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MABPL / WFSBPL - CARGO COMPLEX

KEMPEGOWDA INTERNATIONAL AIRPORT BENGALURU
APPLICATION FOR ISSUE OF COMMON ENTRY PASS

PASTE LATEST
PASSPORT
1. Fresh Issue Re-Issue (Please tick (✔) the appropriate reasons)
SIZE
Fresh Appointment Designation Changed Transfer PHOTOGRAPH
Mutilation Validity Expiry Loss Any Other WITH WHITE
BACKGROUND
Any Other Specify: ……………………………………………………………

2. Name of Applicant: (Please fill up the form in BLOCK / CAPITAL letters)

3. Nationality DOB:
4. Designation
5. Identification Marks: ………………………………………………………………………………………….
6. Father’s Name

7. Present Address: (Address Proof to be enclosed)

House No. Street

Area / Locality
Police Station
District
State Pin code

8. Permanent Address: (Address proof to be enclosed)

House No. Street

Area / Locality
Police Station
District
State Pin code

Contact No. (Office) :

Mobile No. :

Email ID : ……………………………………………………

PLEASE SIGN INSIDE THE BOX

USING BLACK INK
Applicant Signature:
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9. Background check details: (Police Verification issued by SP/Commissioner & above or Passport)

Passport No Issued on

Police Verification No:

PVC Issued by .......................................................................Issued on:

10. Address proof & ID proof: (Attach any one of the following documents)

Aadhaar No.
Voter ID Card: Issued at: ……………………………………………..........
Driving License No. Issued at: ……………………………………
Ration Card No. Issued at: ……………………………………

11. Name of Company / Agency: ……………………………………………………………………………

Registered office address: ……………………………………………………………………………...
………………………………………………………………………………………………………………..
(Proof of Registration to be enclosed with application - Certificate of Incorporation/Certificate of
Registration / Udyam registration for MSME)

12. Pass Issue category (Tick ✔ the appropriate)

Customs House Agent Console Agent Airlines Bonded Trucking Any Other
Whether AEO Certified YES NO (Enclose copy of AEO certificate)
Any Other Specify: …………………………………………………………………………………………….

13. CHA’s No / IATA No & Validity

14. Area to be visited: (Tick ✔ the appropriate) Office Area Customs Examination Area Dock
Area International Domestic All Area Except Security Hold Area
15. Purpose: Tendering of Cargo Delivery of Cargo Regulatory Functionary Duties
Any Other Specify: ……………………………………………………………………………………………………
16. Details of Pass previously held:

(a) Pass Number Valid up to

(b) It is certified that I was not debarred by the issuing authority from issue of pass on ground of misconduct in
the past.
(c) I undertake to behave in an orderly manner and shall not do anything detrimental to the interest of MABPL /
WFSBPL cargo terminal.
(d) I certify that the particulars furnished by me above are correct, I also understand that suppression of
information or giving false information would make me liable to legal action as well as denial of entry pass.

Applicants Signature : ……………………

Name : ……………………………………
Date : ……………………………………
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17. This is to certified that:

a). Mr./Ms./Mrs.………………….………… has good moral character and there is nothing adverse
against him/her, and He / She has been working with our organization since ………………………
Issue of permit to him/her will not be hazard to the safety of Airport / Cargo Terminal.
b). I/We also undertake to return the pass, when not required or on acceptance of Resignation /
termination.
c). The applicant had not obtained any pass by MABPL / WFSBPL in the past or had Issued and
the same is surrendering herewith.
d). I/We undertake that the above-mentioned employee shall not indulge in any UNETHICAL
practice while dealing with MABPL / WFSBPL.
e). I/We undertake that the above-mentioned employee shall abide by various rules, regulations
and instructions enforced / issued from time to time by the MABPL / WFSBPL regarding handling
of Import/Export/Domestic Cargo, movement of persons and vehicles and / or any restrictions
thereto at the Cargo Terminal and Cargo terminal premises.
f). The above mentioned employee is authorized to take delivery of Cargo cleared under the
name of this Agency/Company and of which indemnity form is enclosed herewith.
g). The above-mentioned employee / official has been verified for good character and
antecedents By Police authorities (Attested Photocopy of the Police Verification or passport is
enclosed)
h). Further we also undertake the responsibility of paying recovery of any damage / abuse
caused to MABPL / WFSBPL property / personnel, if any.
i). I hereby undertake to surrender the pass to your pass office on resignation / Termination /
Transfer or Expiry of validity.
j). In case the pass is lost /Stolen, I / We will immediately inform to pass office along with a copy
of Police complaint receipt / FIR.

18. To be certified by Authorized Signatory of the sponsoring agency / organization.

Date:____/____/_____ Signature: ___________________________

Name: ______________________________

Official seal of the organization: Designation: _________________________

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Note:
1. Possession of the entry Pass by a person other than the named in the entry pass shall render him
liable to prosecution for impersonation.
2. The MABPL / WFSBPL reserve the right to cancel the Entry Pass without assigning any reason
thereof.
3. Notwithstanding the above, MABPL / WFSBPL reserves the right to restrict the issue pass for any
other area requested by the applicant. In case, any of the columns are not filled/are wrongly filled, the
Application may be summarily rejected.
4. All the correspondence regarding MABPL / WFSBPL Common Entry Pass shall be addressed to

MABPL: WFSBPL:

The VP – Safety & Security, The Head of HSSE,

Menzies Aviation (Bengaluru) Pvt Ltd. WFS Bengaluru Pvt Ltd.
Cargo Terminal -1 Plot No. C04L, Cargo Terminal -2
Kempegowda International Airport, Kempegowda International Airport,
Bangalore -560300 Bangalore -560300

FOR OFFICE USE ONLY

Details of Pass issued:

Pass No: _________________________________________________________

Area / Color: ______________________ Valid up to ______________________

Details Entered by: __________________ Signature: _____________________

Checked and verified all details of Mr. / Ms. / Mrs. __________________________

of M/s_________________________________& issue of Pass is recommended:

Signature: Signature:

In-charge, Pass Section. In-charge, Pass Section.

MABPL WFSBPL

Approved / Not Approved

VP -Safety & Security Head of HSSE

MABPL WFSBPL

Note: Signature of both MABPL and WFSBPL representative are must for Issue of common pass.