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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. ___________________________________
_______________________________________________________________________
(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 _______________
6. Detailed address to which information will be sent and in which form.
________________________________________________________________________
________________________________________________________________________
7. Is this information not made available by the public authority under voluntary
disclosure? ________________________________________________________
8. Do you agree to pay the required fee? __________________________________
9. 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:

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