APPLICATION FORMAT FOR VEHICLE PASS ( LCV / 2 WHEELER)

FOR NON-EMPLOYEES
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Application No……………………………
To
The In-charge,
Pass Section,

Through: Signature of minimum AGM ranks Executive.

1. Regn. No of Vehicle & make :_______________________________________

2. Vehicle owners name :_______________________________________
3. Type of Vehicle :_______________________________________
4. Vehicle hired by(name of the
individual/Firm) :_______________________________________

5. Present Address(vehicle owners):_________________________________________

____________________________ _____________

__________________________________________

________________________________________

6. Permanent Address(vehicle owners)______________________________________

________________________________________

________________________________________

7. New/Lost /Damaged Gate Pass:__________________________________________

8. Time of entry /exit :___________________________________________
9. Entry /Exit Gate :___________________________________________
10. Period for which Gate pass is required :From______________To________________
11. Contact No. :__________________________________________

Date : Signature of the Applicant

Documents enclosed:

Photocopies duly attested by forwarding authority

i)Vehicle Registration Book iii)Vehicle Insurance Certificate
ii)Driving Licence (If self-driven) iv)pollution under control certificate

Signature of Personnel Officer (Cont. Labour Cell) with Seal

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SPACE FOR USE OF CISF