Coloured Stamp Coloured Stamp

AIRPORTS AUTHORITY OF INDIA Size photograph of Size photograph of

the employee to be
APPLICATION FOR PHOTO IDENTIY CARD FOR THE EMPLOYEES the employee to be
pinned pinned
Fill up the form below CAPITAL LETTERS

With two copies of coloured Passport size

Photographs (to be pinned with the application

Form and on the back of it Name, Designation and

Employee no is to be written with Black Ball – pointed pen (Specimen Signature of the Employee)

1 Name in Full KISHOR KALLUL CHETIA

2 Designation AGM(ATM)
3 Place of posting LGBI AIRPORT Region NER
GUWAHATI
4 Employee no 10017377 Date of Birth Basic Pay 92460
10017377

5 Residential address & Tel No FLAT NO A1/3RD FLOOR , SYNERGY PARADISE

BIDYA MANDIR PATH, BHETAPARA , GUWAHATI – ASSAM 8752881291
Blood Group A+ Allergic NIL Major illness NIL
to
drugs
Next of kin : Name & Tel No UNA RAJKHOWA CHETIA 8752881291
(for emergency)
Particular of dependents
Name Date of Birth Relationship Whether Married
or Unmarried
1 UNA RAJKHOWA CHETIA 18-06-1977 WIFE MARRIED
2 AMLAN JUNAK CHETIA 19-05-2011 SON UNMARRIED

Signature of the Employee

Forwarded by:

(Authorised signatory of the concerned Dept. with Name, Designation and seal)

Details verified by Personal Dept.

(Authorised Signatory of the Personal Dept with seal) Unit identification Number

Signature of the Airport Director, Unit -in Charge RED or his Authorised Signatory)
AIRPORTS AUTHORITY OF INDIA

Application for issue of Medical Photo identity Card for AAI Employee and their Organisations

Fill up the form below in CAPITAL LETTERS, with

one each set (two photographs each person of Coloured Stamp

coloured stamp size photographs with white Size photograph of
the employee to be
background of employee and dependents ( all photographs pinned
are to be pinned with the Application form and on

the back of it Name and relation with employee

to be written with black point pen)

1 Name in full KISHOR KALLUL CHETIA

2 Designation AGM(ATM)
3 Place of posting LGBI AIRPORT GUWAHATI
4 Employee No 10017377
5 Date of Birth 31-07-1977
6 Basic Pay 92460
7 Residential Address A1/3 , SYNERGY PARADISE, BIDYA MANDIR PATH
BHETAPARA , GUWAHATI , ASSAM PIN 781028
8 Contact No 8752881291
9 Blood Group A+
10 PF ID No 310777KC06988

Details of Dependents: -

Sl no Name Date of Birth Relationship Maritarial Status

1 UNA RAJKHOWA CHETIA 18-06-1977 WIFE MARRIED
2 AMLAN JUNAK CHETIA 19-05-2011 SON UNMARRIED

Signature of the Employee

For use of personnel: -

The above details have been checked and found correct based on the service records of the
individual employee.

Verified by

Signature of Manager/Sr Manager (EH Section)

Signature of Jt General Manager/General Manager