( TO BE FILLED IN TRIPLICATE FOR
OUT POST )
Paste a P.P. Photograph here duly attested by
recommending Officer
1. Name of applicant/Sponsor :
with address
2. Name of person in whose behalf ILP is required :
( In Block Letter )
3. Fathers/Husbands name :
4. Relationship with the sponsor :
5. Permanent Address (Block Letter ) :
(a) Village :
(b) Post Office :
( c) Police Station :
(d) District/ State :
6. Nationality :
7. Age :
8. Religion :
9. Give the address of the place where the person/ :
labourer have stayed during the last two years.
10. No. of persons/labourers already with the applicant :
( Give ILP No. with issue date ).
11. Mention place where persons are proposed to be :
kept/ engaged
12. Purpose (Mention clearly ) :
13. In case of agricultural purpose mention cultivable :
areas owned by the applicant (Certificate to be
obtained from the village authority )
14. Have you attached past port size photograph :
in triplicate.
15. Period for which ILP is required :
16. Whether the Provisional ILP is issued is enclosed :
with the applicant or not ?
17. Have you attached PRC/RC ? :
Recommendation :-
The concerned person appeared before me on
.
I have verified the particulars furnished above
and the case is recommended & photographs are
duly attested by me.