INTEGRAL COACH FACTORY, MADRAS-38
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APPLICATION FORM FOR COMPLEMENTARY PASS (WIDOWS)
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1. Name of the Applicant :

2. Permanent address :

3. Name of the ex-employee :
(deceased)

4. Family Identity card No. :
(i) Date of issue :

5. Pass applied for : Single/Return Journey

6. Class of pass : First/Second

7. Pass applied in favour of :

8. Destination :
From :
To :

9. Date required :

10. (i) Previous pass No. Dated is enclosed.

(ii) Shri. is authorised to take delivery of the pass on my behalf.

Signature of the widow