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SIZE OF THE LOCKER |
STATUS |
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LICENCEE 1 |
LICENCEE 2 |
LICENCEE 3 |
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SMALL |
3 PHOTOGRAPHS |
3 PHOTOGRAPHS |
3 PHOTOGRAPHS |
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MEDIUM | |||||||
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LARGE | |||||||
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X-LARGE | |||||||
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JUMBO | |||||||
| SPECIMEN SIGNATURE | ||||||||
| NAME(S) | ||||||||
| FATHER/HUSBAND'S NAME (WRITE "F" OR "H" in box) | ||||||||
| NIC NUMBER | ||||||||
| PASSPORT NUMBER | ||||||||
| DATE & PLACE OF ISSUE | ||||||||
| DATE OF BIRTH | ||||||||
| PROFESSION | ||||||||
| RESIDENTIL ADDRESS | ||||||||
| TELEPHONE/FAX # | ||||||||
| OFFICE ADDRESS | ||||||||
| TELEPHONE/FAX # | ||||||||
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OPERATING INSTRUCTIONS (IF ANY) |
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Required:-
1.
3 Passport size photographs 1X1.
2. One N.I.C copy
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