application for issue of no objection certificate - alrahiman

A PPLICATIO N FO R ISSUE O F NO O BJEC TIO N C ERTIFICATE FO R O BTA INING INDIA N PA SSPO RT Nam e ofapplicant Designati onwith nam e ofOffice 3. Perm anentaddress

4. Payandscaleofpay

(a) DateofBirth 5. Date ofcommencementofcontinuous service underGovernment Place proposed to be visi t Purpose ofvisit

8. I fitjsforseeking employment,whether a decl aration to the effectthathe will

eitherresignthisjoborwilltake prior permission abroad has been attached 9. Exped ed peri od ofabsence from duty

10. Address ofthe place ofvisitifavailable

11. How theexpenditureforjotlrneyandstayabroad : 12. Mode ofdisbursementofIeave salary

13. W hetherany disciplinarycase is pending againstthe applicant 14. W hetheranyIiability is outstanding againstthe applicant

15. W hetherapplicantis underany contractualobligation bonded ornon bohded with Governm entis so detai led lSolemnlyaffirm thatthe information given are correct Signature ofthe appli cant 1,.............-....-.......................................-...................................01fprfpt)jt(1(,1)11,rtrthll,t1hslI -ll()lltlllrlr)rit)rr)llrryllislpl()r1frl)rrltkl(, Governmentbefore I eaving India to abroad. .

Signature ofthe applicant.

PR O FO R M A REPO RT (Tobefilled fn by theHeadofOff/ce)

W hetherany discipl inal proceedings are pending orcontemplated against in indi vidual

2. W hetherany Vigilance case is pending orcontem pl ated against him

3. W hetherthere are groundsto believe thattheappli cantcouldfigure adversel y onthe securi tyrecordsoftheGovt.

Certi fiedthattheinformationgivenaboveandthatgiven bytheapplicantSl.No.1to 15areverisedandfoundcorrect. His application is recommended.

Signature: Name:

Designation ofthe Officer:

Station: Date:

DECG RATIO N TO ACCO M PANY THE APPLICATIO N F0 R O BTAINING NO O BJECTIO N CERTIFICATE Tö TRAVEL A BRO A D

Ido hereby declarethatIwillnotenjoy thestayabroadbeyondtheperiodof leaveshown in my application

2. 1do hereby declare that Iwillnotindulge in m y any work ofpropoganda whichw illbedeterm entaltotheinterestofnationality.

3. 1dohereby declarethatonly suchjob whichwillnoteffectmy statusasa (P0st) Of K eralaGovernm entwillbetnken undertheforeign em ploym ent .

4. 1do hereby declarethatIw illabidebytherulesand conditionsasperG. 0.(P)

No.274/70Tin.dated,24-9-1970& G.0.(P)No.65/76/Fin.dated,25-2-1976. Ido hereby declarethat1haveno bonded obligation to sel' vetheD epartm ent .

6. 1dohereby declarethatnovigilenceordisciplinary action againstm e

.

I dp hereby declare that l have not taken any leave for the sam e purpose previously.

Signature CountersignatureoftheHead ofOftk e

A N N EX U R E B AlICentralG overnm entem ployees,State G overnm entem ployees,Em ployees of Statutory Bodies and Public SectorUndeA kings and theirdependentfam ily m em bers are required to produce an Identity Cedificate (Strikeoutprotionnotapplicable) (To begivenin Duplicateon OriginalStationary)

()fi:11,tthr)lrltlrll Içtçtrïïl1)plxhrltt,r'l4)1()54th(,()fttll -ti(()fflce11(b(1rtliii;)............-......................................................

-

Ii1/18rtj18(1()r)llrlCl()r!tflhrthilh/rïl(,rllL)thrti;)()f1581ri/t;rtlt....................-..-.,..................................................... andhis/heridentityiscertified.ThisMinistry/Depadment/Organisationhasnoobjectiontohis/her acquiring IndianPasspod.The undersigned isdulyauthorisedtosi gnthisIdentityCerti ficate.Ihave read

the provisionsofSection 6(2)ofthe PassportsAct,1967and certifythatthese are notattracted in case ofthis applicant. 1recom m end issue ofan Indian Passportto him /her.ltis cedified thatthis

organizationis a central/State Government/PublicSector/undedaking/Statutorybody.TheIdentity

Ref.No & Date:

Applicant's photo to be adested by certifying authority

Nam e and Designation,Address &

A N N EXU RE C

INTIM ATIO N BY A N EM PLOYEE TO H I5 EM PLO YER O F H IS

INTqNTION TO APPW FO R A PASSPO RT (ForAIICentralGovernmentemployees,StateGovernmentemployees,EmployeesofStatutoryBodiesand PublicSectorUndelakingswhoarenotproducingaNoObjectionCerl/#cale) (on Off/c/alStationaœ)

m y intention to apply fora passpod.

Signature& Seal. The Head ofOffice (i n acknowledgementofthe receiptofthesai di ntimation)