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Form –A
See Rule -4(I)
APPLICATION FOR INFORMATION UNDER SECTION 6(1) OF THE ACT
To
The Public Information Officer
Assistant Public Information Officer
Department of Information & Communication Technology,
Secretariat Building Annex-I, Third Floor,
Government of Mizoram
Aizawl – 796001, Mizoram.
Ph: 0389-2310888/2319637 Fax: 2319632
01. Full Name of the applicant :
02. Father/ Spouse Name :
03. Permanent Address :
04. Particulars in respect of identity of the applicant :
05. Particulars of information solicited
a) Subject matter of information :
b) The period to which the information relates :
c) Specific details of information required :
d) Whether information is required by post or in person
(The actual postal charges shall be Included in providing information)
e) In case by post (ordinary/ registered/speed) :
06. Address to which information will be sent & in which form :
07. Has the information provided earlier ? :
08. Is this information not made available by the public authority ? :
09. Do you agree to pay the required fee ? :
10. Have you deposited application fee ? :
(If yes details of such deposit)
11. Whether belongs to BPL category :
have you furnished the proof of the same
Place :
Date :
Full Signature of the applicant Address
Office of the Public Information Officer
Received the application form …………………………………………………………
address …………………………………………………………………………………
on ……………………….. seeking information.
Place :
Date :
Full name of Public Information Officer
Designation & Seal
