ServicePlus- Issuance of COVID -19 ePass

Applicant Details

Applicant's Name *

Gender *

Male

Female

Transgender

Mobile Number *

E-Mail

Identity Proof Type *

Identity Card Number *

Category of Travellers *

Student

Migrant Worker

Tourist

Pilgrim

Medical

Student

Applicant's Photograph *

Movement Type *

Travel within Andhra Pradesh

Travel outside Andhra Pradesh

Travel from Other state to Andhra Pradesh

section.12373

Flat No. /Street No. *

Area/ Locality *

Town/ Village/ Ward No.

State *

District

Postal / Zip Code *

Present address belongs to? *

Rural Area

Urban Area

Country *

section.12396

Flat No. / Street No. *

Area / Locality *

Town / Village

State *

District

Postal / Zip Code *

Destination address belongs to? *

Rural Area

Urban Area

Country *

Travel Details

Type of Travel *

Reason for Travel *

Date & Time of Travel *

Estimated Date of Arrival on Destination Address *

Date & Time of Return Travel *

Estimated Date of Arrival on Return Address *

Travel Arrangement *

Type of Vehicle *

Vehicle Number *

Traveling as *

Seating Capacity of the bus *

Brief Details of Public Transport you are adopting to travel *

Traveller(s) Details

Name *

Gender *

Mobile Number

Identity Proof

Id Proof Number

Is there any cold/cough or fever or related symptoms? *

Ever been quarantined by authorities in the recent past? *

Name *

Gender *

Mobile Number

Identity Proof

Id Proof Number

Is there any cold/cough or fever or related symptoms? *

Ever been quarantined by authorities in the recent past? *

Declaration

I hereby declare that above details are true and correct to the best of my knowledge. Also, I undertake that if anything is found untrue I shall be liable for punishment/penalty as per law.

I hereby declare that I have downloaded Aarogya Setu App and have done Self Assessment on Aarogya Setu App.

I Agree *

Additional Details

Applied to the Office*

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