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
__________________________________________________________________________________
SPACE FOR USE OF CISF