Medical Cell, DGCA MEDICAL NOC APPLICATION

Opp Safdarjung
New Delhi Airport), Aurobindo Marg
110 0033
-

Dale: 18.02. 2022

ISSUEOF NOC FOR CONDUCT OF CLASS-I MEDICALS

,
Since (state Ahamkaha, Amanna ing. (Name), PMR No
1514/2014
1 . 2 request for an NOC
reason(s) why NOC is required)
.AA uO a.andatemalr. dulaud laA **"***"*** Mdical ni hal)
*)*"*************"
2
.pomaLLi. ********' s ******'"***"****"*

My delails are as follows

(a)
Emai id.kamh
Contact Number hasinaho8@mail.m
(c) 1120844D52
.Nam Mwmbau. bo06.
*** ************S
********************* ***'*****'''***'***'
(d) Age. G.s..
(e Details
of last mèdical
*************** ********

Date...........i. **,02.14 (Vaidit 18.02.o * * * * * * * ' * * * * * * * " * ' ' * * " * * * * * * " * * * * * ' * * ***

Placeof Medical..M.umbat.
Type of Medical Class-1/ Class-2.. S& . ***'* ****'************* *
Status Fiu
Temporary Unfiv Permanent Unfit..
6) Forthcoming Medical.
.. ******''****'**** **** *°*''***'**

Date..:03202. '*****'*****'**********'***°'****°******'************ ***

Face. AM.. amga . ****** *******°*******************************°
3. Thave not exercised the pri!ages of my license vhen my medical was not valid

4. NOC may be (select 1 option) posted to mel sent atongwith PMR/ held at DGCA for ccllection by
me.
Yours faithfully.

hanha
(AKANKSMA AMARNATH SINGH
Enclosures:
1) Copy of Last Medical Assossmont issued by DGCA ( If not rocoivod, thon CA.35 issuod by
Boarding Centre)
2) Copy of License
3) Copy of 1 & last page of log book
4) Documents supporting reason for delay e.g. medical certificates if reason was medical

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