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FORM-I

[See rule 5 and rule 6(provision) ]

 

Application for issue of permit for visit/residence in the island or for issue of fresh permit when original permit has been renewed three times

 

To

 

         _____________________________

 

         _____________________________

 

Sir,

         I, Shri/Smt/Kumari.______________________________ son/daughter/wife of (late*) Shri. ___________________________________________ hereby apply for a permit under the Laccadive, Minicoy and Amindivi Islands(Restrictions on Entry and Residence) Rules, 1967 authorising me (and the members of my family)* to enter and remain in _____________________________ island (s) of the Union Territory of the Laccadive, Minicoy and Amindivi Islands and in that connection furnish the following particulars:-

 

1.  Name in full (in black letters                         :

 

2.  Father’s name/Husband’s name (state whether   :

     alive, and if alive, present occupation and

     residence)

 

3.  Permanent address                                    :

 

4.  Address in the islands                                :

 

 

5.  Place of birth                                           :

6.  Date of birth                                           :

 

7.  Profession (with name of the employer, if any)  :

 

8.  If the applicant is not a citizen of India, state     :

     whether he is holder of a passport or permit and,

     if so, the following particulars of the passport or

     permit.

 

     (i)  Number and date of issue                        :

     (ii) Designation of the issuing authority and      :

          place of issue.

    

     (iii) Period up to which it is valid  :

 

9.      9)  Previous visits to and residence in the island          :

     if any

 

From                         To                          Islands visited or which         No.& date of permit

                                                                    Applicant resided

 

1.

 

2.

 

3.

 

10. Name and address of two persons in the           :

     mainland whom the applicant is well known.

 

11. Visible distinguishing marks of the applicant     :

 

12. Proposed period of stay in the island.             :

 

13. Purpose of the visit to the islands and details     :

     of interest, if any in the islands.

 

14. Particulars of wife and children below 18 years  :

     of age, if any who will be accompanying the

     applicant (Attach three copies of recent passport

     size photographs of self and all members of party.

     Pardanaship of Gosha Women need not furnish

     Photograph)

 

15. Whether any previous application for permit:

     was rejected (give details)

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         I hereby declare that the information furnished above is correct and true to the best of my knowledge and belief.

 

 

                                                          Signature/L.H.T. impression of the applicant

Place   :

 

Date   :

 

…………………………………….. Specimen signature or L.H.T. impression of

                                                          applicant and his wife which shall be detached

                                                          and affixed to the permit.

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  * ORDERS OF THE COMPETENT AUTHORITY IF THE APPLICATION IS REJECTED

 

The above application is rejected for the following reasons:-

 

1.

 

2.

 

3.

 

etc.

 

Place:

 

Date:

 

                                                                    Signature

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·            Delete not applicable

·             N.B. All persons above 18 years of age except ladies accompanying their husbands shall make separate applications.

 

 

          PENALTY:

 

                Who ever contravenes any provision these rules shall be punishable with imprisonment which may extent to one month, or with fine which may extent to one thousand rupees or with both.

 

 

 

DECLARATION

 

 

 

            I declare that Shri/Smt……………………………………………………………….. S/O ………………………………………………………………. Who is my …………….. is accompanying me to island and will be staying with me at the islands that I hold myself responsible for all his commissions and omissions during his/her stay in the island.  That I undertake to send him/her back to mainland immediately the Administration direct me to do so with or without giving reasons and that I shall report to the Registration Officer concerned as soon as he/she leaves the island.

 

 

 

                                                                        Signature:

 

Place:                                                               Name      :

 

Date:                                                                Address   :

 

 

FORM – II

(See rule 6 )

APPLICATION FOR RENEWAL OR ENDORSEMENT OF PERMIT

 

To

                        ………………………………………..

                        ………………………………………..

                        ………………………………………..

 

Sir,

 

                        I, Shri/Smt/Kumari* ……………………………………………………… son/daughter/wife* of (Late*) Shri……………………………………………………… holder of the enclosed permit No. …………………….. dated ………………………. Issued under the Lakshadweep islands ( Restrictions on Entry and Residence) Rules, 1967, do hereby request that the said permit may kindly be renewed up to …………………… endorsed for …………………………………………………………………………… island(s)* for the following reason:-

 

1.

2.

3.

etc.

 

Place:

 

Date:                                                                Signature/L.H.T. impression of applicant.

 

 

( FOR OFFICIAL USE ONLY )

* ORDERS OF COMPETENT AUTHORITY IF APPLICATION FOR RENEWAL/ENDORSEMENT IS REJECTED

 

The above application is rejected for the following reasons:-

 

1.

2.

3

 

The permit is returned herewith.

 

 

Place:

Date:                                                                                            Signature.