Government of Punjab

Form A (See rule 3(1))

To,
The Public Information Officer
__________________________
__________________________
1. Full
Name
of
the
applicant
_______________________________________________
2. Fathers/
Spouses
Name
_______________________________________________
3. Permanent
Address
____________________________________________________
_____________________________________________________________________
4. Particulars
in
respect
of
identity
of
the
applicant_____________________________
_____________________________________________________________________
5. Particulars of Information Solicited.
(a) Subject
matter
of
information.
___________________________________________
(b)The
period
to
which
the
information
relates.
_______________________________
(c) Specific
details
of
information
required.
___________________________________
_______________________________________________________________________

6.
7.

8.
9.

(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
or
Speed).
____________________________
(f) Has a self addressed envelope with proper stamp been included
_______________
Detailed address to which information will be sent and in which form.
________________________________________________________________________
________________________________________________________________________
Is this information not made available by the public authority under
voluntary
disclosure?
________________________________________________________
Do
you
agree
to
pay
the
required
fee?
__________________________________
Have you deposited application fee, (If yes, details of such deposit).
________________________________________________________________________

10.
Whether belongs to Below Poverty Line Category. (If yes, furnish
the
proof
of
the
same
with
the
application).
_______________________________________________

Signatures of
Applicant
Place:
Date: