Public Authority*
Complainant's Particulars
Full Name
Citizen Status
Residing Country
Is the Complainant Below Poverty Line(BPL)?
 Contact Details
Complete Address*
State / UT
District
Name of City / Town / Village
PIN / ZIP/ Area Code  
Contact No.
Fax
Email ID
 Details of Public Information Officer (PIO) approached, if any
Have you applied to any  PIO for Information  related to this complaint  
 Details of First Appellate Authority (FAA) approached, if any
Have you applied to any  FAA for Information  related to this complaint  
 Complainant Details
Does it Pertain to the  Life or Liberty of a  citizen?  
Are you a Senior Citizen? ( above 65 years)  
Are you Differently Abled?  
Please enter the Complaint Description
(if you have text in electronic form simply, copy and paste here)
Fees Deposited (Exempted only for BPL)
 Supporting Documents
Document Name Date Upload Soft Copy

Copy of Form A

Copy of Appeal Memo of 1st Appeal in Form 'D'

Response of PIO Date & File

Copy of Order of the FAA

Copy of Form E