Application No
        Date:
APPLICATION FORM FOR ISSUANCE OF  2D ANNUAL CARD
FOR ENTRY IN PORT AREA - GOVERNMENT OFFICERS / EMPLOYEES 		 

Photograph

PART

1. Strike the cards status:

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

2. 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 Address

Firm / Company

 Firm / Company / Address

Tel (Office):

Tel (Res): 

Fax #:

E-mail:

 

Copy of Service / Departmental Card: (Attach Attested Copy)

 

Application letter from Govt. Organization:

 

 

  AFFIRMATION

            I solemnly affirm that the information given in this form
is true and correct to the best of my knowledge and belief.
 I fully understand that my false statement or suppression
of any fact shall render me liable to disciplinary action.
 

 

Signatures / Thumb impression of Applicants.


 ATTESTATION

 

Signature, Name & Seal of the Gazetted Recommending Authority

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