APPLICATION FORM FOR VIGILANCE

CLEARANCE
(For obtaining Passport Only)

FORM NO. __________________ VOJ/VOK/CENTRAL

________________________

DATED

Note: Please enclose Registered Self-addressed Envelope ( ) with the

application form.

Paste Attested
Photograph here.

01. NAME OF THE APPLICANT :

________________________________________
(IN FULL / CAPITAL)
(Shri/Smt/Miss)
02. FATHERS / GUARDIANS NAME :
________________________________________
03. HUSBANDS NAME
:
________________________________________
04. DESIGNATION
:
________________________________________
05. GAZETTED/ NON-GAZETTED :
________________________________________
06. PRESENT PLACE OF POSTING :
________________________________________
(WITH DEPARTMENT)
________________________________________
07. DATE OF BIRTH
:
________________________________________

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08. PERMANENT ADDRESS

:
________________________________________

________________________________________
09. PRESENT ADDRESS
:
________________________________________
________________________________________
10. EDUCATIONAL QUALIFICATION :
________________________________________
11. DATE OF FIRST APPOINTMENT :
________________________________________

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12. SERVICE PARTICULARS (SINCE FIRST APPOINTMENT).

PLACE OF
POSTING
(since
appointment)

DESIGNATIO
N

FROM
MONTH /
YEAR

TO
MONTH /
YEAR

Dispatch No. ________________________

Dated _______________________________
Signature of the Applicant
Counter Signature by
CONTROLLING OFFICER (WITH SEAL)
NAME :
DESIGNATION:
Note: -

Forms without self-addressed envelope will not be

entertained.
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