Application No
        Date:
APPLICATION FOR ISSUANCE OF 2D ANNUAL CARD
FOR ENTRY IN PORT AREA		  

Photograph

PART

1. Strike which type of pass is required:

1Annual Individual Entry Pass 1Annual Cargo Vehicle Pass 1Annual  Non-Cargo Vehicle Pass
1Upto 10 x Wheelers   1Above 10 x Wheelers

2. Strike the cards status:

1New 1Renewal 1Duplicate (Attach copy of police report)

3. Provide following information:

Name:

Father's Name:

C.N.I.C Number:

(Attach Attested Copy )

Occupation / trade of Applicant:

Designation:

Date of Appointment

Present Residential Address:

Permanent Residential Address 

Firm / Company

 Firm / Company / Address

Tel (Office):

Tel (Res): 

Fax #:

E-mail:

Police Verification:               1Verified                  1Not Verified

(If verified attach copy)

NTN Number of Owner / Firm / Company: (attach copy)

 

4.   For Cargo / Non Cargo Vehicle:

Name of  Owner of Vehicle / Driver:

Vehicle Registration No:

Owner’s C.N.I.C Number:

( Attach Attested Copy)

Registration Book Number

(Attached Attested Copy)

Validity of Route Permit (As Applicable):

(Attached Attested Copy)

 

  

 

Signatures / Thumb impression of Applicant

Signature & Seal of Owner of the Company

Pages 1,2,3,4,5,6,7,8,9,10,11,12,13