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ACCOMMODATION DEPARTMENT
REQUEST FOR AccOMMODATION
(3rcodT}A# fert frtaT )
(TO BEFLED IN BIOCK L:TIERS)
TO: THE AcCOMMODATION DEPARTMENT (3JHdAIBr t4TT)
To Enquire Booking Status or
RADHA SOAMISATSANG BEAS (TETT HEI SUI)
Complete Cancellation Via -SMS
DERA BABA JAIMAL. SINGH (T arat tfis). PhoneNo 70870|2700
BEAS, PUNJABPIN CODE-143 204 (34TT, YTG-143 204) Type ABS ? For Hclp

TELEPHONE S T) 01853-288200

AADHAAR NO.: V1sITOR ID:

(3HTÉ st )
(Mr/Mrs./Ms )(sft/ sfH H): GENDER (fI)
(First Name),9Ecn Middle Name) (f a aTH) (Last Name) (3f34 4)

FULL.Y VAcCINATED: YESNo VACCINATION BENEFICIARY ID:

(ATIACH CERIFICATEPIOTOCOPY Hfehtc fì hteior re aTÖ)
FATHER'S NAME: SPOUSE'SNAME:
(yft/yt HTH)
DATE OF BIRTH /A GE(T-Hfaf 39): INITIATED (r47 fHGT t aT aÉ): YESL No
RESIDENTIAL ADDRESS(TT T 4AT):
CITY(IB):
DISTRICTfae): STATE(T): PIN(f #s):
MOB. NO.(SELF)(taIÆrt ): EMAIL ID:

PROFESSION/WORK(44T): DESIGNATION(341f):
DiSABILITY, IF ANY(faHrrTHfAT 4fz an:
STAYING AT SAME ADDRESS
PARTICULARS OF ACCOMPANYING PERSONS -ONLY DEPENDENT FAMILY MEMBERS

DATE OF BIRTIH AADHAAR NO. VACCINATION BENEFICIARY ID |RELATION(H)

|S.NO. NAME (TTH) 3TUTT :) (ATTACH CERTIFICATE PHOTOCOPY)
( MiDDLE NAME) (LAST NAME)
(FIRST NAIE)
(31f3 A4)

2
3
4.
5
6.

ARRIVAL DATE: DEPARTURE DATE:

MM YYYY
(ITd fafr) DD MM YYYY
(GT faftr)
(1 CONFIRM THAT ALL THE ABOVE MEMBERS,ELIGIBLE FOR VACCINATION AS PER THE AGE CRITERIA DEFINED BY GOVT.

DATE (rfr: SiGNATURE OF APPLICANT (TAGGH EAIHT)

FoR OFFICE USE ONLY
FROM: To:
NUMBER OF PEOPLE: AcCOMMODATION ALLOTTED: BoOKING No.
REMARKS:

ACCOM/RE/2021/01
 ACCOMMODATION DEPARTMENT
REQUEST FOR ACCOMMODATION

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DEPARTMENT (3HdHI3TH Pone No 0802700
ACCOMMODA TION
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DERABABA JAIMAL (3UTRT,Ya-14 204)
PNJAR PIN CODE-143204
BEAS.
VIsITOR ID:

AADHAAR N0.. (rE e )

(3TeTT GENDER (f:

(Mr.Mrs./Ms )(t/ sHt Hrf):(Fust Nae),4EGTm Middle Nanc)( a hT HIH (Uast

Name) (3fa TI4)

VACCINATION BENEFICIARY ID:

No
FULLY VATINATED: YES
SPOUSE'SNAME:
FATHER'SNAME: (ufa/yof 1 T4)
INITIATED(THGT- fHdT T): YEsNoO
314):
DATEOF BIRTH/ AGE(J-4aftr/
RESIDENTIAL ADDRESS( T 4aT):
CITY(9ET):

PIN(fEFT ts):
STATE(TA):
DISTRICT(t):
EMAIL D:
MOB. NO.(SELF)(Hargt t): DESIGNATION(3UTfu):
PROFESSION/WORK(44HTu):
t an):
DISABILITY, IF ANY (fHTrAHÍAI sft a DEPENDENTFAMILY MEMBERS STAYING
AT SAME ADDRESS
PERSONS ONLY
PARTICULARS OF ACCOMPANYING VACCINA TION BENEFICIARY ID RELATION (HAU)
DATE OF BIRTH AADHAAR NO. (ATTACH CERTIFICATE PHOTOCOPY)
NAME (HT) TUT
/S.NO. (LASINAME)
l(FRsT NAME) (MipDLE NAME)
(91faA TH)

1.
2.
3.
4
5
6.
ARRIVAL DATE: DEPARTURE DATE: D) MM yYYy
DD MM / YYYY
(IT fafr)
(1CONFIRM THATALL THE ABOVE MEMBERS, ELIGIBLE FOR VACCINATION AS PER THE AGE CRITERIA DEFINED BY GOVT.

DATE (frfy; SIGNATURE OF APPLICANT (3TAGE EHATT)

FOR OFFICE USE ONLY
FROM: To:
NUMBER OF PEOPLE: ACCOMMODATION ALLOTTED: BoOKING NO.
REMARKS:
ACCOM/RE/2021/01