APPLICATION FO R ISSUE OF NO OBJECTION CERTIFICATEFO R OBTAINING INDIAN PASSPORT

Name of applicant

Designation with name of Office

3. Permanent address

4. Pay and scale of pay

(a) Date of Birth

5. Date of commencement of continuousservice under Government

Place proposed to be visit

Purpose of visit

8. If it js for seeking employment, whethera declaration to the effect that he willeither resign this job or will take priorpermission abroad has been attached

9. Expeded period of absence from duty

10. Address of the place of visit if available

11. How the expenditure for jotlrney and stay abroad :

12. Mode of disbursement of Ieave salary

13. W hether any disciplinary case ispending against the applicant

14. W hether any Iiability is outstanding

against the applicant

15. Whether applicant is under anycontractual obligation bonded or nonbohded with Government is so detailed

l Solemnly affirm that the information given are correct

Signature of the applicant

1, .............-....-.......................................-................................... 01 fprfpt)jt (1 (,1)11, rtr thll,t 1 hslI-ll () lltll-lrl r) rit)r r)ll rryl-lislp-l()r1 frl) rrl tkl (,Government before Ieaving India to abroad. .

Signature of the applicant.

PROFORMA REPO RT(To be filled fn by the Head of Off/ce)

W hether any disciplinal proceedingsare pending or contemplated againstin individual

2. W hether any Vigilance case is pendingor contemplated against him

3. W hether there are grounds to believethat the applicant could figure adverselyon the security records of the Govt.

Certified that the information given above and that given by the applicant Sl. No. 1 to 15 are verised and found correct.His application is recommended.

Signature:

Name:

Designation of the Officer:

Station:

Date:

DECG RATION TO ACCOMPANY THE APPLICATION F0ROBTAINING NO OBJECTION CERTIFICATE Tö TRAVEL

ABROAD

I do hereby declare that I will not enjoy the stay abroad beyond the period ofleave shown in my application

2. 1 do hereby declare that I will not indulge in my any work of propogandawhich will be determental to the interest of nationality.

3. 1 do hereby declare that only suchjob which will not effect my status as a

(P0st) OfKerala Government will be tnken underthe foreign employment.

4. 1 do hereby declare that I will abide by the rules and conditions as per G. 0. (P)No. 274/70Tin. dated, 24-9-1970 & G. 0. (P) No. 65/76 /Fin. dated, 25-2-1976.

I do hereby declare that 1 have no bonded obligation to sel've the Department.

6. 1 do hereby declare that no vigilence or disciplinary action against me.

I dp hereby declare that l havepreviously.

not taken any leave for the same purpose

Signature

Counter signature of the Head of Oftk e

A N N EX U R E B

AlI Central Governm ent em ployees, State Governm ent em ployees, Em ployees ofStatutory Bodies and Public Sector UndeA kings and their dependent fam ily

m em bers are required to produce an Identity Cedificate(Strike out protion not applicable)

(To be given in Duplicate on Original Stationary)

()f i:1 1, tthr)l rltlrll Içtçtrïïl 1) plxhrlt t,r'l 4)1() 54th(, ()f ttll-ti (()fflce 11(b(1 rtliii;) ............-..........-............................................

-Ii1 / 18 rtj 18 (1 () r)ll rl Cl () r!t flh rthilh/ rïl (, rll L)th rti; ) ()f 15 81 ri / t; rtlt. ...................-..-.,.....................................................

and his / her identity is certified. This Ministry/Depadment / Organisation has no objection to his/her

acquiring Indian Passpod. The undersigned is duly authorisedto sign this Identity Certificate. I have read

the provisions of Section 6(2) of the Passports Act, 1967 and certify that these are not attracted

in case of this applicant. 1 recom mend issue of an Indian Passport to him/her. lt is cedified that this

organization is a central / State Government / Public Sector / undedaking / Statutory body. The Identity

Ref. No & Date:

Applicant'sphoto to beadested bycertifyingauthority

Nam e and Designation, Address &

AN NEXURE C

INTIM ATIO N BY AN EM PLOYEE TO HI5 EM PLOYER O F HIS

INTqNTION TO APPW FOR A PASSPORT(ForAII Central Government employees, State Government employees, Employees of Statutory Bodies and

Public Sector Undelakings who are notproducing a No Objection Cerl/#cale)

(on Off/c/al Stationaœ)

my intention to apply for a passpod.

Signature & Seal.

The Head of Office(in acknowledgement of thereceipt of the said intimation)