| 1.I wish to obtain copy (ies)of the above which I require for the purpose of |
|
| | |
2.I shall not make use of or reproduce except for the specific purpose stated. |
| 3.I shall deposit with the Department of National Archives two copies
of publication in which the requested subject is included |
| Name ----------------------------------------- | Signature ------------------------------------ |
| Dept./organization :---------------------------- | Date ---------------------------------------- |
| Address --------------------------------------- ------------------------------------------------ |
Signature) ----------------------------------- on receipt) |
| Tel:(office) ------------------------------------ | Date ----------------------------------------- |
| (Residence) ----------------------------------- | |
| Signature of officer granting permission: ------------------------------------------------------------------ | |
| Prices |
For use by the Department |
||
| 1. A 4 size | ------------------------------------------ | Voucher No: | ----------------------------------------- |
| 2. A 3 size | ------------------------------------------ | No. of copies | ----------------------------------------- |
| 3. A 2 size | ------------------------------------------ | Amount | ----------------------------------------- |
| 4. A 1 size | ------------------------------------------ | Signature | ----------------------------------------- |
| 5. Others | ------------------------------------------ | Date | ----------------------------------------- |