HAJ COMMITTEE OF INDIA

KHADIM-UL-HUJJAJ ONLINE APPLICATION FORM FOR HAJ – 1441 (H) – 2020 (C.E.)

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EMBARKATION POINT SRINAGAR ADULT INFANT DOWNLOAD DATE

1 0 05-02-2020 07:54:02

APPLICANT’S NAME (Surname followed by Name) BHAT FAYAZ AHMAD

ACCOMMODATION CATEGORY AZIZYA-RAS/RAS
APPLICANT’S DETAILS (As per International Passport)
PASSPORT NUMBER R3363558 PLACE OF ISSUE SRINAGAR
DATE OF ISSUE 18-07-2017 DATE OF EXPIRY 17-07-2027
FATHER’S NAME GHULAM NABI MOTHER’S NAME ZAIBA BHAT
BHAT
SPOUSE’S NAME RAFIQA BHAT GENDER MALE

DATE OF BIRTH 02-03-1963 PLACE OF BIRTH PARIGAM MARITAL STATUS MARRIED

PULWAMA
BLOOD GROUP O+ EDUCATION MATRICULATION / OCCUPATION STATE GOVT.
SSC
PRESENT RESIDENTIAL ADDRESS JAGIR PARIGAM PULWAMA

DISTRICT PULWAMA STATE JAMMU & PIN CODE 192301

KASHMIR
MOBILE NO. 9858898121 EMAIL ID bhatfayaz@gmail.com
DETAILS OF NOMINEE OF APPLICANT
NAME TOWSEEF AHMAD BHAT FATHER’S / HUSBAND’S NAME FAYAZ AHMAD BHAT
RELATIONSHIP SON MOBILE NO. 9796199559
ADDRESS JAGIR PARIGAM PULWAMA

PIN CODE 192301 DISTRICT PULWAMA

STATE JAMMU & KASHMIR Signature- Thumb Impression of Nominee
BANK ACCOUNT DETAILS
NAME OF BANK BRANCH CODE NAME OF THE BRANCH IFS CODE ACCOUNTS NO.
JK BANK SKIMSS SKIMSS SOURA JAKA0SKIMSS 0342040100004405
NAME & ADDRESS OF OFFICE
NAME OF DEPARTMENT SK INSTITUTE OF MEDICAL SCIENCES ADDRESS SHERI KASHMIR INSTITUTE OF
MEDICAL SCIENCES SOURA
SRINAGAR 190011
DESIGNATION SECTIONAL OFFICER STATE OF HEALTH YES
Previous Exp. FRESHER / Language opted for Urdu Do you want to perform ADAHI (Qurbani) NO
Haj Guide through IDB
KUH Prev Year 1 KUH Prev Year 2 KUH Prev Year 3
Sr Language Speak Read Write
1. ARABIC No Yes No
2. ARABIC Yes Yes No
3. ENGLISH Yes Yes Yes
4. URDU Yes Yes Yes
5. KASHMIRI Yes Yes Yes

UNDERTAKING

1. I have carefully read the CIRCULAR issued by HCoI for selection of Khadim-ul-Hujjaj for Haj-2020.
2. I declare that all the above information and particulars are correct and i will stand disqualified if any information is found to be incomplete /
incorrect at any stage.
3. Application received without supporting documents will not be entertained.
4. I shall have to adhere to the rules and regulations of Haj Committee of India / Consulate General of India (CGI) Jeddah & State / UT Haj
Committees.
5. I hereby declare that no departmental enquiry / criminal case is pending against me in any Courts of Law. Which may result in debaring to travel
out side the Country.

Note: Selected/Waitlisted KuH shall submit signed hard copy of application alongwith all relevant documents as specified above and submit the same
to the respective State/UT Haj Committees (SHCs).

Date :_______________________
Place :_______________________ ___________________________________________
Signature / Thumb impression of the applicant.

FOR OFFICE USE ONLY

Certified that candidate conforms to the norms prescribed for Khadim-ul-Hujjaj vide Circular no. 08. dated 22/01/2020 of HCoI. He / She is eligible for selection.
 ___________________________________________
Seal and Signature of Executive Officer/SHC.

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