ServicePlus- ePass for movement during COVID-19 restrictions

GOVERNMENT OF ASSAM

APPLICATION FORM FOR VEHICLE e-PASS FOR MOVEMENT DURING COVID 19 RESTRICTIONS

Applicant Details

Full Name of the Applicant *

Mobile Number *

Date of Birth *

E-Mail *

Type of Applicant *

Address of the Applicant

House No/Bylane No/Street Name *

Landmark/Locality/Ward No *

Village/Town/City *

District *

Police Station *

Post Office *

Block

Mobile No *

Pass Details

Vehicle/Boat Registration No *

Vehicle/Boat Type *

Journey Type *

Number of Persons Travelling *

Pass From Date *

Pass To Date *

Purpose of Travel *

Reason of Purpose *

Travel Category *

Source Address (Route) *

Destination Address (Route) *

Source District (Route) *

Destination District (Route) *

Remarks (Reason justifying travel) *

Mention Co-passengers Name (separated by comma) *

Mobile Number (Family member / HODs of workplace who is residing in Destination State,district of the person travelling)

Application Processing Location

Office of the Deputy Commissioner

Office of the Sub Divisional Officer

Application Processing Location

Select District to Submit Application *

Section

Select Sub-Division to Submit Application

Declaration

I Agree *

that all the information in the form is correct to the best of my knowledge. If any information furnished is found incorrect or falsely represented, I understand that legal action will be initiated against me.

I understand that the authorities decide on pass availability and validity and may accept or reject my application without giving any reason thereof. I accept that pass if issued is liable for cancellation as authority may please.

While travelling I/we will wear mask or face cover and maintain social distance.

Additional Details

Apply to the Office*

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