NATIONAL FEDERATION OF STATE COOPERATIVE BANKS (NAFSCOB)

NAVI MUMBAI – 400 703

FORM – A

See Rule – 4(1)

APPLICATION FOR INFORMATION UNDER SECTION 6(1) OF THE ACT

To:

The Central Public Information Officer

National Federation of State Cooperative Banks (NAFSCOB)

J.K. Chambers, Vth Floor, Plot No.76, Sector – 17,

Vashi, Navi Mumbai – 400 703

1	Full name of the applicant
2	Father/Spouse name
3	Permanent address
4	Particulars in respect of Identity of the applicant
5	Particulars of information solicited
	a) Subject matter of information
	b) The period to which the information relates
	c) Specific details of information required
	d) Whether information is required by post or in person (The actual postal charges shall be included in providing information)
	e) In case by post (ordinary, registered or speed)
6	Address to which information will be sent & in which form
7	Has the information provided earlier
8	Is this information not made available by the Public authority
9	Do you agree to pay the required fee
10	Have you deposited application fee (If yes details of such deposit)
11	Whether belongs to BPL category, have you furnished the proof of the same

Place:

Date:

Full Signature of the applicant & Address

Office of the Central Public Information Officer

Received the application from ……………………………………. Address

…………………………………………………………………………………………………

on …………… seeking information.

Place:

Date:

Full Name of Central Public Information Officer

Designation & Seal