FORM – B
[ See Rule 4 (2) ]

Information for Payment

From

Name & Designation of the Public Information Officer

To

Name of the applicant
Address

Sir,

Please refer to your application dated …………………. addressed to the undersigned requesting information on ……………………………………………….. I am to inform you that the following amount towards cost for providing information may be deposited in cash, to enable the undersigned to furnish information sought for.

Please make payment within a period of fifteen days from the date of receipt of this intimation failing which the application shall be rejected.

Yours faithfully,