Aep Application Form 311b2n

BUREAU OF CIVIL AVIATION SECURITY AERODROME ENTRY PERMIT (AEP) APPLICATION FORM (AEPAF) Fill up the form in CAPITAL LETTERS. Copy of recent colored port size photographs needs to be ed in the space provided. All the columns must be filled up otherwise application is liable to be rejected. All dates are to be given in DD/MM/YY format. Any overwriting / correction must be countersigned with official seal.

Photograph (Auto-Generated)

1.

AEP Application Reference Id:

2.

Type of AEP requested (Check Appropriate Box) a. Single Airport Multi Airport-Single Region Airport Multi Airport-Multi Region Airport b. Temporary AEP

Permanent AEP Commercial AEP

Government Security Agencies Protocol Foreign National 3.

ISSUE CATEGORY FRESH: (If selected, Appointment Order to be ed for private OR Posting Order to be ed for govt. employees) RE-ISSUE:(If selected, please select following reasons) Designation Change:(If selected, Promotion order to be ed) Transfer:(If selected, Transfer order to be ed) Mutilation:Expiry: (If selected, copy of previous AEP to be ed) Loss: (If selected, copy of FIR/police complaint along with penalty challan and internal enquiry conducted to be ed) Any other reason: (If selected, mention reason and relevant document) _______________________________________________________

4.

Previous AEP Colour / Zones: -

Purple / A, D, T, S, P, B, F, Ft, C I & X

5.

Date as of (3)

6.

Applicant Name

SANTANU GHOSH

(Pls. mention type of ID-proof document)

AADHAAR CARD

31/12/2016

7.

Aadhaar Number if Available

3111-7297-7469

8.

Father’s Name: -

MANOJ KUMAR GHOSH

9.

Mother’s Name: -

REKHA GHOSH

10.

a. Permanent Address: KALYANPUR, BESIDE RAM THAKUR MANDIR, AGARPARA, NORTH 24 PARGANAS KOLKATA, PIN 700109, WEST BENGAL b. Present Address: E-1204, Shriram Suhaana, Opposite BMSIT College, Nagenahalli Gate, DDSuryavamshiLaLayoutLayoutDoddaballapur YELAHANKA, BANGALORE, PIN-560064, KARNATAKA

Type of Address Proof Attached

AADHAAR CARD

11.

Email Id: -

[email protected]

12.

Mobile No: -

9538882914

13.

Emergency Mobile No: -

9830407112

14.

Blood Group:-

A+

15.

Date of Birth:-

16th MAY 1969

16.

Date of Superannuation:-

17.

a. Organization Name:

BANGALORE INTERNATIONAL AIRPORT LIMITED

b. Designation:

ASSISTANT VICE PRESIDENT

c. Employee No.:

101550

d. Place of duty:

PROJECTS, TERMINAL & AIRSIDE

e. Nature of duty:

CONSTRUCTION

f. 18.

Office Address:

KEMPEGOWDA INTERNATIONAL AIRPORT LIMITED, PROJECT OFFICE, DEVANAHALLI, BIAL, BANGALORE – 560 300

Did you apply for AEP earlier? YES NO Whether issued or not? YES NO

19.

Details of existing AEP in possession: -

AEP No.: - HYD00028172; Valid Upto:- 31/12/2016; Place of Issue:- HYDRABAD 20.

Information relating to applicants other than Indian nationals. a. Nationality:-

__________________________________

b. port No:-

__________________________________

c. Place of Issue:-

__________________________________

d. Date of Issue:-

__________________________________

e. Expiry of port:-

__________________________________

f.

Type of Visa:-

g. Expiry of Visa:21.

__________________________________ __________________________________

AVSEC Awareness Training: Date of Training: - 25/11/2016; Location: BIAL, E&M – SISIL CONFERENCE ROOM Name: -

; Organization of the AVSEC Instructor: