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(Through Proper Channel)

Sub: Request for issue of No objection Certificate for obtaining a Passport.

I wish to obtain a Passport for visiting ___________________, I request that I may kindly be granted No
objection Certificate to enable me to produce it before the appropriate Passport issuing authority. The
detail of my bio-data and other particulars are given below:-

1. Name
2. Designation.
3. Fathers name
4. Date of birth
5. Date of appointment
6. Grade & rate of pay
7. Divisiion/branch in which working
8. Station of posting
9. Present residential address.
10. Place of residence during the last 5 years.

11. Present address
12. Countries for which passport
is required.

13. Reasons for obtaining passport.

I declare that :-

1. I will be abide by the provision of Indian Passport Act, Indian Custom Act and any other
Act of the Government of India.

2. I will not request for release of foreign exchange from Railways and will make his own
arrangement for foreign exchange required for the trip.

3. I understood that issue of passport will be subject to the clearance from Civil Authorities
and the Income Tax Department.

4. I will not pursue any study or training while aboard without prior permission of the

5. I will not indulge in any activity which might be prejudicial to the interests of India or any
other foreign country and that his / her additives during this/her stay abroad will not
affect the friendly relations between Indian and any other country/countries.

6. I will get the approval and sanction of leave from the appropriate competent authority
every time before proceeding abroad.

7. I will abide by the general conditions as laid down by the Government of India from time
to time.

8. I have read the provisions under section 6 (2) of Passport Act 1967and certify that these
are not attracted in my case. There is nothing under the provision of said act which can
debar for obtaining a passport.

Yours faithfully,

Station. Signature of Applicant.
Dated. with Name below the Signatures.

Forwarded to:

DRM/ADRM DRM Office for necessary action. There is nothing under section 6 (2) of Passport Act 1967
which can debar me for obtaining a passport.


Station. Signature of the Sr.Sub.

Branch Officer Name
Designation Designation
Dated. Date