COVID 19 Medical EPass Registration

Fill Your Details

e-Pass is being issued only for medical emergency. Submit valid supporting documents otherwise application will be rejected..

Destination State*

Destination District*

Select Pass Category*

Name*

Mobile No*

Current Address*

Id Type*

ID Number*

Attach Photo ID Proof*(Max photo size : 1 MB and File type jpg/jpeg )

Attach Application form,Valid Proof Like Doctor Prescription ,Doctor Referral Letter,etc*(Max file size : 1 MB and File type jpg/jpeg/pdf )

Road Map*(Like: Kalidas road to Ghantaghar)

Attach Vehicle Certificate(bike or car)*(Max file size : 1 MB and File type jpg/jpeg/pdf )

Vehicle Type*

Vehicle Number

Date of Travel*

Details*

Captcha*

I hereby declare that the above information is true to the best of my knowledge.
I shall comply with the provisions in law and be liable for criminal action for furnishing incorrect/ false information.
I will produce the relevant/ original documents, as and when desired by the concerned authorities.
I have no symptoms of corona