Application for the Grant of a Pass Under Section 7 of the Andaman and Nicobar Islands (Protection of Aboriginal Tribes) Regulation 1956
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FORM ‘A’ (See Rule 4) Application for the grant of a Pass under Section 7 of the Andaman and Nicobar Islands (Protection of Aboriginal Tribes) Regulation 1956 Attested To Photograph paste here The Deputy Commissioner & One South Andaman District. attach I, …………………………………………(name of the applicant) hereby apply for a pass under Section 7 of the Andaman and Nicobar Islands (Protection of Aboriginal Tribes) Regulation, 1956, and the rule made there under, authorizing me and my child/children aged below 15 years to enter and remain in the following reserved area in the Andaman and Nicobar Islands for the period commencing from Date…………………………… ending on date………………………… namely:- I. Detailed of reserved area:- …………………………………… II. Personal particulars 1. Name in full (in block Capitals) with aliases if any ………………………..... 2. Father’s/Husband’s Name …………………………………… 3. Date of birth, and present age: …………………… …………. 4. Place of birth, District and state in which situated: Vill………………Dist…… 5. Height in meters: ………………….. 6. Colour of hair: ………………….. 7. Colour of eyes: ………………….. 8. Distinguishing marks ………………….. 9. Present address in full: Vill……………………………Dist. ……………………… State………………………..Phone No……………….... 10. Permanent home address in full i.e. Village …………………………. Thana …………………………. District …………………………. State …………………………. 11. Actual date of arrival in A&N Islands……………………………………………… 12. Nationality ………………………………………………………………………………. 13. Religion …………………………………………………………………………………... 14. Vocation 2- 15. Whether held any office under the Govt. in the past and if so details thereof. 16. Particulars of places with period of residences Where the applicant was resided for more than One year at a time during the preceding 6 years: Residential address in full i.e. Name of the District village, Thana and District or Headquarters of the place Period house Number, Lane/Street/Road mentioned in the preceding and Town. col. From To (b) Of children if so be included in the pass Age and date of birth Sex Name in full (ii) Purpose of visit to the reserved area (give full details) : (iii) Details of employment, if any, proposed to be taken : Up in the reserved area and the name of the Employer, if any. (iv) Details of business, if any, to be conducted in the : Reserved area. (v) Number of pass previously held, if any : (vi) Details of any other kind of interest of the applicant : In the reserved area authorized under the Andaman And Nicobar Islands (Protection of Aboriginal Tribes, Regulation, 1956 or the rules framed there under (vii) Has the applicant ever been convicted of an offence : Under the A&N Islands (PAT) Regulation, 1956 or Any other law and if so the details of the offence and The punishment awarded? (viii) Whether in possession of a valid passport, If so the same may be enclosed in original. : (ix) Are you a foreign national? If so the visa And permit issued under the Foreigners (Restricted Areas) I agree to abide by the provisions of the Andaman & Nicobar Islands (Protection of aboriginal Tribes) Regulation, 1956 and the rules framed there under, and also by the terms and conditions of the pass if granted. Dated the ………….day of ………..2016 Signature of the Applicant CHARACTER & ANTECEDENTS CERTIFICATE FOR ISSUE OF TRIBAL PASS 1. Name …………………………………… 2. Father’s/Husband’s Name …………………………………… 3. Place and date of birth …………………………………… 4. Full Address: Vill……………………..Dist………………………State…. 5. Nationality …………………………………… 6. Purpose/Details of work to …………………………………… be done in the Tribal areas 7. Antecedents …………………………………… This is to certify that the character and antecedents of Shri./Smti…………………………………………………….have been verified by me. They are true and fair to the best of my knowledge and I will take the responsible for any offence if any done by the above mention person. He may be issued the tribal pass. Place: Date: Signature of Gazetted Officer FORM-D [See Rule 5(2) APPLICATION UNDER RULE 5(2) OF THE ANDAMAN AND NICOBAR ISLANDS (PROTECTION OF ABORIGINAL TRIBES) RULES, 1957 FOR THE RENEWAL OF PASS FOR ENTRY INTO THE RESERVED AREA To The Deputy Commissioner, South Andaman District Port Blair. 1. ………………………………………… S/o ………………………………………was granted Pass No. ……………… authorizing me to enter the following reserved area in the Andaman and Nicobar Islands and to remain therein from the Period commencing from ……………………… to and ending on……………………………, namely:- (DETAILS OF THE RESERVED AREA) 2. The aforesaid pass was renewed from time to time and rendered valid upto the …………………………………….. As the pass has since expired, I hereby apply for its renewal, on the same terms and conditions, for further period commencing from the …………………………… and ending on the………………………… . The required particulars are as follows:- a) No. of the expired / expiring pass ………………………………………… b) Date of grant of the expired /expiring………………………………………… c) Date of last renewal, if any, of The expired/ expiring pass ………………………………………… d) Names and addresses of the persons By or under whom the applicant was…………………………………………. Employed or engaged in the reserved Area during the last period e) Name and address of the person by or………………………………………… under whom the applicant was employed or engaged in the reserved area at the………………………………………… close of the last period. f) Name and address of the person by or………………………………………… Under whom the applicant is proposed to be employed or engaged during the………………………………………… Period for which the pass is to be renewed g) Has the applicant been convicted of any......…………………………………… Offence during the last year and, if so, The details of the offences and the ………………………………………… Punishment awarded? h) Present address of the applicant VILL…………………………………………… PS……………………………………………… DISTRICT ……………………………………. PHONE ………………………………………. 3. The expired/expiring pass is attached herewith. Dated: Signature of applicant N.B. --- The expired/expiring pass must accompany this application. .