Professional Documents
Culture Documents
Date of Birth
Application (DD/MM/YY)
Name.
Aadhar Mobile
Number Number
1. Do you have any of the following Flu like symptoms (Please tick anyone option) :
Description Yes No
Cough
Breathlessness
Sore Throat
I hereby declare that all the information mentioned above is true to the best of my knowledge and will
immediately inform to COVID-19 Central/State Govt. Authority, if any symptoms arise during or after
the visit.
Place :
(Signature of the candidate )