Directorate of Information and Publicity Government of NCT of Delhi Block no 9, Old Sectt Delhi-110054 Form for Press Card (APPLICATION FORM (IN TRIPLICATE) TO BE FILLED IN BY THE APPLICANT ACCOMPANIED WITH 3 COPIES OF PASSPORT SIZE PHOTOGRAPHS SHOULD BE FORWARDED BY THE EDITOR OF THE PAPER CONCERNED.) 1. Name in full (In capital letters) 2. a)Designation _____________________________________________________ b)Nature of Employment: 3. Father's/Husband's name _________________________________________ 4. Qualifications _________________________________________ 5. Date of birth _________________________________________ 6. Blood group __________________________________________ 7. Nationality ________________________________________ 8. Present residential address _________________________________________ Full time Part time Contractual Others Telephone(R)______________Mobile_______________________ 9. Address during last 3 years _________________________________________ (if different from col.8) 10. Name & address of __________________________________________ the Organisation in which working Telephone(O)_______________E-mail Address_____________________ 11.Language and periodicity of the Publication/ Language of the Channel _________________________________________ 12.Current Circulation (for print media) __________________________________________ 13.Current Sales Turn over of the company (for Electronic media) ___________________________________________ 14.Whether accredited with PIB (Govt of India)/ Yes/No other state Government .If yes, give PIB No. ___________________________________________ 15.Journalistic experience for last 3 years with details________________________________________ (Enclose copy of the certificates for proof) 16.Reference of two citizens of your locality: Sl.no. Name Occupation Address Tel.No. 17.Recommendations of two journalists accredited with Government of NCT of Delhi with particulars as below: Sl.No Name Designation Name of the Particulars of Press Signature . Publication/ Card channel Card No. Valid Upto Declaration: I hereby certify that the above information is correct and complete to the best of my knowledge and belief. Signatures of the applicant Checklist of documents attached:-YES NO 1.Forwarding letter from the Editor recommending the case. 2.Four stamp size photographs. 3.Copy of the appointment letter. 4.Copies of the 3 years experience certificate. 5.Copy of the current circulation(RNI/DAVP)/sales turn over certificate. 6.Copies of last One year's issue of publication.
