GOVERNMENT OF INDIA BUREAU OF CIVIL AVIATION SECURITY AERODROME ENTRY PERMIT (AEP) APPLICATION FORM (AEPAB) Fi up the form in CAPITAL LETTERS, Two copies of recent coloured passport size photogra ‘Non in ha stam in space below. Al the columns must be filed up otherwise appl [eto be given in DD/MM/YY format. Any overusting / correction m: Pa TOR OFFCE USE = = 1.2one__2.Terminal__3.AEP No, 2. Working pot ; : Dien ee ft ci oak Seg é 5. caVerfeaton (SH0/80/0 anyother w 2. Fresh sue /Reassue (yr). fre Tae 1a) Previous AEP Colour / Zone 2. a. For Fresh issue tick ) reasons mentioned below. Fresh Appointment [] Designation Change Transfer Mutiation ee oe hejuier aaa: Grnoet ee o ». Date a of 2): Se AG 3. Name I HLOINT EY roy | 4. Father's Name_ R an raha! Se F 5. Mother's Name 6.a.Pesmanent Address: GQUTAM CeleNy, NA Present Addiess: CH. Ri ral Aadhae Number 7. Date of Birth [0 ate of superannuation 21 fom SP Oreneatoar Gere aye Bsn Reet alae — ld Place of duty: New Be UT 4 Nature of duty: AM in €.Office Address:_ Sp PTT: EcoNoMic Affaires Min te aE ESsaRCE 2 ri '. Educational Qualification, Cae Ee TG 41. Details of AP in possession: AEP No,__NI Valid upto 42. information relating to applicants other than indian nationals 3. Nationality 'b, Passport No. «Place of Issue: 4. Date of issue ‘2. Expiry of Passport fType of Visa 1 Expiry of visa, 13 F(a) ls any case pending against you with the police or court? Ye (b) If Yes, furnish full details on a separate sheet of paper. Wi (a) Were you ever arrested? (b) if yes, furnish full details, 1 (a) Were you punished departmental? (Yes, furnish full details: 18, AVSEC Awareness Training Nos Eolas Date of Training: Location: _ Name & Organization of the AVSEC Instructor, certify that the particulars furnished by me above ‘ving fase information would make me liable to legalPART “B" 1 Leertfy that the above person ison the payroll of our organization + the particular given are correct andthe applicant essentialy needs Aerodrome EDLY Permit in order to perform his / her duties. Recommended for issue of pto__f_/___» ‘AEP for zones {Tick () where applicable] fora period uF (alolrisTeleleieicicd GL cs [1 PS terminal (signature of Authorized Signatory with Seal) ane ete ae Designation PART “C” {To Be centfied By the administrative Officer ofthe Applicants Department) “TEMPORARY employee of our organization. tL tcertify that the above person is a PERMANENT / 1 cet ae bersonal les hove been checked andthe Information furnished by He ‘Applicant in separate sheet) found Correct / Not Correct (details tobe mentioned it tbe mentioned in separate sheet) 3, Details of Viglance Enquiries/Cases, if any (details to 3 ata ot rte to return the AEP to BCAS within one week after the applicant's need for the AEP Place: res Date: officially ends. NB: Delete inapplicable alternative (Signature of authorized signatory with Seal) Date: Name___ Designation. Part “D" details (To be completed by a referee/witness) [Applicant's job ttle: Section (5) 8-C: Reference or accountability Name of Agency". Section Employment permanent contract: VES / NO if No, Please provide details of length contract, Reason for leaving previous job. Name and address of previous employer low long have you known the applicant? ‘+ Inwhat capacity is he/she known to you?, «Are you related to or cohabitate with the: Is there any further comment you F Section ¢: Section |: Integr TA). The purpose ofthis reference isto ensure that integrity to work within airport. tis a criminal offs identity document. To your knowledge, Is there which suggest alack of integrity or otherwise ref ‘permit allowing then access Into sensitive areas i you have ticked YES please provide detail a ‘THIS ORIGINAL COMPLETED FORM MUST BE FO! ‘D FORM. A SIGNED/STAMPED. ‘Aa DOUBLE SIDE! MUST BE ATTACHED.