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    Form - A: Signature of Applicant: - Date

    Uploaded by

    kanilkumarf8
    The document is an identity card application form containing personal details like name, designation, address, and contact information. It also includes employment details like date of joining, retirement date, and reason for identity card issuance. The form needs to be certified by the sponsoring authority for photo pass issuance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Form - A: Signature of Applicant: - Date

    Uploaded by

    kanilkumarf8
    10 views2 pages
    The document is an identity card application form containing personal details like name, designation, address, and contact information. It also includes employment details like date of joining, retirement date, and reason for identity card issuance. The form needs to be certified by the sponsoring authority for photo pass issuance.

    Original Description:

    Aai

    Original Title

    243300036351

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

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    The document is an identity card application form containing personal details like name, designation, address, and contact information. It also includes employment details like date of joining, retirement date, and reason for identity card issuance. The form needs to be certified by the sponsoring authority for photo pass issuance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    10 views2 pages

    Form - A: Signature of Applicant: - Date

    Uploaded by

    kanilkumarf8
    The document is an identity card application form containing personal details like name, designation, address, and contact information. It also includes employment details like date of joining, retirement date, and reason for identity card issuance. The form needs to be certified by the sponsoring authority for photo pass issuance.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    Photo (3X3 cms with çi= & d Photo (3X3 cms with

    75% area covered 75% area covered


    FORM - A
    with image of the with image of the
    dsUæh; ljdkj@jkT; ljdkjksa@la?k jkT {ks= ç'kkluksa vkSj muds lEc) v/khuLFk
    face) front attested face) to be pasted
    dk;kZy;ksa vkSj miØeksa Lok;Ùk fudk;ksa@ tks muds LokfeRo esa gSa ;k muds
    by sponsoring here (Not to be
    Authority to be fu;a=.kk/khu gSa@ ds deZpkfj;ksa gsrqA attested)
    pasted For Officials of Central Governments/ State Governments/ UT
    Administrations and Their attached/ Subordinate offices and
    Undertaking/ Autonomous Bodies owned or controlled by them
    Reference No. : 243300036351
    1. igpku i= dk çdkj /Type of Identity Card Central Government

    2. Js.kh /Category Regular

    3. dkMj /Cadre SRA

    3. çFke uke /First Name eukst ç'kkar / MANOJ PRASHANTH

    4. vafre uke /Last Name ,p,e /HM

    5. inuke /Designation ys[kk vf/kdkjh / ACCOUNTS OFFICER

    6. osru vk;ksx /Pay Commission 7th CPC

    7. osru cSaM@ osru Lrj /Pay Scale/ Pay Band Level 6 (35400-112400)

    7 (A). xzsM is ¼tgka ykxw gks½ /Grade Pay (Wherever applicable)

    8. ea=ky;@ jkT; ljdkj foHkkx@ljdkjh miØe Hkkjrh; foekuiru / AIRPORTS AUTHORITY


    OF INDIA
    /Ministry/State Government Department/Public Undertaking çkf/kdj.k

    9. jDr dk lewg /Blood Group B+

    10. dk;Z&LFky dk irk /Address of Place of Working VISAKHAPATNAM

    11. tUe frfFk /Date of Birth 08/07/1988

    12. nwjHkk"k la[;kad % dk;kZy; /Telephone Number: Office 08912851100

    13. nwjHkk"k la[;kad % vkokl /Telephone Number: Res 8555931011

    14. firk@ ifr dk uke /Father's/ Husband's Name H YESUDASU

    15. lsokfuo`fÙk dh rkjh[k /Date of Superannuation 31/07/2048

    16. igpku fpà /Mark of Identification SMALL MOLE ON RIGHT CHEEK

    17. jktif=r @vjktif=r /Gazetted/ Not-Gazetted Gazetted

    18. tkjh djus dk dkj.k /Reason for Issue Fresh Appointment

    1- çekf.kr fd;k tkrk gS fd mijksä tkudkjh lgh gSA 2- iqjkuk igpku i= Øekad ------ ;gk¡ layXu gS ;k iqjkuk igpku i= [kks
    x;k gS vkSj ekeys dh lwpuk iqfyl dks jlhn la[;k ------ds ek/;e ls nh xbZ gS] jlhn layXu gSA
    1. Certified that the aforesaid information is correct. 2. The old Identity card No......... is here by enclosed or the old Identity Card
    is lost and the matter has been reported to the Police vide Receipt No.........enclosed.
    (Delete whichever is inapplicable).

    Signature of Applicant: __________________


    Date: __________________
    Reference No. : 243300036351
    1. çFke uke /First Name eukst ç'kkar /MANOJ PRASHANTH

    2. vafre uke /Last Name ,p,e /H M

    3. inuke /Designation ys[kk vf/kdkjh /ACCOUNTS OFFICER

    भाग-II/ PART - II
    ¼çk;kstd vf/kdkjh }kjk çekf.kr fd;k tkuk gS½ /(To be certified by the Sponsoring Authority)

    ¼1½ vkosnd }kjk nh xbZ lwpuk dk lR;kiu fd;k x;k gS vkSj ;g lgh ikbZ xbZ gS vkSj bl ç;kstu ds fy, j[ks x, jftLVj ds Q‚eZ
    ^d* esa ntZ dj yh xbZ gS ¼2½ vPNs O;ogkj dk çek.ki= layXu gS ¼vfu;r etnwj/fngkM+h dkexkj ds fy, QksVks ikl ds ekeys esa½
    ¼3½ eSa ea=ky;/foHkkx ds fy, QksVks ikl tkjh djus ds fy, vf/k—r çk;kstd vf/kdkjh gwa ¼4½ ekaxi= dh vuqfyfi fjd‚MZ ds fy,
    QksYMj esa j[k yh xbZ gS ¼5½ l{ke çkf/kdkfj;ksa dk vuqeksnu çkIr dj fy;k x;k gSA
    (i) The information furnished by the applicant has been verified to be correct and has been entered in the register in
    Form ‘A’ maintained for this purpose; (ii) The good conduct certificate is enclosed ( in case of photo passes for
    casual labor / daily wagers); (iii) I am the authorized sponsoring authority for issue of photo passes for the Ministry /
    Department (iv) Duplicate copy of the requisition has been kept in the folder for records; (v) Approval of the
    competent authorities has been obtained.
    ¼tks ykxw u gks] mls dkV nsa½ /(DELETE WHICH-EVER IS INAPPLICABLE)

    çdkj Hkou ftuds fy, ykxw gS vof/k


    / TYPE COVERAGE OF BUILDING /PERIOD

    (i) x`g ea=ky; lqj{kk tksu ds varxZr lHkh Hkouksa ds fy, vksiu 5/1 Year

    OPEN for all Buildings under MHA Security Zone

    (ii) lhfer ¼Hkou ¼Hkouksa½ ds uke fufnZV djsa½% 5/1 Year


    Restricted for [Specify name(s) of the building(s) ]:
    (1)
    (2)
    (iii) dkj.k ¼u;[email protected]@xqe gksuk@inuke esa [email protected]½
    Reason ( Fresh / Renewal / Loss/ Change in Designation / Transfer )

    ea=ky;@foHkkx dh xqIr lhy çk;kstd vf/kdkjh dk uke vkSj gLrk{kj


    Secret Seal of the Ministry / Department Name and Signature of the Sponsoring Authority

    inuke ¼eqgj ,oa Qksu uacj½


    Designation ( Stamp with Telephone No.)
    dksM la--------------------------
    Code No. ____________

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