N-Form (2013)

PAKISTAN ATOMIC ENERGY COMMISSION

Nomination Form for Official Visit / Study / Training, etc; Abroad

Title of proposed visit:

Dates: ________ ___ __ Place: ______________

1.	Name: _____________________________ (Male/Female) 2. S/o, D/o, W/o:

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3.	CNIC:… 14. Date / place of birth: .

5.	Designation: 6. Establishment: (Open/Classified)

7.	PIN: 8. Date of joining PAEC: 9. E-mail:

10.	Mailing Address:

11.	Ph. (Off):_________________ (Res):____ (Cell): 12. Fax:

13.	Passport No. (Official/Private) __ Date of Issue: _ Valid till:_ ___ _

14.	Field of Specialization:

15.	Experience:

16.	Present Assignment:

17. Relevance with proposed visit and usefulness:

18.	Keywords (4-5) describing your expertise:

19.	Total official foreign visits during PAEC Service: _____	(Complete list must be attached if not already provided)

20.	Details of the last three official foreign visits:

S. #	Title of visit	From -

To (dates)	Name of Institution/ Country(s) visited	Source of funding

21. Sponsor: (foreign/local/PAEC). If PAEC, details of expenditure (DA: US$ Air fare Rs. )

22.	Please provide details if the candidate is already nominated for any other foreign visit.

(Signature of Nominee with date)	(Signature & Seal of Head of Establishment)

* For Ph.D/Post-doc, field of proposed study, topic of Ph.D research, academic record from Matric onwards, amount of monthly scholarship/fellowship in US$, air-fare responsibility and expected start date/month, be provided on a separate page.

N-Form (2012 A)

DG IAT

2013-04-19

DIGIT