AV.22025/02/2014-PMR Government of India, Directorate General of Civil Aviation Opposite Safdarjung Airport, New Delhi
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1 AV.22025/02/2014-PMR Government of India, Directorate General of Civil Aviation Opposite Safdarjung Airport, New Delhi CIRCULAR No. Med 1/2015 Dated: Subject: Amendment of Personal Details in the records held at Medical Cell, DGCA. At times, individuals are approaching medical cell, DGCA for change of Name/Date of Birth/Place of Birth/Address due to discrepancy in various records held by them viz. school certificates, passport etc. The following documents (attested copies) should be submitted to DGCA along with updated and correct personal details with duly filled in prescribed application form (Annexure 2): S. No Amendment Documents required in support ( Any one of the following ) 1 Name (a) Affidavit signed and attested in presence of a Judicial Magistrate or Executive Magistrate/Notary Public or Consular Officer in an Indian Mission abroad. Additionally, the applicant should insert advertisements in two reputed newspapers (one local newspaper of the area in which he/she is residing and the other in newspaper of the area of permanent address) and submit original newspaper at the time of applying (b) (c) (d) (e) Promulgation of a change of name in the Gazette of India/State Govt. /Union Territory. Class X Board Certificate Passport Marriage registration Certificate (In case of post-marriage changes in name ) 2 Date of Birth (a) Birth Certificate issued by a Municipal Authority or district office of the Registrar of Births & Deaths. The Birth Certificate should contain the name of child, name of father and mother, date of birth, place of birth, sex, registration number and date of registration. If the Birth Certificate doesn t contain the name of child, a declaration on plain paper signed by parents, is required to be submitted specifying the name of the child. (b) (c) Class X Board Certificate Passport Contd.2/
2 -2-3 Place of Birth (a) Birth Certificate 4 Address Change (a) Water/Electricity/Telephone Bill (b) Passport (c) UID/Aadhaar Card This supersedes earlier Public Notice dated 21 May Sd/- (Seema Gambhir) Wing Commander Jt Director Medical Services For Director General of Civil Aviation
3 Annexure 2 GOVERNMENT OF INDIA OFFICE OF DIRECTOR GENERAL OF CIVIL AVIATION OPPOSITE SAFDARJUNG AIRPORT, NEW DELHI APPLICATION FORM FOR AMENDENT OF PERSONAL DETAILS IN THE RECORDS HELD AT MEDICAL CELL, DGCA 1. PMR file No.. 2. Name & Initials Self attested photo 3. Licence No. (if issued). 4. Correspondence Address.. 5. Contact No. & Id: 6. Justification for change in particulars 7. Details where amendment required (Strike whichever is not applicable) Name Date of Birth Place of Birth Address Change OLD* NEW* REMARKS * To be filled in capital letters P.T.O
4 Attachment: Tick ( ) the attached document:- (For Amendment in Name ) - Affidavit signed and attested in presence of a Judicial Magistrate or Executive Magistrate/Notary Public or Consular Officer in an Indian Mission abroad. Additionally, the applicant should insert advertisements in two reputed newspapers (one local newspaper of the area in which he/she is residing and the other in newspaper of the area of permanent address) and submit original newspaper at the time of applying - Promulgation of a change of name in the Gazette of India/State Govt./Union Territory. - Class X Board Certificate - Passport - Marriage registration Certificate (In case of post marriage changes in name ) (For Amendment in Date of Birth ) - Birth Certificate issued by a Municipal Authority or district office of the Registrar of Births & Deaths. The Birth Certificate should contain the name of child, name of father and mother, date of birth, place of birth, sex, registration number and date of registration. If the Birth Certificate doesn t contain the name of child, a declaration on plain paper signed by parents, is required to be submitted specifying the name of the child. - Class X Board Certificate - Passport (For Amendment in Place of Birth ) - Birth Certificate (For Amendment in Address ) - Water/Electricity/Telephone Bill - Passport - UID/Aadhaar Card Place: ( Signature of applicant ) Date : Remarks by Medical Cell
5 ए.व.22025/02/2014-प एमआर भ रत सरक र न गर वम नन मह नदश लय सफदरज ग एयरप ट क स मन, नई द ल दन क: प रप स. म ड 1/2015 वषय:- म डकल सल म ड ज स ए क रख ज न व ल व य तक अ भलख य र म स श धन समय-समय पर, य तय व र ध रत अपन व भ न अ भलख यथ क ल म णप, प सप ट आ द म प ए ज न व ल वस ग त क वजह स न म/ज म त थ/ज म क थ न/पत आ द बदलन क लए म डकल सल ड ज स ए म आत रहत ह व हत आवदन प (स ल नक ) म व धवत भर गए अ यतन और सह य तगत य र स हत न न ल खत द त वज (स य कत तय ) ड ज स ए म त त क ज ए :-.स. स श धन समथन म अप त द त वज( न न ल खत म स क ई एक) 1. न म (क) कस य य ध श य क यक र य य ध श/न टर प लक य वदश क कस भ रत य मशन क क स लर अ धक र क उप थ त म ह त रत और स य कत शपथप इसक अल व आवदक क कस द य त सम च र प (एक वह जसम वह रह ह /रह ह, क थ न य सम च र प म और द सर उनक थ य पत व ल क सम च र प म) क व पन म व पत करन च हए और आवदन भजत समय सम च र प क म ल त पश करन च हए (ख) भ रत/र य सरक र/स घ र य क र जप म न म बदलन क लए य पन (ग) 10व क क ब ड म णप (घ) प सप ट (ड.) वव ह प ज करण म णप ( वव ह पर त न म बदलन क दश म) 2. ज म क त र ख (क) कस नगरप लक धक र य ज म म य र ज र क जल क य लय व र ज र ज म म णप ज म म णप म ब च क न म, म त - पत क न म, ज म क त थ, ज म थ न, ल ग, र ज शन स य और र ज शन क त थ क ह न ज र ह ज म म णप म ब च क न म न ह न क दश म, ब च क न म उ ल खत करत ह ए ब च क म त - पत व र ह त रत घ षण प पश करन अप त ह (ख) 10व क क ब ड म णप (ग) प सप ट मश:...2/...
6 -2-3. ज म थ न (क) ज म म णप 4. पत म प रवतन (क) प न / बजल /टल फ न क बल (ख) (ग) प सप ट य आईड /आध र क ड यह दन क 21 मई, 2012 क प ववत स वज नक स चन क अ ध मण म ह (स म ग भ र) व ग कम डर स य त नदशक च क स सव ए क त मह नदशक न गर वम नन
7 अन ब ध 2 भ रत सरक र मह नदशक न गर वम नन क क य लय सफदरज ग एयरप ट क स मन, नई द ल य तगत य र 1. प एमआर फ इल स न म एव आ य र ल इसस स.(य द ज र ह )... वय स य कत फ ट 4. प च र क पत स पक स एव ईमल आईड : य र म प रवतन क क रण ववरण जह स श धन आव यक ह... (ज ल ग नह ह उस क ट ज ए) न म ज म क त थ ज म क थ न पत म प रवतन प र न * नय * ट पण * स फ अ र म भर ज न च हए क.प.उ.
8 स ल नक: स ल न द त वज म (' ') क नश न लग ए :- ('न म' म स श धन क लए) कस य य ध श य क यक र य य ध श/न टर प लक य वदश क कस भ रत य मशन क क स लर अ धक र क उप थ त म ह त रत और स य कत एकप य वलख/ शपथप इसक अल व आवदक क कस द य त सम च र प (एक वह जसम वह रह ह /रह ह, क थ न य सम च र प म और द सर उनक थ य पत व ल क सम च र प म) क व पन म व पत करन च हए और आवदन भजत समय सम च र प क म ल त पश करन च हए भ रत/र य सरक र/स घ र य क र जप म न म बदलन क लए य पन 10व क क ब ड म णप प सप ट वव ह प ज करण म णप ( वव ह पर त न म बदलन क दश म) ('ज म क त र ख' म स श धन क लए) कस नगरप लक धक र य ज म म य र ज र क जल क य लय व र ज र ज म म णप ज म म णप म ब च क न म, म त - पत क न म, ज म क त थ, ज म थ न, ल ग, र ज शन स य और र ज शन क त थ क ह न ज र ह ज म म णप म ब च क न म न ह न क दश म, ब च क न म उ ल खत करत ह ए ब च क म त - पत व र ह त रत घ षण प पश करन अप त ह 10व क क ब ड म णप प सप ट ('ज म थ न' म स श धन क लए) ज म म णप ('पत' म स श धन क लए) प न / बजल /टल फ न क बल प सप ट य आईड /आध र क ड थ न: (आवदक क ह त र) दन क: म डकल सल व र ट पण
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