10. APPLICATION (FOR ABROAD PERMISSION TO TEACHERS BY CDSE - HYDERABAD) Name of the Teacher Designation Name of the School Date of Birth Residential Postal Address Details of first Appointment a) Designation b) Date of Appointment | Classes handling in the Stoo! for : Subject No. of Periods Classes: -V VI-X Date from which he/she is working In the school Details of Dependants as per service book entry with page no. Details of cases pending a) Whether there are any allegations pending against him/her. b) Whether any disciplinary proceedings : are pending or contemplated against the individual. c) Whether any Vigilance cases are pending or contemplated against the individual d) Whether there are grounds to believe: that the applicant could figure adversely on the security Records of the GovernmentML. Details of Government loans/Dues 8) House building Loan with interest b) Motor car/ Cycle loan ©) Any other Loans from Government d) House rent appears towards Government: Quarters €) Other Government dues 12, Place of visiting country 13. Duration of 14. Purpose of visiting place 15. Contact Address in visiting place DECLARATION . Declare that the above Particulars furnished by me are true and correct. Signature of the applicant CERTIFICATE This is to certify that the $bove particulars are verified fiom the records of the Individuals and found correct, Signature of the G H.M. Signature of GHM/M.E.O Signature of the District Educational OfficerANNEXURE - B NO-OBJECTION CERTICATE (TO BE ISSUED BY THE HEAD OF DEPARTMENT OBTAINING THE LEAVE) Certified that Sri/Smt .. S/o, Dio, W/o. is a Temporary / Permanent employee of (office . + from, and is at present holding the post of .are dependent family members of .. and his/her identify is certified. This Ministry / Department / Organization has no objection to his/her acquiring .. ‘The undersigned duly authorized to sign this identify certificate. I have read the provision of section 6(2) of the Passport act, 1967 and certify that these are not attracted in case of this applicant. I recommend issue of an Indian passport to him/her. It is certified that this organization is a central / State Government / Public sector undertaking / statutory body. The identify card No. of Sri/Smt. . Name: Designation: Individual Photo & ’ Should be Attested Address; by the Gazetted officer Phone no.:CERTIFICATE OF FAMILY MEMBERS Certified that the applicant Sri, / Smt, School .. has the following members as par the entry in Service Register of the Indivi. Relationship with the Application SLNo. Name Age Occupation Place: ” Date: Head of OfficeCERTIFICATE OF NO PENDING CHARGES S/o/Wio This is to certify that Sri/Smt .... ag tires working as District .... .. Mandal ... has no disciplinary proceedings / pending charges and allegations against her/him and also there are grounds to believe that the applicant could adversely on the security regards of the Government. . Date: Place: Head of the Office DUES CERTIFICATEOF S/o/Wio This is to certify that Sri/Smt .... working as .. at. Mandaj . -has no pending dues to governrhent in regard to Home Building Loans / Motor Car / House rent arrears / Other Government dues which are objectionable for issuing NOC Date; Place: Head of the OfficeThis is to certify that Sri/Smt ...., +. working as ... Mandal . . District ... has no Criminal / Vigilance cases pending against him / her to the best of my knowledge and belief on the strength of available records / on enquiry. Date: Place: Head of the Office SERVICE CERTIFICATE This is to certify that Sri/Smt .... S/o/Wio .. working as ... 0 BE ea Mandal . wow District .... . Her Date of Birth is . Her first Appointment is . Her date of Present School is _. Her service found Satisfactory. Head of the Office