P. 1
Application for NRK ID Card

Application for NRK ID Card

|Views: 377|Likes:
Published by biswasnair

More info:

Published by: biswasnair on Jan 09, 2011
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as PDF, TXT or read online from Scribd
See more
See less

08/24/2015

pdf

text

original

At]£m^mdw kuP\yamWv

IfÀ t^mt«m
(]mkv t]mÀ«v sskkv )
{]hmkn Xncn¨dnb ImÀUv
At]£m^mdw (hntZiw)
District (PnÃ) PIN Code(]n³tImUv ):
Panchayat/Municipality/Corporation
(]©mb¯v /ap\n kn ¸m enän/tImÀ¸ td j³)
District (PnÃ)
Signature of the NRK
({]hm kn bpsS H¸v )
Telephone number with STD Code (t^m¬ \¼À tImUv DÄs¸sS):
Place of issue (\ÂInb Øew) Date of issue (\ÂInb XobXn)
Day
Znhkw
Year
hÀjw
Day
Znhkw
Month
amkw
Year
hÀjw
NORKA-ROOTS, 4
th
Floor, Centre Plaza, Vazhuthacaud, Thiruvananthapuram-695 014, Kerala, India
+ 91-471-2332416, 2332452 Fax:+91-471-2326263, e_mail: mail@norkaroots.net, URL: www.norkaroots.net, www.norka.gov.in
1. Name (as in passport) t]cv (]mkvt]mÀ«n DÅXpt]mse)
2. Date of Birth (P\\¯obXn)
3. Passport Number (]mkvt]mÀ«v \¼À)
4. Country of Residence
(Ct¸mÄ Xma kn ¡p¶ cmPyw)
5. Address for communication (I¯ b bv¡p ¶ Xn \pÅ hnemkw)
6. Address abroad (hntZis¯ hnemkw)

E-mail (CþsabnÂ)
Telephone No with ISD code (t^m¬ \¼À tImUv DÄs¸sS)
7. Address in Passport (]mkvt]mÀ«nse hnemkw)
8. Profession (sXmgnÂ)
9. a) Duration of overseas stay (hntZi¯v F{X Imeambn

Xmakn¡p¶p)
10. Details of Sponsor (kvt]m¬kdpsS hnhc§Ä)
Month
amkw
P I N
(Please read the guidelines before filling up the application. Use only CAPITAL Letters)
(At]£ ]qcn ¸n ¡p ¶ Xn\v ap³]v \n_ Ô \ IÄ hmbn¡p I. Cw¥ojv henb A£ c¯nÂ
]qcn¸n ¡p I)
hÀjw amkw
A GOVERNMENT OF KERALA UNDERTAKING
NORKA
Page: 2
11. Educational Qualifications
(hnZym`ymk tbmKyXIÄ)
12. Whether family lives abroad or in native place
(IpSpw_w hntZit¯mtWm kztZi¯mtWm)
13. Marital status (sshhmlnImhØ)
14. Religion (aXw)
15. Details of family members including parents (amXm]nXm¡Ä DÄs¸sS IpSpw_mwK§fpsS hniZhnhcw)
16. Name of Nominee with relationship (AhIminbpsS t]cpw _Ôhpw)
Declaration ({]XnÚ)
I declare that the details given above are true to the best of my knowledge and belief. If anything stated is found false, legal action may be taken
against me. (apIfn sImSp¯ncn¡p¶ hnhc§sfÃmw Fsâ Adn hnÂs¸«n S t¯mfw kXyamsW¶v Rm³ CXn\m km£ys¸Sp¯p¶p.
GsX¦nepw hnhcw sXämsW¶v t_m[ys¸«m F\ns¡Xnsc \nba \S]SnIÄ kzoIcn¡mhp¶XmWv.)
Name and Signature of the Applicant/*Family Member
At]£Is‚/IpSpw_mwKØns‚ t]cpw H∏pw
ATTESTATION FROM INDIAN EMBASSY / CONSULATE ABROAD
The applicant has signed in my presence and he/she is living this country since ......................(month)................(year).
Name and Signature of the Embassy/Consulate Official with seal
OR
ATTESTATION FROM DESIGNATED OFFICIALS / AUTHORITY IN KERALA
At]£Is\ F\n°v t\cn´dnbmw. ta¬∏d™ hkvXpXIƒ ]q¿Wambpw icnbmsW∂v CXn\m¬ Rm≥ km£ys∏SpØp∂p.
Place (Øew) ........................................................................
Date (XobXn) ........................................................................ t]cpw H∏pw (ko¬ klnXw)
FOR OFFICE USE ONLY
Code number : .............................................................
Date of Registration : .............................................................
ID Number : .............................................................
Status : .............................................................
Single Divorced Married
Abroad
hntZi¯v
In native place

kztZi¯v
Chief Executive Officer/Authorised Officer
Norka-Roots
Name (t]cv) Relationship (_Ôw) Age (hbÊv)
Name (t]cv) Relationship (_Ôw) Age (hbkv)
I nominate the following person for claiming the insurance benefit, in the event of my death. ( B\p Iq ey §Ä ssI¸ äp ¶ Xn\v Xmsg ]d 
bp ¶  Bsf Rm³ \ma\nÀt±iw sN¿p ¶p.)
]©mbØv {]knU‚v /hm¿Uv saº¿/Iu¨kne¿/Fw.  F¬.F/Fw.  ]n.  / 
tI{µ  /  kw  ÿm\ Kk‰Uv Hm^o  k¿
Page: 3
{]hmkn Xncn ® dn b¬ Im¿Uv ]≤Xn 2008 BKÃv apX emWv kwÿm \Øv \ne hn¬ h∂ Xv . {]hmkn Xncn ® dn b¬ Im¿Uv
BZy L ´ Øn¬ \ne hn¬ hntZi cmPy ß fn¬ D≈ h¿°v am{X amWv \¬Ip∂ Xv . CXv {]hmkn ae bm fn Iƒ°v tIc f Øn¬ Hcp
Xncn®  dn  b¬ tcJ  bmbn D]  tbm  Kn  °p  ∂  tXm  sSm  ∏w, Im¿Up  S  a  Iƒ°v A]  I  S  ß  sf  Øp  S¿∂p  ≠m  Ip∂ AwK  ssh  I  ey߃°pw
A] I S a c W ßƒ°pw Hcp e£w cq] hsc e`n °p∂ C≥jz d≥kv ]cn c £bpw Dd ∏p h cp Øp ∂p. k¿°m cns‚ hnhn[ {]hmknt£a 
]≤ Xn I fpsS ASnÿm \ tc Jbpw {]hmkn Xncn ® dn b¬ Im¿Uv BWv . CXns‚ Imem h[n aq∂v h¿j am Wv .  c Pn kv t{S j≥ ^okv
200/˛ cq] . Cu ]≤Xn tIc f  k¿°m¿ t\m¿° hIp ∏ns‚ \nb {¥ W Øn ep≈ t\m¿°˛ dq´v kv hgn bmWv \S ∏m °p ∂ Xv .
• hntZiØv Bdp am k Øn e [nIw tPmen sN øp Itbm dkn U‚v s]¿an‰v t\Sn Xma kn °p Itbm sNøp∂ 18 hbv ]q¿Øn 
bmb {]hm kn  tI c fo b¿°v {]hmkn Xncn ® dn b¬ Im¿Un\v At] £n °mw.
• At] £m ^mdw ]©m bØv / ap\n kn ∏m en‰n/tIm¿∏ td j≥ hgnbpw hnhn[ {]hm kn  kw L S \ Iƒ hgnbpw t\m¿°bptSbpw
t\m¿°˛dq´v kns‚bpw Hm^okpIfnepw www.norkaroots.net epw kuP\yambn e`y am Wv .
• ]mkv t]m¿´ns‚ ]I¿∏v (hnk Dƒs∏  sS  bp  ≈  Xv )   A  XXv cmPy  ß  fn¬ \ne  hn  ep≈ \nb  am  \pkr  X  amb hnk/sXmgn¬/
Xma k  s]¿an‰ns‚ ]I¿∏v (DZm: kuZn .C °ma/Exit re-entry Visa ]I¿∏v ), cPn kv t{S j≥ ^okv 200/˛ cq] As√ ¶n¬ 200/
˛ cq] bpsS Unam‚v {Um^v ‰v ( No^v FIv kn Iyq ´ohv Hm^o k¿, t\m¿° ˛ dq´v kv F∂  t] cn¬ AXXv taJem Bÿm \Øv
amdm hp ∂Xv ) klnXw ]qcn ∏n® At] £ Iƒ At] £ It\m At] £ Is‚ A`m h Øn¬ IpSpw _mw Ktam AXXv taJem
Hm^o  kn¬ t\cnt´m X]m¬ hgntbm ka¿∏n  t°  ≠  Xm  Wv .
• At] £m ^md Ønse F√m tImf ßfpw hy‡ ambn ]qcn ∏n t° ≠ XmWv . A]q¿Whpw A]m I X Iƒ D≈Xpamb At] 
£  Iƒ ]cn  K  Wn  °p  ∂  X  √.
• At]  £m  ^m  d  Øn¬ ImWn  ®n  ´p≈ hnh  c  ߃ icn  bm  sW∂v AXXv cmPy  ß  fnse C¥y≥ Fw_kn As√  ¶n¬ \m´n 
ep≈ hm¿Uv saº¿/ Iu¨kn  e¿, ]©m  bØv {]kn  U‚v / ap\nkn  ∏¬ sNb¿am≥/tab¿/Kk  ‰Uv Hm^o  k¿ F∂n  h 
cn¬ Bsc ¶nepw km£y s∏ Sp Øn  t] tcm Sp IqSn ko¬ ]Xn ∏n®p H∏p sh t° ≠ Xm Wv .
lmPcmt°≠ tcJIƒ
1. ]mkv t]m¿´ns‚ kzbw km£ys∏SpØnb _‘s∏´ t]PpIƒ ˛ hnk t]Pv Dƒs∏sS
2. \ne hn ep≈ hnk/sXmgn¬ s]¿an‰v /Xmak s]¿an‰v ]I¿∏v
3. tdj≥ Im¿Uv e`y am sW ¶n¬ ]I¿∏v
4. ]m kv t]m¿´v sskkv t^mt´m ˛ 2 FÆw
5. cPnkv t{Sj≥ ^okv 200 cq]
Pn√Ifp w At]£ Ab bv t°≠ _‘ s∏´ taJemtI{µßfpsS hnemkhpw NphsS sImSp °p ∂p
Pn√, taJe
At]£ ka¿∏n t°≠ taJemtI{µ Øns‚ A{Uv
Z£nW taJe
Thiruvananthapuram, Kollam, Pathanamthitta
(Xncp  h  \  ¥  ]p  cw, sIm√w, ]Ø  \w  Xn  ´)
Norka- Roots Regional Office
Certificate Authentication Centre
Lotus Villa, Sasthamangalam
Thiruvananthapuram
Phone: 0471- 2317950, 2317951
e_mail: idcelltvm@norkaroots.net
a[y taJe
Thrissur, Ernakulam, Palakkad, Kottayam,
Alappuzha, Idukki
(Xriq¿, Fd Wm Ip fw, ]me °m Sv , tIm´ bw,
Be  ∏p  g, CSp°n)
Norka- Roots Regional Office
Certificate Authentication Centre
Door No. 41/1313- B, V.M Complex
C.P.Ummer Road , Ernakulam
Phone: 0484 2371830, 2371810
e_mail: idcellekm@norkaroots.net
D¯c taJe
Kasargod, Kannur, Kozhikode, Malappuram,
Wayanad (Imk¿tIm  Sv , IÆq¿, tImgn  t°m  Sv ,
ae  ∏p  dw, hb  \mSv )
Norka Roots Regional Office
Certificate Authentication Centre
2nd Floor, Zamorine Squire
Link Road, Kozhikkode
Phone: 0495- 2304882, 2304885
e_mail: idcellclt@norkaroots.net
Page: 4
AUTHORISATION LETTER
I Sri/Smt.......................................................................(name of the NRK) bearing
Passport No:....................................(passport number) working in ..........................................
...............................................................................................................................................
................................................................................................................. (address abroad)
with permanent address ..........................................................................................................
...............................................................................................................................................
...................................................................................... (address in India) do hereby authorize
Sri./Smt..................................................................................................................................
my .....................................(wife/husband/father/mother/son/daughter/brother/sister/any
other relationship) to apply and collect NRK ID Card on behalf of me. The nominee given
in the application form is as per my decision.
Date:
Place: Signature of the Non Resident Keralite

........(month)........... Date (XobXn) .. Chief Executive Officer/Authorised Officer Norka-Roots ............ Name of Nominee with relationship (AhIminbpsS t]cpw _Ôhpw) I nominate the following person for claiming the insurance benefit............. : ............ legal action may be taken against me.........................-F¬...................................................-/tI{µ-/-kw-ÿm\ Kk‰Uv Hm^o-k¿ t]cpw H∏pw (ko¬ klnXw) FOR OFFICE USE ONLY Code number Date of Registration ID Number Status : .. GsX¦nepw hnhcw sXämsW¶v t_m[ys¸«m F\ns¡Xnsc \nba \S]SnIÄ kzoIcn¡mhp¶XmWv................... ta¬∏d™ hkvXpXIƒ ]q¿Wambpw icnbmsW∂v CXn\m¬ Rm≥ km£ys∏SpØp∂p.........Bsf Rm³ \ma-\nÀt±iw sN¿p-¶p...) Name and Signature of the Applicant/*Family Member At]£Is‚/IpSpw_mwKØns‚ t]cpw H∏pw ATTESTATION FROM INDIAN EMBASSY / CONSULATE ABROAD The applicant has signed in my presence and he/she is living this country since .. Educational Qualifications (hnZym`ymk tbmKyXIÄ) 12......... Marital status (sshhmlnImhØ) Religion (aXw) Married hntZi¯v Single kztZi¯v Divorced Details of family members including parents (amXm]nXm¡Ä DÄs¸sS IpSpw_mwK§fpsS hniZhnhcw) Name (t]cv) Relationship (_Ôw) Age (hbÊv) 16......... ( B\p-Iq-ey-§Ä ssI¸-äp-¶-Xn\v Xmsg ]d- bp-¶........ in the event of my death.........(year)....................................F/Fw...... : ....... : ... (apIfn sImSp¯ncn¡p¶ hnhc§sfÃmw Fsâ Adn-hnÂs¸-«n-S-t¯mfw kXyamsW¶v Rm³ CXn\m km£ys¸Sp¯p¶p.......................... ]©mbØv {]knU‚ v/hm¿Uv saº¿/Iu¨kne¿/Fw....................) Name (t]cv) Relationship (_Ôw) Age (hbkv) Declaration ({]XnÚ) I declare that the details given above are true to the best of my knowledge and belief................................ 15........ If anything stated is found false.....-]n.... Name and Signature of the Embassy/Consulate Official with seal OR ATTESTATION FROM DESIGNATED OFFICIALS / AUTHORITY IN KERALA At]£Is\ F\n°v t\cn´dnbmw..................................................... Place (Øew) . Whether family lives abroad or in native place Abroad In native place (IpSpw_w hntZit¯mtWm kztZi¯mtWm) 13............................ 14.........Page: 2 11.......

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->