APPLICATION FORM FOR ISSUE OF NO OBJECTION CERTIFICATE FOR THE PURPOSE OF APPLYING FOR PASSPORT PART-I 1. ( a) ( b) (c) 2. 3. 4. 5. 6. 7. 8. 9. 10.

Name and designation Father /Husbands name Present post Whether Temporary /Permanent Date of Birth Date of entry in service Date of superannuation Educational qualifications Countries proposed to be visited Purpose of visit Period of visit with duration Name and full address while abroad

11.

12. 13.

If the stay is not on own arrangement, name of the person with whom the applicant will stay and the relationship with that person Any other information which the applicant like to add Identity card Number

I understand that the issue of a No Objection Certificate does not entitle me to the grant of leave, which is to be decided by the appropriate leave granting authority. Two copies of recent Passport size photos are submitted herewith. Place Date Signature of applicant

PART II RECOMMENDATION OF THE DIVISIONAL SUPERINTENDENT Photo to be attested by Divisional superintend ent on it 1.Whether any disciplinary/vigilance case is Pending against the applicant 2.Whether there are any outstanding dues From the applicant which cannot be Recovered from his normal entitlements of Pay and allowances 3.Whether the application is recommended by the Divisional Superintendent Certified that items 1 to 6 & 13 of the application format is verified from the records and found correct. Smt./ Shri / Miss..is a dependent family member of Shri. /Smt.and his / her identity is certified I have read the provisions of Section 6(2) of the Passports ACT 1967 and certify that these are not attached in the case of the applicant

Place Date Divisional Superintendent