FORM 'A'

[See rule 3(1)]

To
The Public Information Officer
Social Welfare Officer,
Sub Tehsil Majri, Tehsil Kharar, Distt. Mohali.
1.
2.
3.
4.
5.

Full name of the applicant: Sh. Hardial Singh

Father's/Spouse's name: Sh. Kishan Singh
Permanent Address: V.P.O. Tira, Tehsil Kharar, District Mohali.
Correspondence Address: V.P.O. Tira, Tehsil Kharar, District Mohali.
Particulars
of
information

required

a. Subject matter of information: Old age pension

b. The period to which the information relates: 01-04-2002 to 31-03-2006.
c. Specify details of information required : Details of old age pension given to
Smt. Surjit Kaur, W/o Karam Singh V.P.O. Tira, Tehsil Kharar, Distt. Mohali.
d. Whether
information
is
required
by
post
Or
in
person
("The actual postal charges shall be Included in providing information)
"By post"
e. In case by post (Ordinary, Registered or Speed post.) "Ordinary post."
6. Is this information not made available by the Public Authority under voluntary
disclosure: Yes.
7. Do you agree to pay the required fee ? Yes.
8. Have
you
deposited
application
fee?
(If yes, details of such deposit) Yes IPO number: 27F 499024 dated : 05-08-2014
9. Whether
belongs
to
Below
Poverty
Line
category?
If Yes, have you furnished the proof of the same with applicant ? No.
Place:
Date :
Full Signature of the applicant and Address
Hardial Singh S/o Sh. Kishan Singh,
V.P.O. Tira, Tehsil Kharar, District Mohali.