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:

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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:

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(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