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Shri Amarnathji Yatra 2015 YATRA PERMIT APPLICATION FORM Please fill in block letters FULL NAME Applicant s photograph which should be signed across this GENDER Tick as applicable Male Female Age Yrs Blood Group NAME OF SPOUSE / FATHER ADDRESS STATE PIN E-Mail if any CONTACT / PHONE NO MOBILE 91 Telephone with STD Code / Mobile number of the person to be contacted in case of any emergency To The Chief Executive Officer Jammu / Srinagar. Sir 1. I may please be issued a Permit for embarking on Shri Amarnathji Yatra. I shall start the Yatra from the Baltal / Chandanwari route on /2015. Shri Amarnathji Yatra 2015 YATRA PERMIT APPLICATION FORM Please fill in block letters FULL NAME Applicant s photograph which should be signed across this GENDER Tick as applicable Male Female Age Yrs Blood Group NAME OF SPOUSE / FATHER ADDRESS STATE PIN E-Mail if any CONTACT / PHONE NO MOBILE 91 Telephone with STD Code / Mobile number of the person to be contacted in case of any emergency To The Chief Executive Officer Jammu / Srinagar. Sir 1. I may please be issued a Permit for embarking on Shri Amarnathji Yatra* I shall start the Yatra from the Baltal / Chandanwari route on /2015. 2. I certify that I have been declared physically fit by the Authorised Doctor / Medical Institute to undertake the journey to the Shri Amarnathji Holy Cave during JulyAugust 2015. The prescribed Medical Certificate is attached* 3. I son / daughter / wife of nominate Shri / Smt. age relationship to be paid the Insurance proceeds upon payment of the Insurance claim in case of my death due to accident. 4. I solemnly undertake to abide by the Dos Don ts / other directions issued by the Shrine Board / District Administration* Full Signature of Applicant No one below the age of 13 years or above the age of 75 years and no lady with more than six weeks pregnancy will be registered for the Yatra* Please fill whichever is applicable. A duly registered Yatri with a valid Yatra Permit issued by the Shri Amarnathji Shrine Board duly endorsed by the issuing institution will be entitled to an Insurance cover of One Lac Rupee from the Insurance Company in the event of his/her death due to any accident inside the State of J K while undertaking the Shri Amarnathji Yatra* The sum assured will be paid through the Shrine Board after the nominee of the deceased Yatri completes the due formalities. For Office Use Business UnitBranch Bank Yatra Registration Slip No* Date Route issued Seal and Signature of Registration Officer Initials of Official. Sir 1. I may please be issued a Permit for embarking on Shri Amarnathji Yatra* I shall start the Yatra from the Baltal / Chandanwari route on /2015. 2. I certify that I have been declared physically fit by the Authorised Doctor / Medical Institute to undertake the journey to the Shri Amarnathji Holy Cave during JulyAugust 2015. 2. I certify that I have been declared physically fit by the Authorised Doctor / Medical Institute to undertake the journey to the Shri Amarnathji Holy Cave during JulyAugust 2015. The prescribed Medical Certificate is attached* 3. I son / daughter / wife of nominate Shri / Smt. age relationship to be paid the Insurance proceeds upon payment of the Insurance claim in case of my death due to accident.

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