APPLICATION FOR NO OBJECTION CERTIFICATE FOR PERSONNEL

PROCEEDING ABROAD ON TRAVEL / POSTING AND FOR PASSPORT.

PART – 1

1. Name in block letters : ______________________________

2. Designation : ______________________________
3. a) Date of Joining in the Samiti : ______________________________
b) Present place of posting : ______________________________
c) Since : ______________________________
4. Address (Present) : ______________________________

______________________________
5. Address (Permanent) : ______________________________

______________________________
6. a) Father’s Name : ______________________________
b) Father’s Occupation & address : ______________________________
7. a) Countries proposed to be visited : ______________________________
b) Date of Departure : ______________________________
c) Purpose of visit : ______________________________
d) Probable period of stay in each : ______________________________
country with dates
e) Probable date of return : ______________________________
8. Approximate amount expected to be spent for the trip including
Journey and stay abroad : ______________________________
9. a) Is the trip abroad financed by self : ______________________________
b) If so, the source of amount being : ______________________________
spent
10. a) Is the trip being financed by other : ______________________________
person
b) If so, the name of person :
indicating relation and address
(documentary evidence and an ______________________________
undertaking from the concerned
person that he would bear the
expenditure are to be enclosed).

11. Details of blood / close Relation : ______________________________

working in Foreign Embassies/firms
in India/abroad

12. Details of applicant’s employment : ______________________________

during last ten years.

Signature of the candidate

Date : ____________
PART – II

1. a) Are the entries given by the : ______________________________

applicant in Part-I are correct
b) If not, the reason/correct position : ______________________________

2. Is the applicant handling any :

classified work, Divulgence of
______________________________
which may effect the security of
service and the country
3. a) Was the individual even :
involved in any departmental
______________________________
inquiry or any other case
pending against the applicant.
 b) If so, nature of inquiry and its ______________________________
result.
4. Is the applicant’s visit requested for, : ______________________________
recommended?
5. Are any financial dues outstanding : ______________________________
towards the application?
6. If yes, the amount and mode of : ______________________________
recovery ?
7. Any compensation paid 9 of Part I : ______________________________

(Signature of the Principal)

Name in ___________________

(BLOCK LETTERS)

Office seal

No. ________________

Date : ______________

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NOTE :- Part II is to be filled by the Principal of the Vidyalaya concerned and

permission is to be granted by the concerned Deputy Commissioner of
the Region.