Procedure for Accessing Information (XVII)

Appendix-XI

Ali Yavar Jung National Institute For The Hearing Handicapped Mumbai – 400 050
Right to Information Act, 2005

REQUISITION FORM

Name of the Applicant: __________________ Date: ______ Time: ______

Address with Telephone No./Email: __________________

Income: ____________

Sensorily Disabled: ____________ Yes/No ______

Details of Information Required: ____________

S.No. ___ Brief title of the subject ____________ Printed/electronic format ______

Signature of the Applicant: ____________

For Office Use

Application Received on ____________ Time ______

Time required to furnish information ____________

Fees Prescribed (if any): ____________

Name of the Public Information Officer: ____________

Asst Public Information Officer: ____________

Signature: ____________ Date ______

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Ali Yavar Jung National Institute For The Hearing Handicapped Mumbai – 400 050
Right to Information Act, 2005

(For Office Use)

Name of the Department: ____________ Date: ______

As per the Act, the following
information is requested: ____________Time: ______

S.No. ___ Brief title of the subject ____________ Printed/electronic format ______ Time limit ___

Name of the Public Information Officer: ____________

Asst Public Information Officer: ____________

Signature: ____________ Date: ____________

(For Department Use)

Name of the Department: ____________

Submission of Information requested: ____________

S.No. ___ Brief title of the subject ____________ Printed/electronic format ______ Remarks ___

Name of the Head of the Department/Section: ____________

Signature: ____________ Date: ______

To:

Public Information Officer/Asst. Public Information Officer