FORM – I
(See rule 24 – A)
APPLICATION FOR “ IDENTITY CERTIFICATE “ FOR APPLYING FOR GRANT /
RENEWAL OF PASSPORT AND “ NO OBJECTION CERTIFICATE “ TO
UNDERTAKE FOREIGN TRIP
(To be filled by the applicant )
1. Name , Designation , Office address :
and scale of pay
(if Selection grade or Special grade
indicate respective ordinary grade
scale of pay)
2. Date of Retirement :
3. Name of Countries proposed to visit :
and duration (need not be filled up
to obtain passport to seek
employment abroad)
4. Purpose of Visit :
5. Source of funds to meet the cost of :
the proposed foreign travel
6. State whether any criminal :
prosecution is contemplated or
pending against you and whether
your presence as witness would be
needed in any criminal case under
investigation or trial
CERTIFICATE
I undertake that I will uphold the honour and dignity of our Nation and
will not indulge in any act prejudicial to the integrity and sovereignty of our Country
during my travel and stay abroad.
Signature of
the Applicant
(To be filled by the Head of Department)
7. Are the particulars furnished by the :
applicant correct as per information
available with the department?
8. Whether the presence of the :
applicant outside India, may or likely
to prejudice the friendly relations of
India with any foreign country.
9. Whether the applicant at any time :
during the period of five years
immediately preceding the date of
his application , been convicted by a
court in India for any offence
involving moral turpitude and
sentenced in respect thereof to
imprisonment for not less than two
years ?
10. Whether any proceedings in respect :
of an offence alleged to have been
committed by the applicant is
pending before a criminal court in
India.
11. Whether any warrant or summons :
for the appearance or warrant for
the arrest of applicant has been
issued by a court under any law for
the time being in force or whether
an order prohibiting the departure
from India of the applicant has been
made by any such Court.
12. Whether the applicant has been
repatriated and has not reimbursed
the expenditure incurred in
connection with such repatriation.
13. Whether any Government dues are
pending recovery, if so, the details
thereof.
14. Whether any disciplinary action is
pending under rule 17(b) of the
Tamil Nadu Civil Services (Discipline
and Appeal) Rules.
15. Whether a certificate has been
obtained from Special Branch C.I.D
(Security) that the applicant does
not figure adversely on the security
records of the Government.
16. Whether any corruption charges or
Vigilance enquiry is pending against
the applicant.
17. Is there any contractual obligation to
be discharged by the applicant
(applicable in the case of travel for
employment only)
18. Recommendation of the Head of the
Department.
SIGNATURE OF THE
HEAD OF THE DEPARTMENT
FORM – II
IDENTITY CERTIFICATE AND NO OBJECTION CERTIFICATE TO APPLY FOR
GRANT / RENEWAL OF PASSPORT
(see rule 24- A)
(To be given in Duplicate)
Under rule 24-A of the Tamil Nadu Government Servants Conduct
Rules, 1973, it is certified that
Thiru/Tmt/Selvi....................................................................................
son /wife/daughter of Thiru........................................................................who is an
Indian National , is a temporary/permanent employee of
this ..........................................................
..................................................................................................(office address)
from ....................
(date) and is at present holding the post
of ................................................................................
Thiru/Tmt/Selvi...........................................................................who is also an Indian
National, is /are a dependent family member of
Thiru/Tmt .................................................
and his/her identity is certified. This department has no objection to his/her
acquiring/renewal of Indian Passport, subject to the following conditions, namely:-
(i) that the individual should not take up any appointment or undergo any
training other than the one specified, if any or study Programme during
his/her stay abroad without prior approval of the Government/ Head of the
Department;
(ii) that the Government /Head of the Department will not be made liable for
any expenditure including traveling expenditure etc., in connection with
his/her trip abroad;
(iii) that he/she should not tender resignation of the post held by him/her
under this Government while abroad and his/her resignation of
appointment will not be accepted on any account;
(iv) that he/she should not canvass or seek any business while abroad;
(v) that before proceeding abroad, he/she should apply to the Government/
Head of the Department for the sanction of leave to which he/she is
eligible and get it sanctioned for the entire period of his/her absence.
(vi) that he/she shall not use the passport obtained on the basis of the
“Identity Certificate “ for any subsequent trip abroad for any purpose
without the prior sanction of the competent authority; and
(vii) that the “Identity Certificate” will be valid only for a period of six months
from the date of issue.
The undersigned is authorized to sign this “ Identity Certificate and No
Objection Certificate”. I have read the provisions of sub section (2) of section 6 of
the Passports Act, 1967 and certify that these are not attracted in the case of this
applicant. I recommend issue of an Indian Passport to him/her. It is certified that
this department is a State Government Department. The Identity Card Number of
Thiru/Tmt.
(employee).......................................................................is ........................................
Reference No. and Date
Name Designation and Address
Telephone No.
THIRU.
Chief Internal Auditor and
Chief Auditor of Statutory Boards
Chengalvarayan Building 7th Floor,
807, Anna Salai, Chennai – 600 002.
Phone No. 044 – 2851 0605
Applicant’s Photo to be attested by the Certifying Authority
Form – III
NO OBJECTION CERTIFICATE TO UNDERTAKE FOREIGN TRIP
(See rule 24 – A)
Under rule 24-A of the Tamil Nadu Government Servants Conduct
Rules, 1973, Thiru/Tmt/Selvi........................................................................................
working as ............................................................................. (specify designation) in
the department of INTERNAL AUDIT AND STAUTORY BOARDS AUDIT is
permitted to visit .................................................................................... (specify the
country / countries) from ............................ to ............................. (specify the
dates) to see his / her son/ daughter/ other relatives / friends or as a tourist or on
pilgrimage or to attend a training / seminar / workshop / conference (strike out
which is not applicable) subject to the following conditions :-
(i) He/she should not take up any appointment or undergo any training
seminar / workshop / conference other than the one specified, during
his/her stay abroad without prior approval of the Government/ Head of the
Department;
(ii) that the Government /Head of the Department will not be made liable for
any expenditure including traveling expenditure etc., in connection with
his/her trip abroad;
(iii) He/she should not tender resignation of the post held by him/her under
this Government while abroad and his/her resignation of appointment will
not be accepted on any account;
(iv) He/she should not canvass or seek any business while abroad;
(v) This “ No Objection Certificate “ is valid only for a period of six months
from the date of issue and it is issued only in connection with the purpose
indicated above and should not be used for any other purpose.
BIO –DATA
1. Name and Designation :
2. Father’s Name :
3. Age & Date of Birth :
4. Temporary Address :
5. Permanent Address :
6. Marital Status :
7. Date of Joining in Government :
Service
8. How long she is residing in the :
Address
9. Place worked and Post held for the : Post held Worked at
past 3 years.
10. Whether any Vigilance case is :
pending/ contemplated against the
individual
11. Proposed visit to foreign country :
I hereby declare that the above statements are true to my knowledge
and I acknowledge the same.
Station :
Date : Signature of the
Applicant.
