HAJ COMMITTEE OF INDIA

ONLINE HAJ APPLICATION FORM FOR HAJ – 1441 (H) – 2020 (C.E.)

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EMBARKATION POINT CHENNAI ADULT INFANT DOWNLOAD DATE

2 0 29-10-2019 08:43:36
CATEGORY GENERAL SERIAL NO OF HCOI

NAME OF COVER HEAD ABDUL RAHUMAN AKBAR ALI

ACCOMMODATION CATEGORY AZIZYA
APPLICANT’S DETAILS (As per International Passport)

PASSPORT NUMBER J4255009 PLACE OF ISSUE JEDDAH

DATE OF ISSUE 16-05-2011 DATE OF EXPIRY 15-05-2021
APPLICANT’S NAME (Surname followed by Name) ABDUL RAHUMAN AKBAR ALI
FATHER’S NAME ABDUL RAHUMAN MOTHER’S NAME AYISHAL BEEVI
SPOUSE’S NAME JANNATH BEEVI GENDER MALE
DATE OF BIRTH 09-10-1955 PLACE OF BIRTH CHENNAI MARITAL STATUS MARRIED
BLOOD GROUP B+ OCCUPATION OTHER EDUCATION QUALIFICATION UNDER GRADUATE / HSC
PRESENT RESIDENTIAL ADDRESS 43/22 NEW STREET
KADAYANALLUR
DISTRICT TIRUNELVELI STATE TAMIL NADU PIN CODE 627751
MOBILE NO. 9688119428 EMAIL ID a_ali_daikin@yahoo.com PAN NO
DETAILS OF NOMINEE OF APPLICANT
NAME NABILA BEGUM FATHER’S / HUSBAND’S NAME AKBAR ALI
RELATIONSHIP DAUGHTER MOBILE NO. 9578069391
ADDRESS 77/15 PARASURAMAPURAM NORTH ST
KADAYANALLUR
PIN CODE 627751 DISTRICT TIRUNELVELI
STATE TAMIL NADU Signature- Thumb Impression of Nominee
NAME OF MEHRAM WITH RELATION (For Female Pilgrim only)
NAME
RELATIONSHIP
PASSPORT NUMBER Signature/ Thumb Impression of Mehram
COVER HEAD’S BANK ACCOUNT DETAILS
NAME OF BANK BRANCH CODE NAME OF THE BRANCH IFS CODE ACCOUNTS NO.
INDIAN 1382 IOB BAZAAR STREET IOBA0001382 138201000008573
OVERSEAS BANK
ARE YOU N R I NO Opting JHOFA Meeqat (Only for Shia NO Are you a Repeater (only for Mehram / NO
Plgrims) companion of Age 70+ applicant)
Language opted for Haj Guide Tamil Do you want to perform ADAHI (Qurbani) YES
through IDB
Original International Passport
Original Bank Pay-In-Slip
I certify that the information furnished above is true and correct.

Signature/ Thumb Impression of Applicant

FOR OFFICE USE ONLY

All entries in the above online HAF have been checked and found in order. Certified that the applicant is eligible to register for Haj-1441 (H) - 2020 (CE).

Online HAF Checked by Verified by Executive Officer, State / UT Haj Committee

 HAJ COMMITTEE OF INDIA
ONLINE HAJ APPLICATION FORM FOR HAJ – 1441 (H) – 2020 (C.E.)

SOLEMN DECLARATION AND UNDERTAKING

for General Category

I,Mr./Mrs./Miss ABDUL RAHUMAN AKBAR ALI S/o./W/o./D/o. ABDUL RAHUMAN,Indian citizen, do hereby solemnly declare on oath in the name of ALLAH that :

1) I am aware that as per Government of India’s policy a person can perform Haj only “Once in a life time” through Haj Committee of India.

2) I have never performed Haj through Haj Committee of India in the past and hence I am eligible to apply for Haj 2020, as per Guidelines of Haj-2020. I am aware that
Repeaters are not eligible for Haj-2020 and if it is detected at any stage that I have already performed Haj through Haj Committee of India, my seat shall be cancelled and the
entire amount deposited shall be forfeited.

3) I have read / understood the Guidelines for Haj 1441 (H) – 2020 (C.E.), specifically with regard to eligibility (para – 4), payments and confirmation (para – 14), cancellation
(para – 15), accommodation and facilities in Kingdom of Saudi Arabia (para – 16), flight (para – 19), baggage (para - 22), refunds (para – 26) and undertake to abide by the
same.

4) I authorize Haj Committee of India to procure Saudi Riyals on my behalf for disbursal / remittance to CGI.

5) I hereby authorize HCoI to send SMS on my Mobile Number even if I am registered under DND registry.

6) Particulars given by me in HAF, Solemn Declaration and Undertaking are true and correct to the best of my knowledge. I do hereby affirm and declare that in case I have
suppressed material information or given false / incorrect Declaration / Undertaking, HCoI shall forfeit the amount deposited by me and I shall be liable for prosecution.

7) I am aware that HCoI reserves the right to change the Embarkation Point opted by me. In such case, I shall be abide by the decision of HCoI and shall not show any
resentment, whatsoever, against the decision of HCoI.

8) I am ready to pay extra charges, as levied by the KSA Haj Authorities for endorsement of Haj visa.

9) I/We understand that Haj Committee of India works without profit motive and does not attract the provisions of Consumer Protection Act, 1986. Further, we understand that
the Courts of Greater Mumbai only shall exercise jurisdiction in all matters of dispute.

10) Haj journey of pilgrims carrying Khash-Khash, Viagara-tablets, Sexual oil and cream, Synthetic Capore, Cystone, Khammera, Gutkha, Khaini, Gul, Pipermint or narcotics
in any form shall be cancelled besides he/she will be penalized for carrying banned items as per of prevailing regulations of Saudi Arabia. If found, they will be liable for
deportation to India from KSA at any stage of Haj.

Date :

Place :

___________________________________________

Signature / Thumb impression of the applicant.

 HAJ COMMITTEE OF INDIA
ONLINE HAJ APPLICATION FORM FOR HAJ – 1441 (H) – 2020 (C.E.)
Pilgrim Detail : 2

EMBARKATION POINT CHENNAI ADULT INFANT DOWNLOAD DATE

2 0 29-10-2019 08:43:36
CATEGORY GENERAL SERIAL NO OF HCOI

NAME OF COVER HEAD ABDUL RAHUMAN AKBAR ALI

ACCOMMODATION CATEGORY AZIZYA
APPLICANT’S DETAILS (As per International Passport)

PASSPORT NUMBER K5354535 PLACE OF ISSUE MADURAI

DATE OF ISSUE 23-07-2012 DATE OF EXPIRY 22-07-2022
APPLICANT’S NAME (Surname followed by Name) JANNATH BEEVI
FATHER’S NAME SHEIK MANSOOR MOTHER’S NAME AYISHA BEEVI
SPOUSE’S NAME AKBAR ALI GENDER FEMALE
DATE OF BIRTH 10-07-1959 PLACE OF BIRTH KADAYANALLUR MARITAL STATUS MARRIED
BLOOD GROUP O+ OCCUPATION HOUSE WIFE EDUCATION QUALIFICATION NIL
PRESENT RESIDENTIAL ADDRESS 43/22 NEW STREET
KADAYANALLUR
DISTRICT TIRUNELVELI STATE TAMIL NADU PIN CODE 627751
MOBILE NO. 9688119428 EMAIL ID a_ali_daikin@yahoo.com PAN NO
DETAILS OF NOMINEE OF APPLICANT
NAME NABILA BEGUM FATHER’S / HUSBAND’S NAME AKBAR ALI
RELATIONSHIP DAUGHTER MOBILE NO. 9578069391
ADDRESS 77/15 PARASURAMAPURAM NORTH ST
KADAYANALLUR
PIN CODE 627751 DISTRICT TIRUNELVELI
STATE TAMIL NADU Signature- Thumb Impression of Nominee
NAME OF MEHRAM WITH RELATION (For Female Pilgrim only)
NAME AKBAR ALI
RELATIONSHIP HUSBAND
PASSPORT NUMBER J4255009 Signature/ Thumb Impression of Mehram
COVER HEAD’S BANK ACCOUNT DETAILS
NAME OF BANK BRANCH CODE NAME OF THE BRANCH IFS CODE ACCOUNTS NO.
INDIAN 1382 IOB BAZAAR STREET IOBA0001382 138201000008573
OVERSEAS BANK
ARE YOU N R I NO Opting JHOFA Meeqat (Only for Shia NO Are you a Repeater (only for Mehram / NO
Plgrims) companion of Age 70+ applicant)
Language opted for Haj Guide Tamil Do you want to perform ADAHI (Qurbani) YES
through IDB
Original International Passport
Aadhaar Card
I certify that the information furnished above is true and correct.

Signature/ Thumb Impression of Applicant

FOR OFFICE USE ONLY

All entries in the above online HAF have been checked and found in order. Certified that the applicant is eligible to register for Haj-1441 (H) - 2020 (CE).

Online HAF Checked by Verified by Executive Officer, State / UT Haj Committee

 HAJ COMMITTEE OF INDIA
ONLINE HAJ APPLICATION FORM FOR HAJ – 1441 (H) – 2020 (C.E.)

SOLEMN DECLARATION AND UNDERTAKING

for General Category

I,Mr./Mrs./Miss JANNATH BEEVI S/o./W/o./D/o. SHEIK MANSOOR,Indian citizen, do hereby solemnly declare on oath in the name of ALLAH that :

1) I am aware that as per Government of India’s policy a person can perform Haj only “Once in a life time” through Haj Committee of India.

2) I have never performed Haj through Haj Committee of India in the past and hence I am eligible to apply for Haj 2020, as per Guidelines of Haj-2020. I am aware that
Repeaters are not eligible for Haj-2020 and if it is detected at any stage that I have already performed Haj through Haj Committee of India, my seat shall be cancelled and the
entire amount deposited shall be forfeited.

3) I have read / understood the Guidelines for Haj 1441 (H) – 2020 (C.E.), specifically with regard to eligibility (para – 4), payments and confirmation (para – 14), cancellation
(para – 15), accommodation and facilities in Kingdom of Saudi Arabia (para – 16), flight (para – 19), baggage (para - 22), refunds (para – 26) and undertake to abide by the
same.

4) I authorize Haj Committee of India to procure Saudi Riyals on my behalf for disbursal / remittance to CGI.

5) I hereby authorize HCoI to send SMS on my Mobile Number even if I am registered under DND registry.

6) Particulars given by me in HAF, Solemn Declaration and Undertaking are true and correct to the best of my knowledge. I do hereby affirm and declare that in case I have
suppressed material information or given false / incorrect Declaration / Undertaking, HCoI shall forfeit the amount deposited by me and I shall be liable for prosecution.

7) I am aware that HCoI reserves the right to change the Embarkation Point opted by me. In such case, I shall be abide by the decision of HCoI and shall not show any
resentment, whatsoever, against the decision of HCoI.

8) I am ready to pay extra charges, as levied by the KSA Haj Authorities for endorsement of Haj visa.

9) I/We understand that Haj Committee of India works without profit motive and does not attract the provisions of Consumer Protection Act, 1986. Further, we understand that
the Courts of Greater Mumbai only shall exercise jurisdiction in all matters of dispute.

10) Haj journey of pilgrims carrying Khash-Khash, Viagara-tablets, Sexual oil and cream, Synthetic Capore, Cystone, Khammera, Gutkha, Khaini, Gul, Pipermint or narcotics
in any form shall be cancelled besides he/she will be penalized for carrying banned items as per of prevailing regulations of Saudi Arabia. If found, they will be liable for
deportation to India from KSA at any stage of Haj.

Date :

Place :

___________________________________________

Signature / Thumb impression of the applicant.

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