(1) An appeal or a complaint may be filed in Hindi or in English and all related documents shall also be filed in Hindi or in English. Where a document, in original, is in a language other than Hindi or English, a certified authenticated translation in Hindi or English shall also be filed along with the original document. This shall also apply in the case of Registrar of the Commission Seal and emblem Language of the Commission written statement, rejoinder, reply or any other document filed before the Commission.
(2) The proceedings of the Commission shall be conducted in Hindi.
APPENDIX Form 1 List of Public Authorities, State Public Information Officers & First Appellate Authorities Name of Department...........................................................................................................................
Name of Public Authorities under the Department State Public Information Officers appointed for each Public Authority First Appellate Authority appointed for each Public Authority 1 Designation Address /Ph. No. Designation Address /Ph. No.
2 3 4 5 Form-2 Request for obtaining information u/s 6(1) of RTI Act, 2005 To:
State Public Information Officer’s Designation and Official Address ………………………………………………................................................................................................................................
……………………………………………………………………………………………………………………………………………………………………………….
1. Full Name of the applicant …………………………………………………………………………………………………………………………………….
2. Father’s / Spouse’s Name...............................................................................................................................
3. Address…………………………………………………………………………………………………………………………………...…………………………….
.……………………………………………………………………………………………………………………………………………………………………………..
4. Email address, if any………………………………………………………………………………………………………………………………………………
5. Telephone No. and/or Mobile No. ...................................................................................................................
6. Details of information sought (if necessary, attach separate page):
……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………………………………………………….………..
7. Does the information sought concern the life and liberty of a person: Yes/No If yes, the reasons therefor…………………………………………………………………………………………………………..……………………… …………………………………………………………………………………………………………………………………………………………..………………..
…………………………………………………………………………………………………………………………………………………………..………………..
8. Details of fee deposited.................................................................................................................................
9. Does the applicant belong to BPL category: Yes/No (If yes, attach BPL certificate)
10. List of enclosures ………………………………………………………………………………………………………………………………………………… .. …………………………………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………….…… Place……………………………………….
Date.......................................
Full Signature of the applicant Acknowledgement Received the application from………………………………………………………………………………………………………………………………..
Address…………………………………………………………………………………………………………………………………………………………………………… on……………...………………(date)seeking information u/s 6(1) of RTI Act, 2005, registered at serial no………………………….…..
Date……………………………… Signature and full name of SPIO Official seal Form-3 RTI Application Register S. No In case application If additional fee required Date on which requested Information or rejection order sent Remark relates to another Name public authority Date of and address Application Designation and Date of intimation of additional fee to applicant Date of receipt of additional fee of Amount of applicant Address of Date of additional SPIO to transfer fee whom transferred
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Form-4 Transfer of RTI application to another public authority To:
…………………………………………………………..
…………………………………………………………..
..............................................................
..............................................................
(Designation and address of SPIO to whom application is being transferred) Sir, Please find enclosed herewith an application from.....................................................................................................
……………………………………………………………………………………………………………………………………………………………………………....
(Name and address of applicant) dated…………………………................. (Regn. No ................................... ), seeking information u/s 6(1) of RTI Act, 2005.
The aforesaid application is being transferred to you because the subject matter of serial no. ...................... of the information sought falls within the jurisdiction of your department/office.
It is certified that the applicant has paid Rs............... (Rupees ........................ only) on account of fees for obtaining information under the Act, which has been deposited in the Government treasury / account.
Yours faithfully ( ) Date: State Public Information Officer Name and address of the Department /Office Telephone No. ..........................
Copy to:
…………………………………………………….
…………………………………………………….
…………………………………………………….
(Name and address of applicant) As the information at Serial No. ............. sought in your aforesaid application does not fall within the jurisdiction of this Department/Office, it has been transferred to the State Public Information Officer of the public authority having jurisdiction. You are requested to contact the State Public Information Officer mentioned above.
( ) State Public Information Officer Name and address of the Department /Office Form-5 Intimation regarding provision of information sought under RTI Act, 2005 Letter No:-………………………………………………….. Dated:-…………………………………………..
From:
……………………………………………………………………….
……………………………………………………………………….
...........................................................................
...........................................................................
(Designation, address and phone no. of SPIO providing the information under RTI Act, 2005) To:
……………………………………………………………………… ……………………………………………………………………… ..........................................................................
..........................................................................
(Name and address of applicant seeking the information under RTI Act, 2005) Sir /Madam, Please refer to your application dated ………………................, registered at serial no ........................... , addressed to the undersigned regarding supply of information under section 6(1) of the RTI Act, 2005.
The information sought by you is given below:
…...................................................................................................................................................................................
……………………………………………………………………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………………………………………….
………………………………………………………………………………………………………………………………………………………………………………………..
(If above space is inadequate, separate pages may be attached.)
If you are not satisfied with the answer you may file an appeal under Section 19(1) of the Act within thirty days of the receipt of this letter to the First Appellate Authority whose address is given below:
Designation, address and phone no. of First Appellate Authority ...............................................................................................
...............................................................................................
…………………………………………………………………………………………….
Yours faithfully, ………………………………… ………………………………… Form-6 Intimation regarding additional fee representing cost of providing information Letter No:-………………………………………………….. Dated:-…………………………………………..
From:
…………………………………………………………………… …………………………………………………………………… .......................................................................
.......................................................................
(Designation, address and phone no. ofSPIO providing the information under RTI Act, 2005) To:
…………………………………………………………………..
…………………………………………………………………..
......................................................................
......................................................................
(Name and address of applicant seeking the information under RTI Act, 2005) Sir, Please refer to your application dated …………................, registered at serial no……………, addressed to the undersigned regarding supply of information under section 6(1) of the RTI Act, 2005.
In accordance with the provisions of the rule 5 of Uttar Pradesh Right to Information Rules, 2015, you are requested to deposit additional fee of Rs……………..………………. (Rupees… ......................................... ), representing the cost of providing the information as per calculations given below:
………………………………………………………………………………………………….…………………………………………………………………………… ……………………………………………………………………….……………………………………………………………………………………………………… ……………………………………….……………………………………………………………………………………………………………………………………… ……….……………………………………………………………………………………………………………………………………………….……………………..
The above fee may be deposited in the form of postal order/demand draft/banker’s cheque payable to…………………………………………………………………………………………………………………………………………………………………………… If you have any objection against this demand you may file an appeal under Section 19(1) of the Act within thirty days of the receipt of this letter to the First Appellate Authority whose address is given below:
Designation, address and phone no. of First Appellate Authority ...............................................................................................
...............................................................................................
…………………………………………………………………………………………..
Yours faithfully, ………………………………..
………………………………..
Form-7 Intimation of rejection of request for information sought under RTI Act, 2005 Letter No:-………………………………………………….. Dated:-…………………………………………..
From:
…………………………………………………………… ……... …………………………………………………………..
..............................................................
..............................................................
(Designation, address and phone no. of SPIO providing the information under RTI Act, 2005) To:
…………………………………………………………..
…………………………………………………………..
..............................................................
..............................................................
(Name and address of applicant seeking the information under RTI Act, 2005) Sir /Madam, Please refer to your application dated …………......................, registered at serial no.................... , addressed to the undersigned regarding supply of information under section 6(1) of the RTI Act, 2005.
The undersigned regrets to inform you that the information sought by you cannot be provided for the reason(s) given below:
……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… If you are aggrieved by the above, you may file an appeal under Section 19(1) of the Act within thirty days of the receipt of this letter to the First Appellate Authority whose address is given below:
Designation, address and phone no. of First Appellate Authority ...............................................................................................
...............................................................................................
………………………………………………………………………………………….
Yours faithfully, ………………………………..
……………………………….
Form-8 Notice under section 10(2) of the RTI Act, 2005 Letter No:-………………………………………………….. Dated:-…………………………………………..
From:
…………………………………………………………..
…………………………………………………………..
..............................................................
(Designation, address and phone no. of SPIO providing the information under RTI Act, 2005) To:
…………………………………………………………..
…………………………………………………………..
..............................................................
(Name and address of applicant seeking the information under RTI Act, 2005) Sir /Madam, Please refer to your application dated …………................, registered at serial no……………, addressed to the undersigned regarding supply of information under section 6(1) of the RTI Act, 2005.
In this regard I have to inform you that the following part of the information sought by you is exempt from disclosure:
……………………………………………………………………………………………………………………………………………………………………………….
Accordingly, we have separately provided to you only the remaining part of the information which is not exempt from disclosure.
Please note that the reasons for the above decision are as follows:
……………………………………………………………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………………………………………………………..… If you have any objection against this decision you may file an appeal under Section 19(1) of the Act within thirty days of the receipt of this letter to the First Appellate Authority whose address is given below:
Designation, address and phone no. of First Appellate Authority ...............................................................................................
...............................................................................................
Yours faithfully, ………………………………..
………………………………..
Form-9 Notice to third party under section 11(1) of the RTI Act, 2005 Letter No:-………………………………………………….. Dated:-…………………………………………..
From:
…………………………………………………………..
…………………………………………………………..
..............................................................
(Designation, address and phone no. of SPIO providing the information under RTI Act, 2005) To:
…………………………………………………………..
…………………………………………………………..
..............................................................
(Name and address of third party) Sir/Madam, Whereas Sri/Smt resident of has filed an application on with the undersigned under the Right to Information Act, 2005 seeking the following information/record relating to/supplied by you:
……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………… And whereas the undersigned intends to disclose the above information/record or part thereof to the applicant.
Now, therefore, you are hereby called upon to make your submissions in writing or orally, as per section 11 of the Act, as to whether the information/record asked for by the applicant should be disclosed or not.
The submissions or representation against the proposed disclosure should be made by you within ten days from the receipt of this notice, failing which the undersigned will take a decision in the matter in accordance with the provisions of the Act, without giving any further notice.
If you have any objection against this decision you may file an appeal under Section 19(1) of the Act within thirty days to the First Appellate Authority whose address is given below:
Designation, address and phone no. of First Appellate Authority ...............................................................................................
...............................................................................................
Yours faithfully, ………………………………..
………………………………..
(TO BE SUBMITTED IN THREE COPIES) Form-10 Complaint under section 18 of the Right to Information Act, 2005 Dated:…….……………………..
To: U.P. State Information Commission …………………………………………………… …………………………………………………… Lucknow A. Complainant’s contact details:
1. Name of the Complainant
2. Postal Address, cell-phone no and E-mail address (if any) B. Details about the Complaint:
1. Particulars of the State Public Information Name (If available) Officer against whom complaint is preferred. Designation Address
2. Particulars of the First Appellate Authority, Name (If available) if an appeal against the SPIO was preferred u/s Designation 19(1) of the Act.
Address
3. Date on which application u/s 6(1) of the Act was preferred before the SPIO
4. Was any order passed by the SPIO on the Yes / No application submitted u/s 6(1) of the Act ? (If ‘Yes’, a copy of the order passed by the SPIO must be attached.)
5. Brief description of the complaint ……………………………………………………………………..
……………………………………………………………………..
……………………………………………………………………..
6. Ground(s) of the complaint ……………………………………………………………………..
……………………………………………………………………..
( If above space is inadequate, then separate page(s) may be added.)
7. Prayer or relief sought. ……………………………………………………………………..
……………………………………………………………………..
8. Any other information considered relevant by the complainant
9. List of copies of documents relied upon 1. Copy of request for information filed before the SPIO and submitted by the complainant. under section 6(1) of the Act.
2. Copy of order, if any, passed by the SPIO.
3. Copy of appeal, if any, filed before the First Appellate Authority under section 19(1)
4. Copy of order, if any, passed by First Appellate Authority on the appeal.
5. Any other document(s) relied upon by the complainant.
Verification I, (Name of the complainant), son of / daughter of / wife of resident of (address) hereby declare that I have not filed any other complaint in regard to the aforesaid application u/s 6(1) of the Act against the aforesaid SPIO and the particulars furnished in the complaint are to the best of my knowledge and belief, true and correct and that I have not suppressed any material fact.
Place : Signature of the Complainant Date :
Form 11 Register of defective complaints / appeals which are returned Year……………… S.No Date of Name and address of Brief descriptions Date of return of Remarks receipt of the of defect in Defective defective complainant/appellant complaint/appeal complaint/appeal along complaint / pointed out with speed-post appeal consignment number 1 2 3 4 5 6 Form-12 Register of complaints filed under section 18 of RTI Act, 2005 Year……………… Registration No.
Date of Name and address of Name (if available) and Name of Commissioner Remarks registration the complainant designation of SPIO to whom complaint against forwarded for disposal whom complaint and date on which lodged forwarded 1 2 3 4 5 6 Form-13 First Appeal under section 19(1) of the Right to Information Act, 2005 Dated:…….……………………..
To: ……………..………………………........................
……………..………………………........................
(Designation and address of theofficer acting as First Appellate Authority) A. Appellant’s contact details:
1. Name of the Appellant
2. Postal Address, cell-phone no and E-mail address (if any) B. Details about the appeal:
1. Particulars of the SPIO against whom appeal Name (if available) is preferred. Designation Address
2. Date of submission of request for information before SPIO (A copy of the request for information submitted to the SPIO must be attached.)
3. Grounds of appeal (In case appeal is filed against an order of the ……………………………………………………………………… SPIO, then a copy of such order must be filed.) ……………………………………………………………………..
……………………………………………………………………..
( If above space is inadequate, then separate page(s) may be added.)
4. Prayer or relief sought.
……………………………………………………………………..
……………………………………………………………………..
……………………………………………………………………..
5. If appeal is being filed after the prescribed period, then what is the reason for delay? ……………………………………………………………………..
……………………………………………………………………..
……………………………………………………………………..
6. List of copies of documents relied upon and submitted by the appellant.
Signature of the Appellant……………………………… (TO BE SUBMITTED IN THREE COPIES) Form-14 Second Appeal under section 19(3) of the Right to Information Act, 2005 Dated:……….……………………..
To: U.P. State Information Commission …………………………………………………...
…………………………………………………… Lucknow A. Appellant’s contact details:
1. Name of the Appellant
2. Postal Address, cell-phone no and E-mail address (if any) B. Details about the appeal:
1. Particulars of the First Appellate Authority Name (if available) against whom appeal is preferred. Designation Address
2. Particulars of the SPIO concerned.
Name (if available) Designation Address
3. Details of appeal filed under section 19(1) of the Act before the First Appellate Authority (A copy of the appeal and a copy of the order passed, if any, on the appeal must be attached.)
Date of appeal Was any order passed on the appeal? If yes, date of such order Date of receipt of order passed on appeal
4. If appeal is being filed after the prescribed period, then what is the reason for delay? ……………………………………………………………………..
……………………………………………………………………..
……………………………………………………………………..
5. Grounds of appeal ……………………………………………………………………… ……………………………………………………………………..
……………………………………………………………………..
( If above space is inadequate, then separate page(s) may be added.)
6. Prayer or relief sought.
……………………………………………………………………..
……………………………………………………………………..
……………………………………………………………………..
7. List of copies of documents relied upon 1. Copy of request for information filed before the SPIO and submitted by the appellant. under section 6(1) of the Act.
2. Copy of order, if any, passed by the SPIO.
3. Copy of appeal filed before the First Appellate Authority under section 19(1)
4. Copy of order passed, if any, by First Appellate Authority on the appeal
5. Any other document(s) relied upon by the appellant.
Verification I, (Name of the appellant), son of / daughter of / wife of resident of (address) hereby declare that I have not filed any appeal against the impugned order earlier and the particulars furnished in the appeal are to the best of my knowledge and belief, true and correct and that I have not suppressed any material fact.
Place : Signature of the Appellant Date :
Form-15 Register of appeals filed under section 19(3) of RTI Act, 2005 Year……………………… Registration No.
Date of Registration Name and address of the appellant Name (if available) and designation of SPIO before whom the application was preferred u/s 6(1) of the Act Name (if available) and designation of First Appellate Authority before whom the appeal was preferred u/s 19(1) of the Act Dates of orders passed by SPIO and First Appellate Authority Name of Commissioner to whom appeal forwarded for disposal and date on which forwarded Remarks 1 2 3 4 5 6 7 8 Form-16 U.P. State Information Commission Notice to Parties Complaint / Appeal Registration No.................
Sri/Smt .......................................................................................... Complainant / Appellant Vs … ......................................................................................................... Opposite Party From: Registrar U.P. State Information Commission Lucknow To: ....................................................................................
….................................................................................
………………………………………………………………………….......
Whereas a complaint / second appeal has been presented by Sri/Smt .……………..........................................
resident of .................................................................................................(address) and has been registered in this Commission as above;
And whereas the aforesaid complaint / second appeal is being heard by Sri/Smt………………………………………………….
……………………………………………………………………………………………………………………………………………………………………………… In Hearing Room No. ………… And whereas hearing on the aforesaid complaint/second appeal shall be conducted on the………….…....................
of …………………….., 20.......................
Now therefore it is hereby ordered as under:
• You are summoned to appear before the aforesaid Information Commissioner either in person or through an authorised representative, on the aforesaid date of hearing at 10:00 am to participate in the hearing on the above complaint/appeal.
• A copy of the aforesaid complaint/appeal is annexed and you are directed to submit your written statement thereon (in two copies) to the aforesaid Information Commissioner by the aforesaid date of hearing.
• You are directed to produce the following documents/things before the aforesaid Information Commissioner on the aforesaid date of hearing:
………………………………………………… ………………………………………………… (Note: Delete from the above that portion which is not applicable) Take notice that in default of your appearance on the above mentioned date, the complaint/appeal will be heard and determined in your absence.
Date: For and on behalf of Registrar U.P. State Information Commission Lucknow Form-17 Register of penalties imposed under section 20 of the RTI Act, 2005 S.No Registration Name of Date Amount of Name and Name (if available), Date on which compliance of penalty order reported Remarks number of the bench of penalty address of designation and complaint/ which order imposed complainant / address of SPIO appeal passed with appellant against whom the details of penalty imposed penalty Installments, order if any.
1 2 3 4 5 6 7 8 9 Form-18 U.P. State Information Commission Complaint / Appeal Registration No.................
Sri/Smt................................................................................................Complainant / Appellant Vs … ..........................................................................................................Opposite Party From: Registrar U.P. State Information Commission …………………………………………………….
…………………………………………………….
Lucknow To: ..............................................................................................
…...........................................................................................
(Name, designation and address of officer who will recover the penalty imposed) Whereas a complaint / second appeal was presented by Sri/Smt………………...........................................
resident of .....................................................................................................................................................(address) and was registered in this Commission as above;
And whereas the aforesaid complaint/appeal has been decided by the bench of Sri……………………………………………………………………..…………………………………………………………………………………………………… … .................................................................................................................. who in exercise of powers vested under section 20 of the Right to Information Act, 2005 has ordered imposition of penalty on the State Public Information Officer concerned as follows:
(a) Name (if available), designation and address ………………………………………………………………… of the State Public Information Officer on whom penalty imposed . ………………………………………………………………… ………………………………………………………………..
(b) Amount of penalty imposed with details of ..……………………………………………………………..
Installments fixed, if any. ………………………………………………………………..
………………………………………………………………..
A copy of the aforesaid order is annexed.
Now therefore, you are requested to ensure compliance of the aforesaid order by deduction of the amount of the penalty as aforesaid from the salary of the State Public Information Officer concerned and deposit the amount so recovered in the following head of account:
“0070-Other Administrative Services, 60-Other Services, 800- Other receipts, 15-Penalties imposed under Right to Information Act, 2005.” You are further requested to send a report on action taken in compliance of aforesaid order of the Commission within three months of the date of this letter.
Date: Registrar U. P. State Information Commission