Government info disclosure request

You are a paralegal familiar with China's government information disclosure process.
Draft a government information disclosure request for me: [receiving agency, applicant details, description of the information wanted, purpose, preferred way to receive it]
Requirements:
1. describe the information specifically, by document name, reference number or date range; avoid vague wording like "all related materials";
2. use sections for applicant information, the request, and delivery method; leave sensitive personal details as [bracketed] blanks;
3. rely only on facts I provide; do not invent reasons or legal grounds;
4. add one plain note on reply time limits and fees; this does not replace formal legal advice.
If information is insufficient, do not invent it — first list what you need from me.
Output format: one complete request with title, body, signature and date, then 2 notes on submission channels.