Applicant Details

Applicant's Name *

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Gender *

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Male

Female

Transgender

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Mobile Number *

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E-Mail

Identity Proof Type *

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Identity Card Number (Last 4 Digits to be entered if providing Aadhaar) *

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Category of Travellers *

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Student

Essential Service Provider

Tourist

Pilgrim

Emergency / Medical

Marriage

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Applicant's Photograph *

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Movement Type *

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Travel within Andhra Pradesh

Travel outside Andhra Pradesh

Travel from Other state to Andhra Pradesh

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Present Address

Flat No. /Street No. *

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Area/ Locality *

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Town/ Village/ Ward No.

State *

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District

Postal / Zip Code *

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Present address belongs to? *

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Rural Area

Urban Area

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Country *

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Destination Address

Flat No. / Street No. *

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Area / Locality *

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Town / Village

State *

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District

Postal / Zip Code *

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Destination address belongs to? *

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Rural Area

Urban Area

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Country *

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Travel Details

Type of Travel *

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Reason for Travel *

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Date of Travel *

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Estimated Date of Arrival on Destination Address *

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Date of Return Travel *

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Estimated Date of Arrival on Return Address *

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Travel Arrangement *

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Type of Vehicle *

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Vehicle Number *

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Traveling as *

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Seating Capacity of the bus *

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Brief Details of Public Transport you are adopting to travel *

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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? *

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Mobile Number

Identity Proof

Id Proof Number

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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 *

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