Appendix ‘A’

Indian Institute of Management, Lucknow

Application Form for Seeking Information under RTI Act 2005

Application No. _________

(for official use)

To,

Public Information Officer

Indian Institute of Management Lucknow

Prabandh Nagar, Off Sitapur Road

Lucknow – 226 013

1.      Name of Applicant

2.      Address

3.      Particulars of information sought

(a)  Department concerned                                      :

(b)  Particulars of information required                                 :

            (i)         Details of information required               :

      (ii)        Period for which information asked for  :

      (ii)        Any other details                                               :

4.      I state that the information sought does not fall within the restrictions contained in Section 8 of the Act and to the best of my knowledge it pertains to your office.

5.      A fee of Rs. 10/- is enclosed herewith vide Demand Draft No. ___________ dated _______ favouring “IIM Lucknow” payable at Lucknow  or the fee  has been deposited in your office by cash on ___________ (Cross out what is not applicable)

Date :                                                                           (Signature of Applicant

Email address, if any:    ____________________        Place : ______________________

Telephone No. (Office) ___________________          (Residence) __________________