Annexure A to HRMD’s Circular No.

HRMD (ODD-112)/28/2017 dated September 20, 2017

Application Form for Service Certificates

The Director HRMD/ Chief Manager, Date: ________________

SBP Banking Services Corporation,
___________________________________ Office
Subject: Request for Issuance of Service Certificate for the purpose of:
(Check applicable box, as per requirement)
Applying for Passport
Applying for Visa for ________________ (Purpose) ________________ (Country)
Salary information may be included
Other (Please specify): ________________________________________

Kindly issue me Service Certificate for myself and my dependant(s) (if required) as listed
below for submission to above mentioned authority:
Details of Dependants: (if required)
# Full Name Relationship
1
2
3

I undertake to submit a copy of my Passport to HRMD/Staff Matters Unit within 7 days of

receipt of Passport from the Passport Issuing authority.
If applying for educational purpose:
I understand that in case of securing admission into the stated program being pursued, I
shall only be granted leave subject to eligibility as per relevant policy provisions.
Sincerely Yours,
Signature: ___________________________________
Name: ______________________________________ PIN: ________________ Grade: ________________
Department: _____________________Contact No: _____________________ Ext.: ________________

Only for the Use of HRMD- HOK/ SMU at Field Offices

Recommendations: Format of Service
The particulars Certificate
of the applicant forher
including his/ Permanent Employees
dependants’ have been checked from official
record and found correct. Accordingly, if allowed, we may issue required Service Certificate to the employee for
submission to above mentioned authority.
(SBP-BSC Letterhead)

DealingNo.
Officer:
XYZ__________________________________
(ABC-000)/ 000 /201X Issuing Officer: ________________________
( Date )
(Signature & PIN) (Not below OG-4) (Signature & PIN)

(Optional: To whom the

Certificate Received:
certificate is ______________________________
to be submitted) Filing Status:____________________________
(Signature of Concerned Employee) (Signature of Official- Record Room)