FORM ‘D’

REQUISITION FOR ISSUE OF IDENTITY/ADMISSION CARDS

This requisition to be accompanied by two copies of Recent 3 X 2.5 cm. Size photograph

one of which to be Pasted in the space provided.

PART-I

(To be filled in by the Applicant)

1. Name (in Block Letters) :

2. Father’s/Husband’s Name :

3. Deptt./Office/Organisation :

4. Designation/Scale of Pay :

5. Gazetted ( Yes / No) :

(In case of government Servant)

6. Mark of Identification :

7. Type of card required : Identity card/Admission card

8. Reason for Request: Fresh Appointment/Transfer/Change in Designation/Renewal/Mutilation or

Other Reason—

Certified that the above information is correct. The previous Identity/Admission Card No: -

Enclosed/has been returned to…the loss of the Card has been reported to

Police and Copy of the report is enclosed.

Penalty for Loss/Mutilation/Late Renewal/Charges of Photograph etc. have been provided.

Receipt No. …………………….Dated…………..

Dated……… Signature

PART-II

(To be used by the Sponsoring Authority)

Dairy No ………………….. Dated …………….

Forwarded to Secretariat Security Section, Department of Home

The information furnished by the applicant has been verified and found correct. Character/Good Conduct Certificate enclosed (in case applicable).

Approval of the competent Authority for issue of Identity/Admission Card has been/has

Obtained.

Type of the Card: Identity Card/Admission Card

Period:…………………..

Remarks:………………..

Dated:…………………..

Signature of Sponsoring Authority Designation……………………… Tel. No……………………………

(Stamp)

PART-III

(For use by the issuing Authority)

Issued Identity/Admission Card No…………………………….

Valid up to……………………….

Dated……………………………..

Signature

FORM ‘E’

(Receipt to be issued by security Staff on confiscation of expired/mutilated Identity/Admission Card

Department of Home

(Secretariat Security Section)

Seized Identity/Admission Card No. ---------------------------------- Dated ---------------------------------,

Shri-------------------------------------------------Department ----------------------------------------- on account of unserviceable condition/expiry.

Date of expiry-----------------------------------

Signature

Name----------------------------------------------

for Director, Secretariat Security,

Home Department.

FORM ‘F’

(Character and Good Conduct Certificate)

I certify that Shri --------------------------------------------- S/o. ---------------------------------------------------- residence

Of --------------------------------------------- is personally known to me. To the best of my knowledge and belief, he bears good

Moral character. He may issue with an Admission Card for his entry into the Secretariat for Government works.

Signature of the Issuing Officer/Person

Name-----------------------------------------

(Seal)

Address---------------------------------------

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