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FORM ‘A’
Form of Application for Seeking Information Under Section 6(1) and Section 7(1) the Right to
Information Act, 2005
RTI Application No. ___________________
Date of Receipt ___________________
(For official use)
To
The Central Public Information Officer/
PDO, Anemahal Grama Panchayat
(Hassan-Sakleshpur RDPR)
Anemahal Post
Sakleshpur Taluk
Pin code:
1. Full Name of the Applicant (in capital letters) : Rajarajeshwari M G.
2. Complete Address (in capital letters) : C/o Latharani, Behind PWD Office,
Sakleshpur Post, Hassan Dist.
State: Karnataka, Pin Code: 573134
Telephone Nos.
Office : Residence: +917558080143 Mobile: +917019775411
Fax : ________________ E-mail Address: rajisanthosh21062019@gmail.com
3. Whether belong to BPL category : Yes/ No
(If yes, please attach a copy of the BPL certificate, etc. Fees are exempted for citizens belonging to BPL
category) N.A.
4. Details of Application Fee (Demand draft/ pay orders/ IPOs should be drawn in favor of ICAR-Unit, DCFR
payable at Bhimtal):
Cash Receipt/ DD/ IPO/ Date Name of the issuing Amount (in Rs.)
Bankers Cheque No. Bank/ Authority
IPO

5. Particulars of Information require : (Please enclosed separate sheet, if required)

Application Submitted Under Section 6(1) and Section 7(1) of Right To Information Act 2005.
Respected Sir,
I humbly request you to furnish the details of application form and submitted documents along with the
application form (certified copies of
1. Copy of Previous Khata / manual Khata
2. Copy of Sale Deed
3. Latest Encumbrance certificate (EC)
4. Photo of the plot.
5. Photos of the owner(s) -
6. Copy of Photo ID proof of the owner(s) like PAN card/Passport/DL) and electricity bill copy- with the
application form and given E-Khata or E-Swathu (certified Copies- form 11B Properties). Details of the
information sought Properties are given below
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1. Property Owner Name and Address: B.P. Prakash S/o Putta swami Gowda(Late) Kumbradi Estate
Village, Anemahal Grama Panchayat, Sakleshpur Taluk, Hassan Dist.
Property ID: 151600801901000007, Property Code: 1130784, Asset No. 7, Document No. 2107374,
Village: Kumbradi Estate, Printed Date:
29/03/2016.
2. Property Owner Name and Address: B.V. Nagesh, S/o B.V. Veerappa (Late) Kumbradi Estate
Village, Anemahal Grama Panchayat, Sakleshpur Taluk, Hassan Dist.
Property ID: 151600801901000013, Property Code: 472555, Asset No. 13, Document No. 952530,
Village: Kumbradi Estate, Printed Date: 18/02/2015
3. Property Owner Name and Address: B.V. Nagesh, S/o B.V. Veerappa (Late) Kumbradi Estate
Village, Anemahal Grama Panchayat, Sakleshpur Taluk, Hassan Dist.
Property ID: 151600801901000013, Property Code: 472555, Asset No. 13, Document No. 2006531,
Village: Kumbradi Estate, Printed Date: 24/02/2016
4. Property Owner Name and Address: Krishna Shetty, S/o Manjappa Shetty, Kumbradi Estate
Village, Anemahal Grama Panchayat, Sakleshpur Taluk, Hassan Dist.
Property ID: 151600801901000004, Property Code: 953273, Asset No.4, Document No. 1819439,
Village: Kumbradi Estate, Printed Date: 17/12/2015.
5. Property Owner Name and Address: M V Gopinath, S/o M K Vijayaraghavan (Late) Kumbradi
Estate Village, Anemahal Grama Panchayat, Sakleshpur Taluk, Hassan Dist.
Property ID: 151600801901000003, Property Code: 1157031 Asset No.3, Document No. 2159563,
Village: Kumbradi Estate, Printed Date: 20/04/2016
6. Property Owner Name and Address: M V Gopinath, S/o M K Vijayaraghavan (Late) Kumbradi
Estate Village, Anemahal Grama Panchayat, Sakleshpur Taluk, Hassan Dist.
Property ID: 151600801901000003, Property Code: 1157031 Asset No.3, Document No. 6485930,
Village: Kumbradi Estate, Printed Date: 25/11/2019.

Note: Kindly forward this application to the concerned authority if it doesn’t come under your preview as
per section 6(3) of RTI Act.2005.
6. How the applicant would like his information to be sent (Please tick) :
a) By Post b) By E-mail c) By Fax d) To be collected by Person
DECLARATION
This is to certify that I, Rajarajeshwari M G Son/ Daughter/ Wife of M.V. Gopinath (Late) , am
a citizen of India. Further, I state that the information sought does not fall within the restrictions contained in
Section 8 and 9 of the RTI Act, 2005 and to the best of my knowledge it pertains to your office.

Date & Place: Sakleshpur

23/09/2020
Signature of Applicant

NB: Attached the details of form 11B properties in Kumbradi Estate Village of Sakleshpur Taluk and
in Anemahal Grama Panchayat.