HAJ APPLICATION FORM FOR HAJ - 1441 (H) - 2020 (CE ...PHOTOGRAPH Paste your recent passport size...
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PHOTOGRAPH Paste your recent passport size colour photograph having WHITE BACKGROUND (Size:3.5cm x 3.5 cm) HAJ COMMITTEE OF INDIA HAJ APPLICATION FORM FOR HAJ - 1441 (H) - 2020 (CE) 4. NAME OF COVER HEAD (Male adult only) 1. CATEGORY: (I). If Reserved (Age 70+) give details of companions: (a) Give Name of Embarkation Point you want to travel from (b) Fare of Embarkation Point [see Haj-2019 Airfare on 18 &19] Signature (Tick (√) as appropriate) 3. ACCOMMODATION CATEGORY OPTED (Tick (√) desired) Gender: Male Female Date of Birth Place of Birth D D Y Y M M Y Y 5. APPLICANT’S DETAILS (As per International Passport) Passport Number Place of Issue Date of Issue Date of Expiry D D D D Y Y Y Y M M M M Y Y Mother's Name Spouse’s Name Father's Name Y Y Given Name Surname 8. NAME OF MEHRAM WITH RELATION (for female pilgrims only) Name Relationship Passport Number Signature / Thumb Impression of Mehram 7. DETAILS OF NOMINEE OF APPLICANT: Name Relationship Address Signature / Thumb Impression of Nominee Telephone / Mobile No. District Pin Code State Father’s / Husband’s Name 6. PRESENT RESIDENTIAL ADDRESS: Mobile Number Email ID : District State Pin Code 0 Qualification: Marital Status: Married Unmarried Occupation: PAN No.: Aadhaar Card/Enrolement No.: Blood Group: 13. Are you NRI : Yes No 14. Opting JOHFA Meeqat (only for Shia pilgrims): Yes No 10. COVER HEAD’S BANK ACCOUNT DETAILS : Bank Name Branch Name Branch Code Account No. IFSC Code 12. Language opted for Haj Guide (Tick (√) any one): English Hindi Urdu Tamil Telugu Kannada Gujarati Malayalam Assamese Bengali Manipuri I certify that the information furnished above is true and correct. SIGNATURE / THUMB IMPRESSION OF THE APPLICANT Yes No 11. Do you want to perform ADAHI (Qurbani) through IDB : (II) General : (I) Reserved (Age 70+) Ladies without Mehram c) I agree to opt for (a) and pay Airfare approximately as (b) ) Name Relationship Category NCNTZ Category Azizia 2. Embarkation: (can not be change) (Please read information on Page No. 18 &19 ) Yes No Yes No 9. Are you (a) permissible Repeater Mehram : (b)Companion of Age 70+ applicant : SPECIMEN
Transcript of HAJ APPLICATION FORM FOR HAJ - 1441 (H) - 2020 (CE ...PHOTOGRAPH Paste your recent passport size...
PHOTOGRAPHPaste your recent
passport size colour photograph
havingWHITE
BACKGROUND(Size:3.5cm x 3.5 cm)
HAJ COMMITTEE OF INDIAHAJ APPLICATION FORM FOR HAJ - 1441 (H) - 2020 (CE)
4. NAME OF COVER HEAD (Male adult only)
1. CATEGORY:
(I). If Reserved (Age 70+) give details of companions:
(a) Give Name of Embarkation Point you want to travel from
(b) Fare of Embarkation Point [see Haj-2019 Airfare on 18 &19]
Signature
(Tick (√) as appropriate)
3. ACCOMMODATION CATEGORY OPTED(Tick (√) desired)
Gender: Male Female
Date of Birth Place of BirthDD Y YM M Y Y
5. APPLICANT’S DETAILS (As per International Passport)
Passport Number Place of Issue
Date of Issue Date of Expiry DD DD YY YY MM MM YY
Mother's Name
Spouse’s Name
Father's Name
YY
Given Name
Surname
8. NAME OF MEHRAM WITH RELATION (for female pilgrims only)
Name
Relationship
Passport Number Signature / Thumb Impression of Mehram
7. DETAILS OF NOMINEE OF APPLICANT: Name
Relationship
Address
Signature / Thumb Impression of Nominee
Telephone / Mobile No.
District
Pin Code
State
Father’s / Husband’s Name
6. PRESENT RESIDENTIAL ADDRESS:
Mobile Number Email ID :
District State
Pin Code
0
Qualification: Marital Status: Married Unmarried Occupation:
PAN No.:Aadhaar Card/Enrolement No.:
Blood Group:
13. Are you NRI : Yes No 14. Opting JOHFA Meeqat (only for Shia pilgrims): Yes No
10. COVER HEAD’S BANK ACCOUNT DETAILS : Bank Name Branch Name Branch Code Account No. IFSC Code
12. Language opted for Haj Guide (Tick (√) any one): English Hindi Urdu Tamil TeluguKannada Gujarati MalayalamAssameseBengali Manipuri
I certify that the information furnished above is true and correct.
SIGNATURE / THUMB IMPRESSION OF THE APPLICANT
Yes No 11. Do you want to perform ADAHI (Qurbani) through IDB :
(II) General : (I) Reserved (Age 70+) Ladies without Mehram
c) I agree to opt for (a) and pay Airfare approximately as (b) )
Name
Relationship
Category NCNTZ
Category Azizia
2. Embarkation: (can not be change) (Please read information on Page No. 18 &19 )
Yes No Yes No 9. Are you (a) permissible Repeater Mehram : (b)Companion of Age 70+ applicant :
SP
EC
IME
N
