APPLICATION
(Application for issuing of NOC to go aboard)
1 Name of the Employee :
2 Designation :
3 Name of the Office :
4 Date of Birth :
5 Residential Postal Address :
6 Details of first appointment :
a) Designation :
b) Date of Appointment :
7. Date from which he / she is working in the Office
8. Details of dependents as per Service Book entry
With page No.
9. Details of Cases pending:
a) Whether there are any allegation pending
Against him /her.
b) Whether any disciplinary proceedings are pending
of contemplated against the individual
c) Whether any Vigilance cases are pending or
Contemplated against the individual.
d)Whether there are grounds to believe that
the application could be adversely on the Security
records of the Government .
10 Details of Government Loans / dues :
a) House building Loan with interest :
b) Motor Car / Cycle Loan :
c) Any other loans from Government :
d) House rent arrears towards Government
quarters :
e) Other Government Dues :
11. Places of visiting country
12. Duration of Visit
13. Purpose of Visit
14. Contact Address in visiting place
DECLARATION
I, _____________________________________________declare that, the above
particulars furnished by me are true and correct.
Signature of the applicant
CERTIFICATE
This is to certify that the above particulars are verified from the records of the
individual and found correct.
Signature of HM Signature of Dy.I.O’s/MEO/DyEO
Signature of
District Educational Officer,
NO OBJECTION CERTIFICATE ANNEXURE – B
Certified that Sri/Smt___________________________________
____________________________________., ___________________is a permanent
employee of _______________from __________and is at present holding the post of
__________________________________are dependent family Members of Sri / Smt
. _______________________and his / her identity is certified. This Department has
no objection to his / her acquiring Indian Passport. The undersigned is duly authorized
to sign this Identity Certificate. I have read the provision of Section 6(2) if the Passport
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 State
Government body. The Identity Card No. of Sri/ Smt _____________________ is
_________________
Signature of the Applicant
NO COURT CASES PENDING CERTIFICATE
This is to certify that Mr / Mrs ________________________________working as
(desg)___________________________________ at (office) __________________ school in
(place) _______________________ Mandal of ________________district has No Court Cases are
pending and not any disciplinary proceedings are pending against him / her.
------------------------------------------------------------------------------------------------------------------------
NO ALLEGATION AND NO DISCIPLINARY PENDING CERTIFICATE
This is to certify that Mr / Mrs ______________________ working as (desg)
_______________________ at (office) _________________________ school in Place
________________________________ mandal of ___________________ district has no any
allegations are pending and no any disciplinary proceedings are pending against him/her.
------------------------------------------------------------------------------------------------------------------------
NO DUE CERTIFICATE
This is to certify that Mr/Mrs ___________________________ working as
__________________________ (Desg) at (office) ____________________________ school in
(Place) ___________ _____________________ Mandal of _______________________district has
no dues for the following Government Loans:
I) House building loan with interest
II) Motor car / Motor cycle loan
III) House Rent Arrears towards Govt. Quarters
IV) Any other loans from Govt.
-------------------------------------------------------------------------------------------------------------------
VIGILANCE CLEARANCE CERTIFICATE
This is to certify that Smt/Sri ______________________________________ working in
____________________________Mandal _________________________ [Link]. has a clear
record of service and
1. No disciplinary proceedings are pending or contemplated against him/her
2. No Vigilance case is pending or contemplated against him/her.
3. There are no grounds to believe that on the applicant could figure adversely on the security
record of the Government.
Hence NO OBJECTION CERTIFICATE may be issued in his / her favour.
HM/Dy.I.O.s/MEO/DyEO