BHARAT SANCHAR NIGAM LIMITED

(A Government of India Enterprise)

Office of the Chief General Manager, Telecom, Tamilnadu Circle, Chennai – 6
(PR Cell)

Forms to be submitted for issue of ‘No Objection Certificate’ for going abroad

1. PART – ‘A’ Duly filled & signed by the applicant. Please fill all the columns without leaving any column blank.

2. PART – ‘B’ To be filled and signed by SAG level officer for Executives & by JAG level officer for Non-Executives.

Surety –
3. From equal or above rank irrespective of Government dues outstanding in the prescribed format.
I & II

4. Undertaking To be signed by the applicant in the prescribed format.

Vigilance Vigilance clearance Proforma should be downloaded from ERP system, get it verified by Accounts
5.
Clearance Officer (Drawal) and signed by the Controlling Officer

6. Affidavit To be executed on Rs.20/- non-judicial stamp paper duly attested by a Notary Public.

Print out of leave applied for the period going abroad and sanctioned by the controlling officer in
7. Leave
BSNL ERP portal. Leave sanction in SR 1 will not be accepted.

Documents required to be submitted along with the filled in application form:

1. Copy of valid Passport

2. Bank Statements or Sponsorship Affidavit:

a) If the source of finance for the expenditure is through personal savings of self/spouse (either full or partial),
Annual Income Certificate/Bank Statements of last 6 months should be produced. Savings in GPF account cannot
be included as a source of finance.
b) If the expenditures are borne by the host staying abroad or by any other person, a notarised affidavit in
support of the same should be enclosed. Alternatively, a declaration sponsoring the visit duly certified by the
concerned embassy/High Commission of India, may be furnished. The aforesaid affidavit/certificate from the
embassy/High Commission of India should invariably indicate the financial status of the person sponsoring the
visit.

The following employees should forward the filled in forms along with the required documents to
SDE (PR), O/o CGMT, BSNL, Tamilnadu Circle, Chennai-6 through proper channel. Details furnished
in Part ‘A’ should be duly verified with the Service Book before forwarding the application for issue
of NOC.

1) All PGMs/GMs of Tamilnadu Circle

2) Executives (from JTO/JAO to JAG level) of both Engineering & Finance Wing /
Non-executives working in Circle Office/ Units situated in Chennai

All Executives (from JTO/JAO to JAG Level) of both Engineering & Finance Wing and
Non-executives working in SSAs should apply to the Heads of SSAs concerned.

NOTE: Issue of NOC for unabsorbed employees will be dealt by BSNL Corporate Office.

* Please see below for all the prescribed formats.

T22017T
 BHARAT SANCHAR NIGAM LIMITED
Regd. & Corporate Office: Bharat Sanchar Bhavan, Harish Chandra Mathur Lane, Janpath, New Delhi-110 001
Office of the Chief General Manager, Telecom Tamilnadu Circle, Chennai-6

PROFORMA FOR TAKING PRIOR PERMISSION FOR APPLYING FOR PRIVATE VISIT ABROAD

PART – ‘A’ – TO BE FILLED BY THE APPLICANT Per. No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

To be verified with service book and certified by the AO (Drawal)

1. Name (IN BLOCK LETTERS) : ____________________________

2. Designation : ____________________________

3. Pay : ____________________________

4. Office to which attached : ____________________________

5. Passport No. : ____________________________

6. Details of private foreign Travel to be undertaken:

Names of foreign Purpose of Estimated Expenditure (Travel/

Period of travel Source of Funds
Countries to be visited visit Boarding/ Visa/ Misc. etc)

7. Details of private foreign travel undertaken during the last four years:

Period of travel Names of foreign countries visited Purpose

Signature of the applicant: __________________________________

Phone / Mobile No.

Name and Designation __________________________________

PART – ‘B’ – TO BE FILLED BY THE ADMINISTRATION

# To be signed by SAG level officer for Executives and by JAG level officer for Non-Executives.

1. Whether the applicant is handling large amount of Government cash : ________________

2. Whether the applicant is dealing with secret/top secret matters : ________________

3. Whether any case involving serious charges against the applicant is under
investigation (Details thereof) : ________________

4. Whether the applicant is under suspension : ________________

6. Whether any disciplinary proceeding/criminal case is pending against the

applicant (Details thereof) : ________________

Signature of the Head of the Office/Unit #

Seal
 SURETY – I

I, __________________________________ S/o-D/o ________________________________

working as a permanent (Desgn.) ________________________________________________ in

the office of _______________________________________________________________

hereby stand surety for all the Government dues which may be found outstanding against

Shri/Smt/Ms. _______________________________ S/o-D/o __________________________

who is working as (Desgn.) ___________________________________________ in the office of

the ______________________________________________________________________

from the date he/she wants to go abroad.

Date: _________________ Signature __________________________________

Name in full ________________________________

Office _____________________________________

___________________________________________

Certified that Shri/Smt/Ms. _________________________ S/o-D/o______________________ is

a permanent employee of this office and he/she assigned the above document in my presence.

Date: _________________ Signature __________________________________

Name in full ________________________________

Office _____________________________________

___________________________________________

Seal
 SURETY – II

I, __________________________________ S/o-D/o ________________________________

working as a permanent (Desgn.) ________________________________________________ in

the office of _______________________________________________________________

hereby stand surety for all the Government dues which may be found outstanding against

Shri/Smt/Ms. _______________________________ S/o-D/o __________________________

who is working as (Desgn.) ___________________________________________ in the office of

the ______________________________________________________________________

from the date he/she wants to go abroad.

Date: _________________ Signature __________________________________

Name in full ________________________________

Office _____________________________________

___________________________________________

Certified that Shri/Smt/Ms. _________________________ S/o-D/o______________________ is

a permanent employee of this office and he/she assigned the above document in my presence.

Date: _________________ Signature __________________________________

Name in full ________________________________

Office _____________________________________

___________________________________________

Seal
 UNDERTAKING

I, __________________________________________________ HRMS No. _____________

working as ___________________________________________ hereby undertake that I will

not overstay abroad unauthorizedly in excess of the leave granted to me. I further undertake

that I will not tender resignation / negotiate for any employment, etc. while my stay abroad.

In case, if any deviation of the rules or violation of the undertaking given, I shall be liable for

disciplinary action in accordance with the rules of the Government of India.

Date: ________________ Signature _________________________________

Name in full _______________________________

Office ____________________________________

________________________________________
 AFFIDAVIT
( To be executed on Rs.20/- non-judicial stamp paper duly attested by a Notary Public )

I, _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (HRMS No. _ _ _ _ _ _ _ _ _ _ _ )

S/o-D/o _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ presently working

as _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ in _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ do hereby solemnly affirm and declare as under:

a) That I am a citizen of India;

b) That I will not engage outside India in activities prejudicial to the sovernity
and integrity of India;

c) That my departure from India will not be detrimental to the security of India:

d) That my presence outside India will not prejudice the friendly relations of
India with any foreign country;

e) That I, at any time during the period of five years immediately preceding the
application, have not been convicted by a Court of India for any offence
involving moral turpitude and sentenced in respect thereof, to imprisonment
for not less than two years;

f) That proceedings in respect of an offence against me are not pending before

a criminal court in India;

g) That no warrant or summons for the appearance or no warrant for the arrest
against me has been issued by a Court under any law for the time being in
force or order prohibiting my departure from India has been made by any
such Court;

h) That I have not been repatriated in the past / I have been repatriated and
have reimbursed the expenditure incurred in connection with such
repatriation (strike off, whichever is not applicable)

___________________
Date: ____________ Applicant’s Signature

DECLARATION

I, _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ do hereby solemnly affirm and state that

the contents given above are correct and true to the best of my knowledge.

___________________
Date: ____________ Applicant’s Signature