ଓଡ଼ିଶା ସରକାର Government of Odisha · Department of Higher Education

RTI Act, 2005 · Section 6(1)

Model RTI application form

For filing with the Public Information Officer, Vikram Dev University. Use of this form is optional; the Act prescribes no mandatory format.

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Vikram Dev University crest.
Government of Odisha

Vikram Dev University

Po: Jeypore, Dist: Koraput, Odisha, 764 001 · India

Application for information

Under Section 6(1) of the Right to Information Act, 2005

Form VDU/RTI/Form-A

To,
The Public Information Officer
Office of the Registrar
Vikram Dev University
Po: Jeypore, Dist: Koraput, Odisha, 764 001

  1. Full name of the applicant
  2. Address for correspondence Including PIN code. Information will be despatched to this address.
  3. Telephone, e-mail
    Mobile / telephone
    E-mail (optional)
  4. Citizenship The right to information is conferred on citizens of India.
    Citizen of India Other (please specify)
  5. Below Poverty Line (BPL) If yes, attach a self-attested copy of the BPL certificate. The fee will be waived.
    Yes (certificate attached) No
  6. Particulars of information sought State the subject, the period to which the information relates, and a clear description. Please be specific.
    Subject matter
    Period to which it relates
    Description (continue on a separate sheet if required)
  7. Mode of receipt of information
    By post (ordinary) By post (registered or speed) In person at the Office of the Registrar
  8. Whether copies are required
    Yes, photocopies Yes, printouts No, inspection only
    Charges per Section 7(1) and the Odisha Right to Information Rules, 2005 will be intimated.
  9. Application fee
    Mode (IPO / DD / cash receipt / online)
    Instrument or receipt number
    Date of instrument
    Amount (₹)

Declaration. I hereby declare that the information sought does not, to the best of my knowledge and belief, fall within any of the restrictions contained in Section 8 or Section 9 of the Right to Information Act, 2005, and that the particulars set out above are true. I understand that the application fee is non-refundable.

Place and date
Signature of applicant

For office use only

Date and time of receipt
File reference allotted
Fee received (₹) and receipt number
Acknowledgement issued (date)
Forwarded under Section 6(3) to
Reply due by (date)
Initials and seal of receiving officer

Notes for the applicant

  1. The Act prescribes no mandatory format. Use of this form is optional. Any application in writing setting out the particulars at items 1 to 9 is sufficient.
  2. The prescribed fee under the Odisha Right to Information Rules, 2005 is ₹ 10. Applicants below the poverty line are exempt from the fee on production of a valid BPL certificate. SC and ST applicants are exempt under State practice.
  3. The application should be addressed to the Public Information Officer at the address printed above. For information held by another public authority, the application will be transferred under Section 6(3) of the Act and the applicant will be intimated.
  4. A reply will be issued within thirty days of receipt, or within forty-eight hours where the request concerns the life or liberty of a person.
  5. If the reply is denied, partial, or unanswered, a First Appeal lies with the First Appellate Authority, Vikram Dev University, within thirty days. A Second Appeal lies with the Odisha Information Commission, Bhubaneswar.
  6. Online filing is also available through the Government of India RTI Online portal where the State module is enabled.
VDU/RTI/Form-A · Issued by the Office of the Registrar Continue on a separate sheet if required.

Last updated: 26 April 2026 · Reviewed by: Office of the Public Information Officer