For Indian (Fields marked with * are mandatory)

Enter your Journey Date: …………………………………………………………………..

Part A
Passport Details:*
Nationality: Indian Diplomatic Official Personal
All details should be as per Passport Details:-
Passport Number:* Date of Issue:* Date of Expiry:* Place of Issue:*
………………………………………… ………………………………………… ………………………………………… …………………………………………
Given Name:* Sur Name: Father's Name:*
…………………………………………………………. ……………………………………………………….. …………………………………………………………
Gender:* Male Female Others
Date of Birth:* Place of Birth (City):* Place of Birth (Country):*
……………………………………………………….. ……………………………………………………….. ………………………………………………………..
Address Details As in Passport:-
Address Line-1:* Address Line-2:*
………………………………………………………………………………………. …………………………………………………………………………………………
Country:* State:* District:* Pin Code:*
…………………………………………. …………………………………………. …………………………………………. ………………………………………….

Part B
Whether Resident in India: * Aadhar Number: Pan Number:
Yes No ……………………………………………………….. …………………………………………………………
Present Address Details in India:*
Address Line-1:* Address Line-2:*
………………………………………………………………………………………… …………………………………………………………………………………………
Country:* State:* District:* Pin Code:*
………………………………………… ………………………………………… ………………………………………… ………………………………………….
Police Station Name:* Blood Group:* Email ID:
………………………………………………………… ………………………………………………………… …………………………………………………………
Landline Number(Home): Landline Number(Office): Mobile Number(Primary):* Mobile Number(Alternate):
………………………………………… ………………………………………… ………………………………………… …………………………………………
Marital Status:* If Yes, Spouse Name:* Spouse Nationality:* Spouse Passport Number:*
Yes No ………………………………………… ………………………………………… …………………………………………
Profession:* Self Employed Salaried
Designation:* Name of Employer:* Office Address:*
If Salaried, Details:
………………………………………… ………………………………………… …………………………………………
Relatives in Pakistan:* Relative Name:* Mobile No.: Relative Address:*
Yes No ………………………………………… ………………………………………… …………………………………………
Have you visited Pakistan before:* First Visit Date: Second Visit Date: Place & Purpose of Visit:*
Yes No ………………………..……………… ………………………..……………… ………………………..………………
 Part C
Has any criminal case been registered against you or any arrest warrant against you pending before a court of India*
Yes No
FIR Number:* Section of Law:* Police Station:* District:* Present Status:*
If Yes Details:
…………………………. …………………………. …………………………. …………………………. ………………………….
Have you ever been convicted by a court for any criminal offence and sentenced to imprisonment *
Yes No
FIR Number:* Section of Law:* Quantum of Punishment Status: Present Status:*
If Yes Details:
…………………………. …………………………. ………………………………………………………… ………………………….
Police Station:* Police Station District:*
…………………………………………………………………………………….. ……………………………………………………………………………………….
Whether you are presently bound by security proceeding under CrPC or any other similar restriction under any other
local law. If so, details of the same* Yes No
Whether you are/were in past, a member of any organization proscribed/banned under law, in India*
Yes No

Part D
Travelling as group?* Yes
Number of Members:* Name of Member:*
If Yes Details:
………………………………… ……………………………………………………..
Name of Member:*
……………………………………………………..
Name of Member:*
……………………………………………………..
Name of Member:*
……………………………………………………..
No
Passport No. of Member:*
…………………………………………………………..
Passport No. of Member:*
…………………………………………………………..
Passport No. of Member:*
…………………………………………………………..
Passport No. of Member:*
…………………………………………………………..

UNDERTAKING:

a. I undertake that I shall not indulge in any activity during my visit to Sri Gurudwara Kartarpur Sahib through the
Kartarpur Sahib Corridor which is detrimental to the sovereignty, integrity and security of India or is in violation of Laws
of India.
b. I agree to strictly abide by the rules and regulation made by the Government of India to manage and regulate the
smooth operations of the Sri Kartarpur Sahib Corridor.
c. I undertake that I shall not use the Kartarpur Sahib Corridor for any other purpose other than pilgrimage to Sri
Gurudwara Kartarpur Sahib.