1, AEPApplicationReference Id: aa a 3. 4. ” BI N GOVERNMENT OF INDIA }UREAU OF CIVIL AVIATION SECURITY. AERODROME ENTRY PERMIT (AEP) APPLICATION FORM (AEPAR) . xp perwANexr age | UADEEET aorta (Size- 3.5 cm x 4.5 cm) (Auto- generated) AEP requested (Check [\] Appropriate Box) Permanent [Temporary (1 to 30 Days) a. Type oD i 1Day = 1-7Days 1 3 Months 7 6 Months Category « Zones 4. Airport Onn ao oan e Terminal = Issue eategory Operations [Government Security Agencies Protocol 1D inte Foreign National [ Toolof Trade a©D pt of 5 ®@ oe BOF fC R GG IE AnyOterZor Single Airport 1 All Airpors All Domestic Airports [D AllIsternationsl Airports All UptoSAiports(_,__,_,__._) [Airports (With in Region) Ccargo Domestic rt D General Aviation DiIntemational oe Teminal 0-1 0-2 03 CD Fresh 1 Relssue (fselected [\] appropriate box, please upload( 0) relevant document) a. Fresh e Appointinent/ Posting order 0 b Re-Issue _______.——-Designation Change —Promotion Order—g—[]—Fransfer—Transfer Order [ Mutilated’ Damaged Copy of the Document Q OG Expired Previous AEP Loss FIR/Police complaint/ penalty challan and internal enquiry conducted 1D Any Other Reason Relevant doc. 9) a, Dets icant- Male _[7_Femal Nam Aadheet No.* Father'sName Motter’s Name Date of Birth cmeem Blood Group a Gender Nest of kin (Mobile) Type of ID Poet », Details of existing AEP Ta Possession: AEP No. Valid Up To Placeoflssue [ Residential Address: at Se | a. Permanent Address, b. Present Address House No./Street/Rosd House No/Streev Road District District State PinCode State Pin Code ‘Type of Address Proof AttachedEmployee No. Nature ofDuty Office Adéress Other Details: 1 (@)lsanycasepending against you with the police or court? (8) yes, Fumish fll detlls one separate sheet of pape. %, Il, (a) Wereyoueverarrested? (b) tyes, Fumish full cetails TIL (@) Wereyou punished departmentally? (8) Ityes Furnish fell details: 8, Have your AEP Application ever been rejected? Yes C1 Nol Whether Issued or Now? Tl Yes No QpreviousaEP OA 6 DU OT Zones cB DOD F g Rk 10, Information related to aj licants other than Indian Nationals Designation Place of Duty Date of Retirement [— vs O ww O vy O wO Ys O MO o 8s go M cP C&O TAsyOtherZone[ Passport N Place of Isue Date offssve eons Expiry of Pessport Passport a Type of Visa Expiry of Visa Jopancryy Vise 0 Expiny of FATA Goran Expy of Contac opsnen 11, AVSEC Awareness Training: a, Security Staff Dat of Traisin Location : oxen 1 inti To Refieiter Name & Organization ofthe AVESEC Instructor b. Non-Security Staff Date of Training mer Ss worse Location Name & Organization of the AVESEC Instructor “Applicant Signature: Place: Date:- Disclaimer: “Any Govt. ised with 12-digit unique number whieh is same through Signature of Authorized Signatory with seal. Name: Designation out the lifetime should be required for AEP registration, The applicant's 12-digit unique number shall not be used for any authentieation and Bio-metric details of the applicant shall not be retained permanently in the Database/Server. Muse