ServicePlus- Issuance of COVID-19 ePass For Odisha

GOVT OF ODISHA

APPLICATION FORM FOR ISSUANCE OF e-PASS

Following Documents Required for this Service

1. Identity Proof Of the Applicant(Voter ID ,Driving License,PAN Card,Aadhaar Card)

2. Driving License Of Driver

3. Id Proof Of All The Members (In a single File only if number of persons is more than 1)

4. Relevant Supporting Document(In case of Medical matter, recommendation from Medical officer of a Govt. Institution (SDMO / CMO & PHO / Medical Suptd) is needed / In case of funeral matter, the death certificate of the deceased, certificate from Head of the Office regarding genuineness of the Claim etc is needed)

Applying For

Requesting e-Pass From *

Collector & District Magistrate

Sub-Collector

Tahasildar

Applicant Details

Name *

Gender *

E-Mail

Mobile Number *

Identity Proof Type *

Identity Card No *

Address Details

PRESENT ADDRESS (Travelling From)

District *

Tehsil *

Address (Lane No, Street No,House No, Locality etc) *

DESTINATION ADDRESS (Travelling To)

State *

District *

Tehsil *

Village *

Village not in List

Click Here

Village (Name) *

District *

Tehsil *

Village *

Address (Lane No, Street No,House No, Locality etc) *

Address Details

PRESENT ADDRESS (Travelling From)

District *

Sub Division *

Tehsil *

Address (Lane No, Street No,House No, Locality etc) *

DESTINATION ADDRESS (Travelling To)

State *

District *

Tehsil *

Village *

Village not in List

Click here

Village(Name) *

District *

Tehsil *

Village *

Address (Lane No, Street No,House No, Locality etc) *

Address Details

PRESENT ADDRESS (Travelling From)

District *

Tehsil *

Address (Lane No, Street No,House No, Locality etc) *

DESTINATION ADDRESS (Travelling To)

State *

District *

Tehsil *

Village *

Village not in List

Click here

Village(Name) *

District *

Tehsil *

Village *

Address (Lane No, Street No,House No, Locality etc) *

Travel and Driver Details

Type of Travel *

Reason for Travel *

Date of Travel *

Estimated Date of Arrival on Destination Address *

Date of Return Travel *

Estimated Date of Arrival on Return Address *

Travel Arrangements *

Type Of Vehicle *

Vehicle Registration No *

Brief Details of Public Transport you are adopting to travel *

Traveling as *

Seating Capacity of the bus *

Name of Vehicle Owner *

Vehicle Owner Mobile No *

Driver Name *

Driving License No. Of Driver *

Driver Mobile No *

Passenger Details

Details of all Passengers

Name *

Gender *

Mobile Number *

Identity Proof Type *

Identity Card No. *

State (Native) *

District (Native) *

Name *

Gender *

Mobile Number *

Identity Proof Type *

Identity Card No. *

State (Native) *

District (Native) *

Declaration

I agree to undergo institutional quarantine for Self along with Driver and all Co-pass holders and also agree to abide all other terms and conditions.

I Agree *

Additional Details

Applied to the Office*

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