BLANK - Security Vetting Performa

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SECURITY VETTING PROFORMA FOR ISSUANCE OF

AIRPORT ENTRY PASS


Space for
1. Name/Alias ____________________________ Photograph
2. Father’s/Husband Name, profession & address ____________________________
__________________________________________________________________ (Passport Size )
3. a) Date/Place of Birth _____________________ b) Nationality _______________
4. a) N.I.C No. (Attested Copy) __________________________________________ 2" x 1 ½"
b) Passport No. (with date and place of issue)______________________________
5. Origin of Family ____________________________________________________
6. Religion / Sect ______________________ 7. Caste _____________________
8. Education Qualification _______________________________________________
9. Name of Educational Institutions attended ________________________________
10. Department (where presently serving) ____________________________________
11. Present Address with telephone No. ______________________________________
12. Permanent Address with telephone No. ___________________________________
13. Date & Rank of Initial Joining Service ____________________________________
14. Present Appointment with Date & Telephone No. ___________________________
15. Place of postings for the Last 10 years ________________________________
16. Previous Service (if any) ___________________________________________
17. Marital Status / Size of Family _______________________________________________
18. Visit Abroad (with purpose) ____________________________________________
19. Social/Religious/Political activities(Present/Past) ___________________________
20. Name & Address of Two Close Relatives __________________________________
____________________________________________________________________
____________________________________________________________________
21. Name & Address of Two Close Friends (not related) __________________________
____________________________________________________________________
_____________________________________________________________________
22. Last Year’s Airport Entry Pass No. (if issued) ________________________________
23. a) Airport(s) for which pass required ____________________________________
b) Area(s) for which pass required (Nature of Duty) _________________________
_________________________________
c) Justification (for which purpose pass is required) __________________________
24. Letter No. with date for Last Security Clearance and Name of Security Agency (if any) ___
___________________________________________________________________________

CERTIFICATE

1. The information given above is complete & correct in all respect.


2. I am not involved in any illegal / anti state / anti Government activity.
3. I will surrender the Airport Entry Pass in case of adverse remarks reported by security agency.

Signature ____________

COUNTERSIGNATURE WITH OFFICIAL STAMP BY ________________________


THE HEAD OF DEPARTMENT / NOMINA OFFICER
(Name of Applicant)
Date ________________

NOTE: To be submitted in triplicate

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