CONFIDENTIAL

PROFORMA FOR SECURITY CLEARANCE

PIEAS / KINPOE
1. Name

Photograph

Gender

2. Fathers Name
3. Date & Place of Birth
4. Nationality

Religion

Sect

Caste

5. CNIC No (Attach Photocopy)

6. Present Address & Tele No.
7. Permanent Address
8. Names of two references who can testify the candidates character/antecedents:Name

Address

Contact Number

9. Edn/Qualification/Expertise
10. Session (Duration of Studies)
11. Last Institution attended
12. Dual Nationality (if held)
13. Mobile Phone No. and Email
14. Foreign countries visited during last 5 years
Name of Country

Purpose

Place:

Signature:

Date:

Name:
Roll No. Allotted by PIEAS:

Countersigned

CONFIDENTIAL

CONFIDENTIAL
SCEF-0001

PROFORMA
INTERNSHIP / FELLOWSHIP
STRATEGIC COMMISSIONS
1.

Name (s) of Internee:

2.

Son / Daughter of :

3.
4.

CNIC No:

Desired schedule of Internship:

From

To

a.

2015

2017

PIEAS

KINOPE

Duration:

b. Recommending University :
5.

Venue to be visited:

6.

Category:

7.
8.
9.

PIEAS / KINPOE
---------------

Security Status Cleared by SIT

(In case Yes, attach photocopies)

Yes

No

Yes

No

Bio data of Internee attached:

Any other significant information:

CONFIDENTIAL