Government of West Bengal

One way Entry Pass for entering West Bengal on Own Arrangement
(Medical / Non-Medical Emergency / STRANDED Persons)

Pass No. PUR/ENT/30062020000H91653 Date : 30/06/2020

Mobile No. 8409300053
Reason Of Entry Any other Emergency
Identification Document No 790387664193 for medical treatment in jamshedpur
:
Aadhar No.
Source Address Jorapokhar No.1 Destination Address BAMNIDIH, BANDI-BANDHUWAN ROAD,
Jealgora BARABAZAR, BARABHUM
DistrictDhanbad District:Purulia
Jharkhand,828110 West Bengal

Name Sex Age Relationship

1) Details of the Applicant sahida bano Female 53 self

2) Details of other member/members travelling

with the Applicant Name Sex Age Relation Doc No.

3) Type of Vehicle: SUV,SUV, HYUNDAI INDIA LTD. CRETA 1.6CRDI SK

4) Registration No of the Vehicle: JH10AV5194

5) Details of Driver (If Any) Name

NASIMUL HAQUE

# Remarks : This Pass has only one time validity for entering West Bengal and does not automatically allow return journey except for the driver
and vehicle.
* I sahida bano declare that neither me nor any of the person travelling with me is having Corona Positive Report / Symptoms of Corona.
* I sahida bano declare that both my source and destination address does not lie in containment zone.
* I sahida bano 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
* Maximum Four Passengers are allowed in a vehicle including the driver.
* Verification of original documents and Health Screening shall be done at the border of West Bengal. Please co-operate.

* Following documents should be carried in original while travelling-

1. Exit Pass from the authority of source station
2. Identification Document of all the travellers
3. Documents in support of reason of travel.
* Without above stated documents , passholder(s) will not be allowed to enter into West Bengal.
* The pass does not grant any automatic right for entry into West Bengal.
*This Pass can be verified using Whatsapp bot by sending "Hi" to the Whatsapp number +91 8017845555
* This is a computer generated document and doesn't required signature.