Police Department Puducherry APPLICATION FOR NO OBJECTION CERTIFICATE TO GO TO ABROAD/OBTAIN INDIAN PASSPORT 1. Name : 2. Father's Name : 3. Designation : 4. Place of Working : 5. Date of initial appointment : 6. Date of appointment in the present : post 7. Whether permanent/quasi : permanent/Temporary/Ad-hoc 8. Place of visit : 9. Purpose of visit : 10. Duration of visit (specify the period of : visit) 11. Whether it is proposed to take leave. : If so, the nature of leave, to be applied for should also be specified 12. Expense whether met by him/others : with details of sources 13. Address of the relative abroad : 14. Nationality : 15. State whether application is for : renewal of passport or fresh, if renewal (furnish the original passport application No. date on which passport was obtained) 16. (i) Whether the applicant has applied : for NOC previously and whether permission was granted. If so, a copy of the order to be enclosed. (ii) If rejected, the grounds for : rejection and copy of the order rejecting the same by Government, etc. should be enclosed. 17. Whether undertaking submitted : 18. Any other particulars : SIGNATURE OF THE APPLICANT ANNEXURE -I SN Name of the Govt. Servant Present Designation Name of the Father / Husband (for female) Serve Particulars including deputation from date of initial appointment till now (as on date) Preference to I.D. Note/Memo. No. & dt. Wherein disciplinary action was required by the CVO to be taken against the individual, if any was pending in the Dept. / Office as on date. Remarks Name of the Dept. / Office / institution Designation Date of Appointment (1) (2) (3) (4) (5) (6) (7) (8) (9) UNDERTAKING (To be typed in Stamp paper) I, .......,, Pondicherry will not seek any employment from a foreigner during my stay abroad. 2. I am applying Earned Leave for 30 days only as a maximum to go abroad and I may even come earlier and join duty canceling part of my leave. At any rate I assure you that I will certainly rejoin duty on or before the expiry of leave beyond the period, and no correspondence also need be entertained from me for any extension of leave. If, I do not resume duty within the specified time, it may be treated that I have resigned my post in Government with effect from that date, and the same may be accepted by Government. 3. I am giving the undertaking with full knowledge at its implications and with my while hearted consent. SIGNATURE : PLACE : NAME : DATE : DESIGNATION: WITNESSES (1) (2)
