GOVERNMENT OF TAMILNADU

APPLICATION FORM FOR VEHICLE e-PASS FOR ESSENTIAL SERVICES

Applicant Details

Full Name of the Applicant *

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Mobile Number *

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Date of Birth *

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E-Mail

Type of Applicant *

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Address of the Applicant

House No/Bylane No/Street Name *

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Landmark/Locality/Ward No *

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District *

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Tehsil *

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Police Station *

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Post Office *

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Pin Code *

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Pass Details

Vehicle Registration No *

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Vehicle Type *

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Journey Type *

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Purpose of Travel *

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Pass From Date *

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Pass To Date *

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From (Source of Route) *

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To (Destination of Route) *

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Remarks (Reason justifying travel) *

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Members Travelling

Name *

Age *

Mobile Number *

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Declaration

All the information provided in the form is correct to the best of my knowledge. If any information furnished here 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.

I Agree *

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