Application form for e-pass for delivery of essential commodities

Service details

Type of service *

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Applicant Details

Full Name of the Applicant *

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Father's Name *

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Age *

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Mobile Number *

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E-Mail

Address of the Applicant

House No/Street/Locality *

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Village/Town/City *

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Gram Panchayat/Ward No *

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Police Station *

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Block

District *

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Post Office *

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Pincode *

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Pass Details

Items to sell *

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Fruits

Dry fruits

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Type of seller *

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Place of procurement of items *

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Means of transport from place of procurement *

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Vehicle Number *

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Means of carrying the food items door to door *

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Vehicle Number *

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Pass From Date *

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Pass To Date *

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Area of sale

Locality *

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Gram Panchayat/Ward No *

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Village/Town *

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Apply to office

Select office *

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Declaration

I Agree *

That the information furnished in the form is correct to the best of my knowledge. Legal action may be initiated against me if any information is found false at any given point of time.

I shall abide by all the rules and regulations of Government. I shall abide by all the advisories given by the Department of Health and Family Welfare, and district administration in respect of COVID-19.

Moreover, I shall sell the fruits or Dry fruits within the approved rate or below maintaining all existing rules and regulations in the permitted jurisdiction.

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