REGISTER FOR SUPPLY OF SAMPLES / MODELS (Under the Provisions of the RTI Act, 2005) Name of the Public Authority : Name of the Office of SPIO : Name of the SPIO : Name of the ASPIO : Sl. No. Date of application Applicant's Name with Father / Mother / Husband Name and address of communication If citizen of India If living below the poverty line Card No. Nature of Sample or model required 1 2 3 4 5 6 Amount of fee paid Date on which the sample is ready for delivery Actual date of delivery Signature with date of SPIO / ASPIO Application fee Cost of samples / models assessed Amount Date of notification Date of payment of cost 7 8 9 10 11 12 13 Remarks 14 * To be maintained in the office of the SPIO / ASPIO by page marking and giving certificate thereof.
