Indian - MHA

1 For Indian (Fields marked with * are mandatory) Enter your Journey Date: .. Part A Nationality: Indian Passport Details:* Diplomatic Official Personal All details should be as per Passport Details:- Passport Number:* .. Date of Issue:* .. Date of Expiry:* .. Place of Issue:* .. Given Name:* .. Sur Name: .. Father's Name:* .. Gender:* Male Female Others Date of Birth:* .. Place of Birth (City):* .. Place of Birth (Country):* .. Address Details As in Passport:- Address Line-1:* .. Address Line-2:* .. Country:* .. State:* .. District:* .. Pin Code:* .. Part B Whether Resident in India: * Yes No Aadhar Number: .. Pan Number: .. Present Address Details in India:* Address Line-1:* .. Address Line-2:* .. Country:*.

2 State:* .. District:* .. Pin Code:* .. Police Station Name:* .. Blood Group:* .. Email ID: .. Landline Number(Home): .. Landline Number(Office): .. Mobile Number(Primary):* .. Mobile Number(Alternate): .. Marital Status:* Yes No If Yes, Spouse Name:* .. Spouse Nationality:* .. Spouse Passport Number:* .. Profession:* Self Employed Salaried If Salaried, Details: Designation:* .. Name of Employer:* .. Office Address:* .. Relatives in Pakistan:* Yes No Relative Name:* .. Mobile No.: .. Relative Address:* .. Have you visited Pakistan before:* Yes No First Visit Date: .. Second Visit Date: .. Place & Purpose of Visit:* .. UNDERTAKING: a. I undertake that I shall not indulge in any activity during my visit to Sri Gurudwara Kartarpur Sahib through the Kartarpur Sahib Corridor which is detrimental to the sovereignty, integrity and security of India or is in violation of Laws of India.

3 B. I agree to strictly abide by the rules and regulation made by the Government of India to manage and regulate the smooth operations of the Sri Kartarpur Sahib Corridor. c. I undertake that I shall not use the Kartarpur Sahib Corridor for any other purpose other than pilgrimage to Sri Gurudwara Kartarpur Sahib. Part C Has any criminal case been registered against you or any arrest warrant against you pending before a court of India* Yes No If Yes Details: FIR Number:* .. Section of Law:* .. Police Station:* .. District:* .. Present Status:* .. Have you ever been convicted by a court for any criminal offence and sentenced to imprisonment * Yes No If Yes Details: FIR Number:*.

4 Section of Law:* .. Quantum of Punishment Status: .. Present Status:* .. Police Station:* .. Police Station District:* .. Whether you are presently bound by security proceeding under CrPC or any other similar restriction under any other local law. If so, details of the same* Yes No Whether you are/were in past, a member of any organization proscribed/banned under law, in India* Yes No