પાસપોર્ટ એન.ઓ.સી.
ની દરખાસ્ત સાથે સામેલ કરવાના દસ્તાવેજોની યાદી દર્શાવતું ચેકલીસ્ટ.
(૧) નિયત અરજી
પત્રક
(૨) U N D
E R T A K I N G
(૩) S U R
I T Y B O N D
(૪) DECLARATION
OF THE GOVERNMENT SERVANT
(૫) જામીન ના હોવા
અંગે નું પ્રમાણપત્ર
(૬) ફરિયાદ તપાસ
અને બાકી લ્હેણાં અંગેના પ્રમાણપત્રો
(૭) સા.વ.વિ. ના
તા.૫/૬/૦૩ના ઠરાવ અન્વયે પ્રમાણપત્ર.
(૮) એનેક્ષર – આઇ.
(૯) એનેક્ષર – બી
(૧૦) આઇ.ડી.
પ્રુફ.
(૧૧) ત્રણ
ફોટોગ્રાફસ
(૧૨) સર્વિસકાર્ડ.
(૧૩) મુળ નિમણૂંક
ના આદેશની નકલ
(૧૪) જી.પી.એસ.સી.
નિયમિત નિમણૂંકના આદેશની નકલ.
રીન્યુ માટે
(૧પ) અત્રેથી અગાઉ એન.ઓ.સી.
આપેલ હોય તો તેની નકલ
(૧૬) પાસપોર્ટની
નકલ
From:-
Date:-
/ / .
To,
Commissioner,
5,
Dr.Jivraj Mehta Bhavan,
Gandhinagar
382010
Sub:-
Issue of NO OBJECTION CERTIFICATE
FOR
Passport Purpose.
Respected
Sir,
I
am interested to go abroad to meet my relative, I request you to kindly issue
me “NO OBJECTION CERTIFICATE “for the passport Necessary information is
furnished below.
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1.
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2.
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Date
of Birth
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3.
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Date
of Appointment
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:-
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4.
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Present
Permanent
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:-
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5.
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Whether
intending
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:-
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6.
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Date
on which
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7.
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Name
of the place and country
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:-
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8.
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:-
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9.
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:-
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10.
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:-
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11.
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Whether
he is a bonded
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12.
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Whether
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:-
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13.
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Whether
conf
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:-
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14.
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Whether
applied
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:-
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15.
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Whether
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:-
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--
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Yours faithfully
(Applicant’s
Signature)
C E R T I C A T E
This is to
certify that the above information of Dr.Babubhai Kantilal Patel, Deputy
Director (Rural Health) Health Service (H.S) Gandhinagar Have been
verified from the office recorded and found it correct.
Place :.............................
Date :.............................. (Sign of
Head of Office)
U N D E R T A K I N G
1. ………………………here by do under
take to pay up any amount that may be found recoverable form me immediately on
receipt of the intimation form the authorities concerned.
2. …………………here by declare that
I have not received any Government loan and there is no any government due
outstanding against me.
3. I ……………… here by declare
that I have not signed security bond on behalf of any one and that I am not at
security risk of any one.
4. I ………………….here by declare
that I have not accented any bond to serve that Government of Gujarat for
Specified period.
5. I …………………..here by declare
that I will return India
Sign
Date : / /201 Name:-
Place:...................... Designation:-
That
above undertaking Signed in the present of following to gazette officer.
Full
Name and Designation Signature
with official Seal
1) ................................................
................................................
2) ................................................
................................................
S U R I T Y B O N D
We
(1)...........................................of ....................................
........ ........ and (2)
..............................................................hereby declare
ourselves jointly and severally for Mr./Mrs.......................................... and guarantee that he shall
do and perform under the undertaking
No.1 dated .......................
between himself of the one part and Government of Gujarat Gujarat the
other part and in case of his commuting default therein. We hereby agree to
bind ourselves from him as Government dues. And we further agree that the
Government may without prejudice to any other right of remedies of the
Government recover from the said sum as an arrear of land revenue under the
provisions of the Bombay land revenue code 1879. And we discharge us from our Liabilities
to pay said amount jointly and severally.
Sign
Date :
/ /201 Name:-
Place:...................... Designation:-
Name & Address
of Surity Signature of Surity
1) ...............................................
...............................................
..............................................
2) ...............................................
...............................................
..............................................
Signature by above in present of two
gazette officers.
Name and Designation of gazette officers. Signature with official Seal
1) ..........................................
...........................................
2) ..........................................
...........................................
DECLARATION OF THE GOVERNMENT SERVANT
I .................................................,
Working as ......................at Ref. Commissioner of Health Medical &
Medical Education (Health Section)
Gandhinagar EST Branch hereby declare that :
1. There is no departmental proceeding or preliminary inquiry
pending
against me.
2. There is no vigilance commission inquiry pending against me.
3. There is no disciplinary inquiry pending against me.
4. I have not tempered with Government record.
5. No A C B case has been filed against me.
6. I have not acted as surety for any person in financial matters.
7. No. Govt. due pending against
me.
8. I have not taken any loan from Government.
Sign
Place:-
Name :- ........................
Date:-
Designation :- ........................
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અંગેનું પ્રમાણપત્ર
આથી પ્રમાણપત્ર આપવામાં આવે છે કે
અત્રેની કચેરી ................................................... ............................................................................
ખાતે તબીબી અધિકારી વર્ગ-૨ તરીકે ફરજ બજાવતા
ર્ડા................................................................... સામે
આજદિન સુધીમાં કોઇ પ્રાથમિક ફરિયાદ તપાસ, ખાતાકીય તપાસ, કે કોર્ટકેસ ચાલુમાં કે
પડતર નથી.
સદરહું પ્રમાણપત્ર તેઓને પાસપોર્ટ
મેળવવાના હેતુસર આપવામાં આવે છે.
તારીખઃ-
સ્થળઃ- કચેરીના
વડાની સહી અને સિકકો
પ્રતિસહી
વિભાગીય નાયબ નિયામકશ્રી,
આરોગ્ય અને તબીબી સેવાઓ,
જિ.
....................................
બાકી લ્હેણાં
અંગેનું પ્રમાણપત્ર
આથી પ્રમાણપત્ર આપવામાં આવે છે કે
અત્રેની કચેરી ....................................................
...........................................................................
ખાતે તબીબી અધિકારી વર્ગ -૨ તરીકે ફરજ બજાવતા
ર્ડા............................................................. સામે કોઇ
સરકારી કે પંચાયતનું લ્હેણું વસુલ સેવાનું બાકીમાં નથી.
સદરહું પ્રમાણપત્ર તેઓને પાસપોર્ટ
મેળવવાના હેતુસર આપવામાં આવે છે.
તારીખઃ-
સ્થળઃ- કચેરીના
વડાની સહી અને સિકકો
સર્વિસ
કાર્ડ
તબીબી અધિકારી વર્ગ-૨ નું નામઃ- ડો....................................................................................
હાલની ફરજનું સ્થળઃ- ..............................................................................................................
જન્મ તારીખઃ-
................................................ મુળ નિમણુંક તારીખઃ- ..................................
મુળ નિમણુંક નો પ્રકાર ( એડહોક / બોન્ડેડ / જીપીએસસી ) - ....................................................
જીપીએસસી અન્વયે નિયમિત નિમણૂંકની
તારીખઃ- .....................................................................
શૈક્ષણિક લાયકાતઃ-
..................................................................................................................
ફરજની
વિગતઃ-
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તારીખ સુધી.
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સ્થળઃ- કચેરીના
વડાની સહી અને સિકકો
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Annexure B Identity
Certificate
No.
Office Address:
Date:
/ /
Government of
Commissionerate of Health,
Medical
Services and Medical
Education,
(Health Section)
5, Dr. Jivraj Mehta Bhavan,
Gandhinagar
ANNEXURE-'B'
Certified that Dr..........................................................
son of ......................... ..................................... is a employee of Commissionerate Of Health,
Medical Services &
Medical Education (H.S.) from ................................ (Date of
joining in service 29-01-1986) and at present he is
holding the post of Medical Officer in the Office of
.............................................................. . This
Department has no objection to his acquiring Indian Passport. The undersigned
is duly authorized to sign this Identity Certificate. I have read the
provisions of Section 6(2) of the passport Act. 1967 and certify that these are
not attracted in case of this applicant. I recommend to issue of an Indian passport to him. It is
certified that this organization is a State Government body. The
Identity PAN card Number of Dr. ...................................... is ..........................................
.
Date:
Applicant's photo (Head of Office)
To be attested by
Certified Authority
Annexure I
Government of India
Ministry of External
Affairs
CPV Division, Delhi
ANNEXURE 'I'
AFFIDAVIT
(To
be executed on appropriate non-judicial stamp paper and attested by a Notary
Public )
(One original and one self
attested photocopy)
I,
son/daughter/wife of _____________________ residing at
________________________________ Date of Birth ...........................being
an applicant for issue of passport do hereby solemnly affirm and state as
follows :
1. That the names of my parents and spouse
are as follows:
(I) Father :
(II) Mother :
(III) Husband :
2.
That I am continuously resident mentioned address from 1975
3. That
I am citizen
of India by birth/ descent/registration/ naturalization and that I have neither
deprived of my citizenship of India.
4. That
I have not, at any time
during the period immediate preceding ic ted by any court in India for any offence moral turpitude to imprison ment
5. That
no proceedings in respect of any criminal offence alleged to have been
committed by me are pending before any
criminal court in India
6. That
no warrant or summons for my appearance, and no warrant for my arrest, has been
issued by a court under any
law for the time being in force, and that my departure from India
7. That
I have never been repatriated from abroad back to India
at the expense of Government of
India/ I was repatriated from abroad back to
India at the expense of Government of India, but
reimbursed expenditure incurred in connection with
such repatriation.
8. That
I will not engage outside India
in activates prejudicial to the sovereignty and integrity of
India.
9. That
my departure from India will
not be detrimental to the security of India
10. That
my presence outside India
will not prejudice the friendly relations of India
Deponent
VERIFICATION
Verified
on...........(date) at ........................................(place) that the
contents of the above mentioned affidavit are true and correct and nothing
material has been concealed.
Deponent
પાસપોર્ટ એન.ઓ.સી.
ની દરખાસ્ત સાથે સામેલ કરવાના દસ્તાવેજોની યાદી દર્શાવતું ચેકલીસ્ટ.
(૧) નિયત
અરજી પત્રક
(૨) U N D E R T A K I N
G
(૩) S U R I T Y B O N D
(૪) DECLARATION OF THE GOVERNMENT SERVANT
(૫) જામીન
ના હોવા અંગે નું પ્રમાણપત્ર
(૬) ફરિયાદ
તપાસ અને બાકી લ્હેણાં
અંગેના પ્રમાણપત્રો
(૭) સા.વ.વિ. ના
તા.૫/૬/૦૩ના ઠરાવ અન્વયે પ્રમાણપત્ર.
(૮) એનેક્ષર
– આઇ.
(૯) એનેક્ષર
– બી
(૧૦) આઇ.ડી.
પ્રુફ.
(૧૧) ત્રણ
ફોટોગ્રાફસ
(૧૨) સર્વિસકાર્ડ.
(૧૩) મુળ
નિમણૂંક ના આદેશની નકલ
(૧૪) જી.પી.એસ.સી.
નિયમિત નિમણૂંકના આદેશની નકલ.
રીન્યુ માટે
(૧પ) એન.ઓ.સી.ની
નકલ
(૧૬) પાસપોર્ટની
નકલ
પાસપોર્ટ એન.ઓ.સી.
ની દરખાસ્ત સાથે સામેલ કરવાના દસ્તાવેજોની યાદી દર્શાવતું ચેકલીસ્ટ.
(૧) નિયત અરજી
પત્રક
(૨) U N D
E R T A K I N G
(૩) S U R
I T Y B O N D
(૪) DECLARATION
OF THE GOVERNMENT SERVANT
(૫) જામીન ના હોવા
અંગે નું પ્રમાણપત્ર
(૬) ફરિયાદ તપાસ
અને બાકી લ્હેણાં અંગેના પ્રમાણપત્રો
(૭) સા.વ.વિ. ના
તા.૫/૬/૦૩ના ઠરાવ અન્વયે પ્રમાણપત્ર.
(૮) એનેક્ષર – આઇ.
(૯) એનેક્ષર – બી
(૧૦) આઇ.ડી.
પ્રુફ.
(૧૧) ત્રણ
ફોટોગ્રાફસ
(૧૨) સર્વિસકાર્ડ.
(૧૩) મુળ નિમણૂંક
ના આદેશની નકલ
(૧૪) જી.પી.એસ.સી.
નિયમિત નિમણૂંકના આદેશની નકલ.
રીન્યુ માટે
(૧પ) અત્રેથી અગાઉ એન.ઓ.સી.
આપેલ હોય તો તેની નકલ
(૧૬) પાસપોર્ટની
નકલ
From:-
Date:-
/ /
.
To,
Commissioner,
5,
Dr.Jivraj Mehta Bhavan,
Gandhinagar
382010
Sub:-
Issue of NO OBJECTION CERTIFICATE
FOR
Passport Purpose.
Respected
Sir,
I
am interested to go abroad to meet my relative, I request you to kindly issue
me “NO OBJECTION CERTIFICATE “for the passport Necessary information is
furnished below.
|
1.
|
|
:-
|
|
|
2.
|
Date
of Birth
|
:-
|
|
|
3.
|
Date
of Appointment
|
:-
|
|
|
4.
|
Present
Permanent
|
:-
|
|
|
5.
|
Whether
intending
|
:-
|
|
|
6.
|
Date
on which
|
:-
|
|
|
7.
|
Name
of the place and country
|
:-
|
|
|
8.
|
|
:-
|
|
|
9.
|
|
:-
|
|
|
10.
|
|
:-
|
|
|
|
11.
|
Whether
he is a bonded
|
:-
|
|
|
|
12.
|
Whether
|
:-
|
|
|
|
13.
|
Whether
conf
|
:-
|
|
|
|
14.
|
Whether
applied
|
:-
|
|
|
|
15.
|
Whether
|
:-
|
--
|
|
Yours faithfully
(Applicant’s
Signature)
C E R T I C A T E
This is to
certify that the above information of Dr.Babubhai Kantilal Patel, Deputy
Director (Rural Health) Health Service (H.S) Gandhinagar Have been
verified from the office recorded and found it correct.
Place :.............................
Date :.............................. (Sign of
Head of Office)
U N D E R T A K I N G
1. ………………………here by do under
take to pay up any amount that may be found recoverable form me immediately on
receipt of the intimation form the authorities concerned.
2. …………………here by declare that
I have not received any Government loan and there is no any government due
outstanding against me.
3. I ……………… here by declare
that I have not signed security bond on behalf of any one and that I am not at
security risk of any one.
4. I ………………….here by declare
that I have not accented any bond to serve that Government of Gujarat for
Specified period.
5. I …………………..here by declare
that I will return India
Sign
Date :
/ /201 Name:-
Place:...................... Designation:-
That
above undertaking Signed in the present of following to gazette officer.
Full
Name and Designation Signature
with official Seal
1) ................................................
................................................
2) ................................................
................................................
S U R I T Y B O N D
We
(1)...........................................of
.................................... ........ ........ and (2)
..............................................................hereby declare
ourselves jointly and severally for Mr./Mrs.......................................... and guarantee that he shall
do and perform under the undertaking
No.1 dated .......................
between himself of the one part and Government of Gujarat Gujarat the
other part and in case of his commuting default therein. We hereby agree to
bind ourselves from him as Government dues. And we further agree that the
Government may without prejudice to any other right of remedies of the
Government recover from the said sum as an arrear of land revenue under the
provisions of the Bombay land revenue code 1879. And we discharge us from our
Liabilities to pay said amount jointly and severally.
Sign
Date :
/ /201 Name:-
Place:...................... Designation:-
Name & Address
of Surity Signature of Surity
1) ...............................................
...............................................
..............................................
2) ...............................................
...............................................
..............................................
Signature by above in present of two gazette officers.
Name and Designation of gazette officers. Signature with official Seal
1) ..........................................
...........................................
2) ..........................................
...........................................
DECLARATION OF THE GOVERNMENT SERVANT
I .................................................,
Working as ......................at Ref. Commissioner of Health Medical &
Medical Education (Health Section)
Gandhinagar EST Branch hereby declare that :
1. There is no departmental proceeding or preliminary inquiry
pending
against me.
2. There is no vigilance commission inquiry pending against me.
3. There is no disciplinary inquiry pending against me.
4. I have not tempered with Government record.
5. No A C B case has been filed against me.
6. I have not acted as surety for any person in financial matters.
7. No. Govt. due pending against
me.
8. I have not taken any loan from Government.
Sign
Place:-
Name :- ........................
Date:- Designation
:- ........................
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સામે આજદિન સુધીમાં કોઇ પ્રાથમિક ફરિયાદ તપાસ, ખાતાકીય તપાસ, કે કોર્ટકેસ ચાલુમાં
કે પડતર નથી.
સદરહું પ્રમાણપત્ર તેઓને પાસપોર્ટ
મેળવવાના હેતુસર આપવામાં આવે છે.
તારીખઃ-
સ્થળઃ- કચેરીના
વડાની સહી અને સિકકો
પ્રતિસહી
વિભાગીય નાયબ નિયામકશ્રી,
આરોગ્ય અને તબીબી સેવાઓ,
જિ.
....................................
બાકી લ્હેણાં
અંગેનું પ્રમાણપત્ર
આથી પ્રમાણપત્ર આપવામાં આવે છે કે
અત્રેની કચેરી ....................................................
...........................................................................
ખાતે તબીબી અધિકારી વર્ગ -૨ તરીકે ફરજ બજાવતા
ર્ડા............................................................. સામે કોઇ
સરકારી કે પંચાયતનું લ્હેણું વસુલ સેવાનું બાકીમાં નથી.
સદરહું પ્રમાણપત્ર તેઓને પાસપોર્ટ
મેળવવાના હેતુસર આપવામાં આવે છે.
તારીખઃ-
સ્થળઃ- કચેરીના
વડાની સહી અને સિકકો
સર્વિસ
કાર્ડ
તબીબી અધિકારી વર્ગ-૨ નું નામઃ- ડો....................................................................................
હાલની ફરજનું સ્થળઃ-
..............................................................................................................
જન્મ તારીખઃ-
................................................ મુળ નિમણુંક તારીખઃ- ..................................
મુળ નિમણુંક નો પ્રકાર ( એડહોક / બોન્ડેડ / જીપીએસસી ) - ....................................................
જીપીએસસી અન્વયે નિયમિત નિમણૂંકની
તારીખઃ- .....................................................................
શૈક્ષણિક લાયકાતઃ-
..................................................................................................................
ફરજની
વિગતઃ-
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તારીખ સુધી.
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સ્થળઃ- કચેરીના
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Annexure B Identity
Certificate
No.
Office Address:
Date:
/ /
Government of
Commissionerate of Health,
Medical
Services and Medical
Education,
(Health Section)
5, Dr. Jivraj Mehta Bhavan,
Gandhinagar
ANNEXURE-'B'
Certified that Dr..........................................................
son of ......................... ..................................... is a employee of Commissionerate Of Health,
Medical Services &
Medical Education (H.S.) from ................................ (Date of
joining in service 29-01-1986) and at present he is
holding the post of Medical Officer in the Office of
.............................................................. . This
Department has no objection to his acquiring Indian Passport. The undersigned
is duly authorized to sign this Identity Certificate. I have read the
provisions of Section 6(2) of the passport Act. 1967 and certify that these are
not attracted in case of this applicant. I recommend to issue of an Indian passport to him. It is
certified that this organization is a State Government body. The
Identity PAN card Number of Dr.
...................................... is
.......................................... .
Date:
Applicant's photo (Head of Office)
To be attested by
Certified Authority
Annexure I
Government of India
Ministry of External
Affairs
CPV Division, Delhi
ANNEXURE 'I'
AFFIDAVIT
(To
be executed on appropriate non-judicial stamp paper and attested by a Notary
Public )
(One original and one self
attested photocopy)
I,
son/daughter/wife of _____________________ residing at
________________________________ Date of Birth ...........................being
an applicant for issue of passport do hereby solemnly affirm and state as
follows :
1. That the names of my parents and spouse
are as follows:
(I) Father :
(II) Mother :
(III) Husband :
2.
That I am continuously resident mentioned address from 1975
3. That
I am citizen
of India by birth/ descent/registration/ naturalization and that I have neither
deprived of my citizenship of India.
4. That
I have not, at any time
during the period immediate preceding ic ted by any court in India for any offence moral turpitude to imprison ment
5. That
no proceedings in respect of any criminal offence alleged to have been committed
by me are pending before any criminal
court in India
6. That
no warrant or summons for my appearance, and no warrant for my arrest, has been
issued by a court under any
law for the time being in force, and that my departure from India
7. That
I have never been repatriated from abroad back to India
at the expense of Government of
India/ I was repatriated from abroad back to
India at the expense of Government of India, but
reimbursed expenditure incurred in connection with
such repatriation.
8. That
I will not engage outside India
in activates prejudicial to the sovereignty and integrity of
India.
9. That
my departure from India will
not be detrimental to the security of India
10. That
my presence outside India
will not prejudice the friendly relations of India
Deponent
VERIFICATION
Verified
on...........(date) at ........................................(place) that the
contents of the above mentioned affidavit are true and correct and nothing
material has been concealed.
Deponent
પાસપોર્ટ એન.ઓ.સી.
ની દરખાસ્ત સાથે સામેલ કરવાના દસ્તાવેજોની યાદી દર્શાવતું ચેકલીસ્ટ.
(૧) નિયત
અરજી પત્રક
(૨) U N D E R T A K I N
G
(૩) S U R I T Y B O N D
(૪) DECLARATION OF THE GOVERNMENT SERVANT
(૫) જામીન
ના હોવા અંગે નું પ્રમાણપત્ર
(૬) ફરિયાદ
તપાસ અને બાકી લ્હેણાં
અંગેના પ્રમાણપત્રો
(૭) સા.વ.વિ. ના
તા.૫/૬/૦૩ના ઠરાવ અન્વયે પ્રમાણપત્ર.
(૮) એનેક્ષર
– આઇ.
(૯) એનેક્ષર
– બી
(૧૦) આઇ.ડી.
પ્રુફ.
(૧૧) ત્રણ
ફોટોગ્રાફસ
(૧૨) સર્વિસકાર્ડ.
(૧૩) મુળ
નિમણૂંક ના આદેશની નકલ
(૧૪) જી.પી.એસ.સી.
નિયમિત નિમણૂંકના આદેશની નકલ.
રીન્યુ માટે
(૧પ) એન.ઓ.સી.ની
નકલ
(૧૬)
પાસપોર્ટની નકલ
