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Filled by the applicant) 1. Name, Designation, office address and scale of pay (if selection grade or special grade indicate respective ordinary grade scale of Pay) 2. Date of Retirement 3. Name of Countries proposed to visit, and duration,(need not be filled up to obtained passport to seek employment abroad) 4. Purpose of visit 5. 6. Source of funds to meet the cost of the proposed foreign travel State whether any criminal prosecution is contemplated of pending against you and whethe.

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