Location: Terminal

BHARAT MUMBAI CONTAINER TERMINALS PVT LTD

Aplication form port Entry Job Pass (For 1 to 7 Days)
(To Be submitted in Duplicate)

BMCTPL_ 8004 PART A

1. Name of the applicant mohit shukla

2. Father's/ nagendra shukla

Husband's Name

3. Mobile No. 8602648836

4. Age/Date of Birth 19 yrs / 25-12-2005

5. Sex Male

6. Identification Mark & mole on face

BloodGroup B -Ve

7. Address AT JNPT TOWNSHIFT

8. Nationality Indian

9. Occupation service

10. Work Order if any awarded bmct cs 2021

by BMCT

11. Work order period 06/30/2024

12. Place of Work BMCTPL

13. Date and period for which 22/04/2024

From to 28/04/2024
Pass is Required

14.Personal belonging (laptop, etc)

15..Aadhar Card 969942225587

I hereby give an undertaking that particulars furnished by me as above are true to the best of my knowledge. I also submit that no
criminal case is either pending or contemplated registered with the police against me, in case the above information is found
incorrect action may be taken as deemed fit

Date: 22-04-2024
Signature

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