APPLICATION FOR NO OBJECTION CERTIFICATE FOR

OBTAINING INDIAN PASSPORT

PART - A
1. Name of Applicant
(In Block Letters)

2. Designation

3. Pay and Scale of Pay

4. Name of Institution in which working :

5. Whether Officiating/Temporary through
Employment Exchange/Regular/Permanent :
6. Date of Birth

7. Date of Commencement of Continuous

Service Under Govt.

8. Name of entry post

9. Permanent Home Address

10. Countries proposed to be visited by the

Applicant.
:
11. Purpose of visit

12. Duration of Visit

13. Whether the NOC requested is for fresh

Passport or for renewing existing Passport

I hereby affirm that the particulars furnished above are correct.

Place:
Date:
APPLICANT

SIGNATURE OF

PART - B
(To be filled by the Head of the Institution)
1. Name & Designation of the Applicant.

2. Whether the applicant is under any contractual

or bonded obligation to serve the Government.
(If so give details)

3. Whether any liabilities, including loan & advance

:
such as House Building Advance, Motor Cycle
Advance, Computer Advance, Marriage Advance
etc., paid to the applicant from the Govt. Funds
are pending, outstanding. (If so, give details)
4. Whether any disciplinary proceedings is pending
or contemplated against the applicant.

5. Whether any vigilance case is pending or

contemplated against the applicant.

6. Whether there are grounds to believe that the

applicant could figure adversely on the security
records of the Govt.

Certified that the details furnished by the applicant in item (1) to (8)
in
PART A are correct. His/her application is recommended/not
recommended for
the following reasons.

Station:
Date:

Designation

Signature with Name &

DECLARATION
(As per GO (P) 780/83/Fin dated 16/12/1983)

I here by declare that I will not indulge in any work or propaganda

which will
detrimental to the interest of our nationality.
I.
..here by
declare that I am willing to abide by the conditions that the leave
period for
employment at abroad will not count for any service benefits /
Pension/
Pay fixation /etc.
I
here by
declare that the details furnished by me in items 1 to 6 in part A are
correct.

Place:
Date:

Signature of the

applicant

Place:
Date:

Counter signed

ANNEXURE B
ALL CENTRAL GOVERNMENT EMPLOYEES, STATE GOVERNMENT
EMPLOYEES,
EMPLOYEES OF STATUTORY BODIES AND PUBLIC SECTOR UNDERTAKINGS.
THEIR
SPOUSE AND CHILDREN UPTO THE AGE OF 18 YEARS ARE REQUIRED TO
PRODUCE
AN IDENTITY CERTIFICATE (STRIKE OUT OPTIONS THAT ARE NOT APPLICABLE).
(To be given in Duplicate on Original Stationery)
Certified that Shri/Smt/Miss......
Son/Wife/Daughter of
Shri ..... who
is an Indian national, is a

temporary/
Permanent
employee
Address..

of

.from
... and is

(Office

(date)

at
present
holding
the
post
Shri/Smt/Miss/Mst

of

..who is also an Indian national, is/are a dependent family

member(s) of Shri/Smt
... and his/her
Ministry/ Department/

identity is

certified.

This

Organization has no objection to his/ her acquiring Indian Passport. I, the

undersigned,
am duly authorized to sign Identity Certificate.
Section 6(2)

I have read the provisions of

of the Passports Act, 1967 and certify that these are not attracted in case of
this applicant.
I Recommend issue of an Indian Passport to him/her. It is certified that this
Organization is
a Central/State Government/Public Sector Undertaking /Statutory body.

The

Identity Card
Number of
Shri /Smt/Miss (employee)
...

................

is

Ref. No & Date..

Applicants
Photo to be
attested

To
Sri/Smt.

Name, Designation, Address

& Tel No.