APPLICATION FOR ISSUE OF NO OBJECTION CERTIFICATE TO OBTAIN PASSPORT

1. Name & Designation of official

2. Whether temporary/permanent/quasi permanent

3. Date of birth

4. Date of entry in service

5. Date of Superannuation

6. Educational qualification of the applicant

7. Purpose of visit

8. Duration of visit / date of visit

9. Countries proposed to be visited

10. Particulars (with full address) of persons with whom

the
official
will
be
staying
:
11. (A) Relationship of the parties indicated against (10)
above
with
the
official
:
(B) Details of employment, domicile status of the
parties indicated of against Sl. 10 above.
12. Particulars of advance pending (with No. & date of
installment of recovery P.M.
i)
Cycle advance

:
:

ii)

Motor conveyance advance

iii)

House building advance

iv)

Festival advance

v)

Fan advance

vi)

L.T.C. Advance

vii) Any other advance

13. Has the official utilized the advance for the purpose for
which they were sanctioned
14. In the case of House Building advance and Motor
conveyance, has the official submitted the
completion report and other documents required
under the rules promptly or whether there was any
delay. Is there was delay, furnish complete
particulars
with
reasons.

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15. Source or sources for financing the visit to foreign

country in connection with complete detail
:
a) Anticipated expense for the journey
:
b) How the expenses for stay abroad will be met
(details)

16. Any other information which the applicant may

like to add

.
TO BE FILLED IN BY THE HEAD OF THE OFFICE
1. Information given by the official against items (1) to (16)
above checked and found correct
:
2. General behavior of the official
:
3. Nature of work the official is in the department
:
4. Whether the character and antecedent of the official
were verified before appointment in the department
:

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5. Whether any enquiry or investigation or disciplinary

case is pending/contemplated against the official.
:
6. Whether any vigilance case or court case is pending
against the Govt. servant.
:
7. Whether the official is under suspense
:
8. Whether any punishment against the official is current
:
9. Whether the case is recommended
:

COUNTERSIGNED
Signature of the Head of Office/
Division with date & Designation

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