SOCIETY FOR PROMOTION

OF NATURE
TOURISM AND SPORTS
Lakshadweep Office
Willingdon Island,
Kochi-682003

Application For Package Tour To Lakshadweep

Pls submit in word format

1.

Name in full ( in block letters )

: KIRTIMAN

2.

Fathers/Husbands name

: SATYENDRA NATH GUPTA

3.

Permanent Address/for postal

:1st Floor, Backside, B78, Sarvodya Enclave

Delhi-110017

4.

kirtiman.itbhu@gmail.com 8826179477

5.

Emai ID with telephone/Mobile No. :

Compulsory
Nationality.With Gender

6.

Date of Birth & Age as on travel Date : 13/10/1985 and 30 years

7.

Food Preference

: Non-Veg

8.
9.
10.
11.

Name of Tour & Date of Departure.

For stay in island package

: Samudram Package and 10th Nov 2015

: Check in Date
Check Out Date

12.

: Indian (Male)

Class of Accommodation required & number of seats. : Normal and 5 seats

Particulars of other members of the group ( if number of members are more than 5 attach
additional sheet )
Sl.No. Name in full(as in your Id
Date of
Age
Sex
Food Preference
Cards)
Birth
As on
Travel date
1.
SATYENDRA NATH GUPTA 08/10/57
58 years
Male
Non-Veg
ARTI GUPTA
2.
SWETA KUMARI
08/11/65
50 years
Female Veg
3.
KUMAR ADITYAMAN
04/02/89
26 years
Female Non-Veg
4.
19/12/92
22 years
Male
Non-Veg

I hereby declare that the information furnished above is correct and true to the best of My Knowledge
and belief. I undertake to abide by the rules and directions under Lakshadweep ( Restriction on Entry &
Residence) Rules,1967 as applicable to permit holders.
Place: DELHI
Date: 02/09/2015
Signature.(optional)
( All Tourists should have their Identity Cards with them. Baggage restricted to 35 Kg per pax.
Age proof to all tourist must be submitted to verify before boarding)
For Office Use only.
Rs.

Remitted vide Receipts No.

Dated.

NEFT Details if transferred the amount in our bank account:-

Balance if any Rs.