India Application For The Issue Of A Diplomatic / Official Passport Form Page 4

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GOVERNMENT OF INDIA/STATE GOVERNMENT
MINISTRY / DEPARTMENT OF
…………………………………………………………
No………………………………………………….
Date……………………..
Subject : Request for issue of official /diplomatic passports & visa note
S.No
Name of applicant(s)
Designation Payscale &
Present/previous
please attach a list if
Grade Pay
passport(s) Number
required
2. Passport application forms duly filled – in: Attached/Not attached.
3. Details of Visit:
Countries to be visited on
Countries to be transited
Purpose and duration
official duty
4. Political clearance/ PMO clearance: Enclosed
5. It is certified that the visit has been approved by the competent authorities, and the period
of deputation will be treated as GOI/state Govt. Duty and he/she shall draw pay & allowances
in India.
Signature of the forwarding officer alongwith
Name/stamp/Phone no.
( For official Use Only)
Safe Custody
Issue of passport Dip Ppt:
Off. Ppt
Release from s/C
Visa Note for:
Cancellation
Expected date of
Remarke
delivery

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