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4

Aun*xure I
-A'ppllcetion for rrsualce of Identity certiririle(rcyNo objoction certificrte (Noc)
Tor

Sir,

I wish to rypry for an ordinary intemationar passport and heroe


I wor{d request you to
iesue me ar Identity ccrrificate (IC)No objecrion certificato (Nec).
My detairs arc:

Name ofthe Employee

Name of Farher/Husband

Designation

Dele fron which present post held

Idendity Card Ntarber

Office Address

Nameof the ryplicaat for whom IC/l.,tOC has to be issued

Relationship with the lmployee

Two passport size photographs atteched I YesAlo


Undefakingattached (only for ICll yesNo
(Following part to be struckolilNoC is being
apptied)

I haw read the provisioas of arri a" a611 ,yrarrporl rcfl ard thcy arc nat appricahre on
mey'my

t
l*b af paxpon Ac't: Subi€ct td thz dthet $ovisibw o/ this Act, the pajspart
a€J
a$horlty thdl rqfweto ltsue
d wspatt ot tralar docaaenrtar siting
unyforeign cottury and* crause (c) oftub- section
{2} of,*ctron r an
my one ar fiore af the follawing groun&, old on no oth* grouafl
namelyi-
(q) rhat thi qpplicdnt is ttu o clrtie&
of lrr.tia;
dcpendent. I arn also submitting an underlaking
to thar effect in thc prcscribod
furmaf(fuusxurc
I)ona
rmr judicial stacp paper for
rny childlepou*

I ccnify that thc infomration providod


is truo to fie best of my knowrcdgc.
In casc any
discrepeacy i* detccted lt any strege,
I shatr be sorcly riabre for it

Yours faithfully

Nane of the Enployre

(b) *or &e d*pttcaru ,w!, ot tr ltl*b to, rngcg.


oltlrtdc hrdla n *r**@
lntcgttP dlndta:

{c) that the d€wrwc ofihe apprbat{fro,; tndta tray,


or is ltttty ta, bc derr, r*cl ta thc*c*lg
(t1 tha tb pu*w oftk ofltdto:
owltcdr{ ilttld* rndra twv, e b ilLrry,o, p.cjrt*e
,k{ri*n6y nr,,tottrof lrfrovitr
&iyfeaign &*n4o1:
(') that tha dpplrcaat har, at n y fi
e dvfl,g the petiatr ofrtx
Tzats ia,nrdtatery pre€eding thefult orhtt
applica o'1 b,€r' carft'rcted by d cn*
rn f,rdrofor thy o$ercc rnorvkgnorar
tvrprtttdc and scat*axd ta rctqct
thatrolb t,nr/trfrfitcw
/w aat tzss than rwo )frs|:
fl) fia preedngs fu r*Fa oJ ott vJtt..to&ax4 .Atct(tt
altcsed .o lpq ose,
ro ,xn,c bce, @n rriaed
nr b tlld qpltwa te penlbq h{*e a
ciaiwl colrt ta lndte:
(g) thal a wananl
ar wnmorc lor rha apptateflc, or o warrnn,
{or the s.re , of the appttt*m $as beu ktucd by o
co,'r a det ory rawlot rhc thn' b,,ing
rn lanc or rhat an ordat prohibltin.
rhe drparwre lron rndlo olthc
apptlctttt hat beca uade
fo rllty wth ca n;
(h) tha' *€ qpprrca"'| tt. bre,' repdf terad *d h,.t aat rermfuxzd tt. eparnhn
l.palriatiot
rrr...r*ed in corlrrr.,hn vtthrzch

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