APPLICATION NUMBER:

ANDAMAN & NICOBAR ADMINISTRATION

SHIPPING CORPORATION OF INDIA
REQUISITION FOR ACCOMMODATION FOR TRAVEL BY SHIP FROM RAJ NIWAS/
ADMINISTRATION QUOTA/ GOVT. EMPLOYEES QUOTA
Name of Vessel :
Tentative date of sailing :
Sailing from …………………………………….. to ……………………………………………
No. of Berth(s)/ Seats …………………………………………
S.No Name of Applicant Relation Sex Age ID No. Class
1.
2.
3.
4.
5.
6.
7.

Purpose of journey : For Visitors of A&N

Islands:
Permanent Address : Duration of stay in the
Islands:
Address in A&N Islands
Permanent Address
Phone No.
Strike whichever is not applicable.
Applicant Name:
Signature with date:
FOR OFFICE USE ONLY
The applicant is drawing basic pay of Rs. ……………. and working as ……………………………………
……………………………………. has been granted …………………. days leave with effect from
……………… to ……………… to enable him/ her to visit home town/ mainland. He/She will be
accompanied by the following family members.

HOD/ Office

_____________________________________TEAR HERE _______________________________________

Receipt No. …………………… Application No. ………………. received an application for
accommodation for travel by MV ………………………………….. tentative sailing on ………………..
from ……………………… to ……………………….

Initial of Receipt Clerk

With office seal