SAMPLE RTI APPLICATION FORM
To,
The Public information Officer
________________________
____________________________
____________________________
PIN: _______________________
Sir,
Subject: Request for Information under Right to Information Act 2005.
I Sri / Smt /Ms. __________________________________________________________
Son/Daughter/wife of Shri/Smt/Ms. __________________________________________
resident of ______________________________________________________________,
telephone number (with STD Code) ____- _____________________ and/or mobile
number: ______________________________ wish to seek information as under
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
I hereby inform that following formalities have been completed by me:
1. That I have deposited the requisite fee of Rs. _____/- by way of Cash / banker
cheque / Draft / Postal Order/ others ___________________ ) favoring
__________________________________ dated ________________.
2. I need the photocopy of the documents and I had deposited the cost of the
photocopy of Rs. ____/- for _____ (Number of Pages)
or
3. I had deposited sum of Rs. _____/- for the charges of CD. (strike out which ever
is not applicable)
4. That I belong to Category of below Poverty Line (BPL): Yes / No
(Strike whichever is not applicable). If yes, I am attaching the valid photocopy of
the certificate. Yes / No
5. That I am ‘Citizen’ of India and I am asking the information as ‘Citizen’.
6. I assure that I shall not allow/ cause to use/ pass/share/display/ or circulate the
information received in any case and under any circumstances, with any person or
in any manner which would be detrimental to the Unity and Sovereignty or
against the Interest of India.
Signature of the Applicant
Dated:
Following are the name and addresses of PIO of various banks.
Disclaimer : Proper caution is taken for compiling the information, applicants are advised to confirm the address from the website.
VIJAYA BANK :
Shri. K.R.R. Pai
CPIO cum Deputy General Manager
(Planning & Development Department )
VIJAYA BANK
Head Office
41/2, M G Road
BANGALORE
560 001
41/2, M G Road
BANGALORE
560 001
UNITED BANK OF INDIA :
Shri Samar Sengupta
General Manager (Recovery)
UBI, H.O, 11 Hemant Basu Sarani,
United Tower
Kolkata -700001
BANK OF INDIA
CPIO CUM Deputy General Manager
Govt. Business Department
Bank of India
Head Office
2nd Floor, Star House
C-5, G Block, Bandra-Kurla Complex
Bandra (East)
Mumbai 400051
Govt. Business Department
Bank of India
Head Office
2nd Floor, Star House
C-5, G Block, Bandra-Kurla Complex
Bandra (East)
Mumbai 400051
INDIAN BANK
Shri K.G.Balasubramanian
CPIO CUM Deputy General Manager(Law)
Indian Bank, Head office,
66, Rajaji Salai, Chennai 600 001.
Canara Bank
Sri. A. Raveendran
Public Information Officer
Assistant General Manager
Canara Bank, RIA Section,
Strategic Planning & Development Wing,
Head Office, No. 112, J C Road,
Bangalore – 560 002.
SBI
CPIO
The Dy. General Manager - Promotion
(Central Recruitment &
Promotion Department )
State Bank of India
Tulsiani Chambers, 1st Floor, West Wing,
212, Free Press Journal Marg,
Nariman Point,
Mumbai – 400 021
ALLAHABAD BANK
Shri Gangadhar Dash,
Deputy General Manager
Deputy General Manager
Allahabad Bank,
Head Office,
2,N.S. Road ,
Head Office,
2,
Kolkata-1
CENTRAL BANK OF INDIA
Vipin Kapoor
CPIO cum DGM,Operation Dept
Maker Tower 'E'
Maker Tower 'E'
21st Floor,
Cuffe Parade, Mumbai-400005
Cuffe Parade, Mumbai-400005
SYNDICATE BANK
Sri H N Vishweshwar
Deputy General Manager
Personnel Dept, IRD,
Head Office
Manipal – 576 104 PUNJAB NATIONAL BANK
Sh. S. K. Mohla,
DGM-cum-CPIO,
MARD, 2nd Floor, Rajendra Bhawan,
Rajendra Place,
New Delhi- 110008
BANK OF BARODA
Sh. R K BANSAL
Baroda Corporate Centre,
Bandra Kurla Complex,
Mumbai - 400051
Baroda Corporate Centre,
Bandra Kurla Complex,
Mumbai - 400051
PUNJAB & SINDH BANK
Sh Dharam Bir Singh
Assistant General Manager-CPIO
Punjab & Sind Bank,
6 th Floor, Bank House,
21, Rajendra Place,
New Delhi-110008
CORPORATION BANK
Shri. Shrikant
Deputy General Manager,
Corporation Bank,
Head Office, P.B. No. 88,
Mangaladevi Temple Road,
Pandeshwar, Dhakshina Kannada
District, Mangalore – 575 001
6 th Floor, Bank House,
21, Rajendra Place,
New Delhi-110008
CORPORATION BANK
Shri. Shrikant
Deputy General Manager,
Corporation Bank,
Head Office, P.B. No. 88,
Mangaladevi Temple Road,
Pandeshwar, Dhakshina Kannada
District, Mangalore – 575 001
LIC
Ms Thankom T. Mathew
Executive Director(NP/CPIO)
LIC of India , Central Office,
Yogakshema", Jeevan Bima marg,
PO- 19953, Mumbai 400021
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