With effect from 1st July, 2010

APPLICATION FORM FOR BOOKING NPB ARM

GOVERNMENT OF INDIA

GRAM : PROTOTYPE

MINISTRY OF DEFENCE

Phone : (0251) 2610 884-887 Extn: 670, 676, 721

INDIAN ORDANCE FACTORIES

Fax : (0251) 2610 065

MACHINE TOOL PROTOTYPE FACTORY

E-mail : mpf.ofb@nic.in

AMBARNATH 421502. (M.S.)

FOR OFFICIAL USE ONLY
Registration No.

__________________

Registration Date__________________

To
The General Manager
Machine Tool Prototype Factory
Ambarnath - 421502
1
.

FULL NAME

BOOKING OF 0.32 REVOLVER (IOF)

(All entries should be neatly written / typed in CAPITAL letters or neatly typed only)
SANJEEV
KUMAR NANDA

2
.

FATHERs / HUSBANDs NAME

3
.

Telephone No. with STD Code

HARBANS LAL
NANDA
STD Code:
01632
Mobile No.
9814000404
O/S KASURI
GATE,
FEROZEPUR
CITY. PUNJAB
Pin Code:
152002
O/S KASURI
GATE,
FEROZEPUR
CITY, PUNJAB

Mobile No. (Fax No.)

4
.

Full Address For Correspondence

5
.

Permanent Address

6
.

b. Whether license valid for .32 or N.P. Bore

Fax No.

Telephone No.:

01632-503003

Telephone No.

01632-244005

YES / NO

Revolver

YES

c. Valid Area
d
.
Valid Date

PUNJAB (STATE)

Licensing Authority

7. Full Address of Licensing Authority

503003

505/ADM/FZR//D
EC-2013

a. Arm License No.

e
.

Telephone No:

with

26/11/2016
DISTRICT
MAGISTRATE,
FEROZEPUR
DEPUTY
COMMISSIONER
, MINI
SECRETARIAT,
FEROZEPUR
CANTT

Pin code & Telephone No.

(Pin Code must be mentioned)
8
.

Pin Code:
152001

Address in Arm License

SANJEEV
KUMAR NANDA
O/S KASURI
GATE,
FEROZEPUR
CITY-152002,
PUNJAB

9
a
.

(i)
Bank Draft No.(s) & Date
b. Banks Name & Branch

(i)

c. Amount
10. Specimen Signature of the Applicant

3851
94

(ii)

7963
7/-

(ii)

STATE BANK OF INDIA

(iii)

(i)

(Please sign in both the places)

(ii)
11. PAN Card No. (Enclose attested copy)
Enc
l.

: 1. Bank Draft(s)
2. Copy of Arm License (2 Copies)
3. Copy of PAN Card

Note:

1.
2.
3.
4.

Please enclose Bank draft for full amount, attested photocopy (2 Nos.) of your valid Arms License and attested copy of PAN card with the application.
Bank drafts should be drawn in favour of General Manager, M. T. P. F. Ambarnath payable at SBI Ambarnath (Branch
Code 001040).
Amount required for booking is Rs. 78176/- (full amount) for .32 Revolver
Please see Terms & Conditions of Sale and sign on Acceptance Note on page 2.