MORMUGAO PORT TRUST PASS SECTION

(APPLICATION FORM FOR TEMPORARY PERMITS INDIVIDUALS / VEHICLES)

Individual Vehicle
(Which ever is applicable)

A. Firm Code* : Payment Token No * :

B. Firm Name* :
C. Recommended Direct User Company Code :
D. Direct User Company Name :

E. Permits Required* : From To No. of Days

F. No. of Persons : G. No. of Vehicles Total Amount
H. Type of Activity*:
(Please select maximum of two activities)
Clearance of Import cargo / container Admittance of export cargo / container
Stevedoring Work Agency Work Contract Work Ship Chandling
Ship Repairs Sampling, Testing & Survey Attending Trashipper
Attending Barge(s) Attending Launches CE / CME Contract
Private Terminal Operations Lease Holder Work Central / State govt work
Please specify others if any _____________
I. Proof / Details of work (to be enclosed) * : Yes
J . Details of Persons* :
S.No
Name Designation Father's Name DOB Area of Access Antecedent
(Appl No.)




K. Details of Vehicles *:
S.No
Registration. No. Type of Vehicle Area of Access










I/We hereby certify that the above permits are required only for our official
purpose and also I/We hold responsibility for identification and all the activities of the
above mentioned persons / vehicles inside the Port.

(NOTE: ' * ' Mandatory fields)





Authorized Signatory of the firm with seal





FOR OFFICE USE ONLY

The documents have been verified & recommended / rejected for issue of permits.



For Bartronics Incharge / HEP Clerk (O/D)
For ATM (AC)



Permanent HEP Issued / Not Issued.
Unique Code: _____________


Incharge / HEP For Bartronics
For ATM (AC)