Government of West Bengal

One Way Inter-State Exit Pass only for Emergency and other Permitted activities

Permit No. SOU/INT/08052020000A10864 Date : 08/05/2020

Mobile No : 9770949011
Identification Document No 777447640367
:
Aadhar No.
Source Address Barisha Police Chowki,PO: Destination Address Khalesor Umaria
District:South 24 Parganas
West Bengal,700008 Madhya Pradesh,484661

Name Sex Age Relationship

Shayrun Nisha Female 34 self

1) Details of the Applicant

2) Details of other member/members travelling Name Sex Age Relation Doc No.
with the Applicant :

Shekh Israr Male 38 Husband 473412976833

Samaira Manshoori Female 8 Daughter 193868377
3) Type of Vehicle: Car,Mobilio

4) Registration No of the Vehicle: MP21CA5505

5) Details of Driver (If Any) Name Sex Age

Abdul Rakib Ansari Male 27

# Remarks : This Pass has only one time validity for travelling outside West Bengal and do not automatically grant entry back into the state.

* I Shayrun Nisha declare that neither me nor any of the person travelling with me is having Corona Positive
Report / Symptoms of Corona.
* I Shayrun Nisha declare that both my source and destination address does not lie in containment zone.
* I Shayrun Nisha declare that I will abide by the rules laid down by the local authorities from my place of travel
till the destination address,related to corona lockdown and / or otherwise.
* This pass is valid only with the original identification document mentioned in the pass and with the entry pass of the source state.
* This pass does not allow any movement from the containment zone.
* Maximum Four Passengers are allowed in a vehicle including the driver.
**To verify the pass,send the pass number as WhatsApp message to the number +91 8017845555
* This is a computer generated document and doesn't required signature.