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DHHERA
DHHERA
TO BE USED BY YATRI FOR OBTAINING MOBILE CONNECTION, IF REQUIRED TO BE KEPT BY YATRI TILL YATRA IS OVER FOR CROSSING ACCESS CONTROL GATES (DOMAIL)
Full Name : DHEERAJ MISHRA Full Name : DHEERAJ MISHRA Full Name : DHEERAJ MISHRA
Gender : M Age : 47 Blood Group : Gender : M Age : 47 Blood Group : Gender : M Age : 47 Blood Group :
Name of the Spouse / Father : Ramesh Chandra Mishra Name of the Spouse / Father : Ramesh Chandra Mishra Name of the Spouse / Father : Ramesh Chandra Mishra
Address : 117/K/185 K Block Sarvodaya Nagar Kanpur Nagar Address : 117/K/185 K Block Sarvodaya Nagar Kanpur Nagar Address : 117/K/185 K Block Sarvodaya Nagar Kanpur Nagar
Name of the Authorised Doctor/Medical Institute which issued the Health Name of the Authorised Doctor/Medical Institute which issued the Health Name of the Authorised Doctor/Medical Institute which issued the Health
Cerificate Whether declared fit YES Cerificate Whether declared fit YES Cerificate Whether declared fit YES
Date of issue of Health Certificate 30 Jun 2023 Date of issue of Health Certificate 30 Jun 2023 Date of issue of Health Certificate 30 Jun 2023
In case of emergency, please contact : In case of emergency, please contact : In case of emergency, please contact :
Ramesh Chandra Mishra (/ 6306210979) Ramesh Chandra Mishra (/ 6306210979) Ramesh Chandra Mishra (/ 6306210979)
Signature of Yatri / Seal & Signature Signature of Yatri / Seal & Signature Signature of Yatri / Seal & Signature
his representative Registration Officer his representative Registration Officer his representative Registration Officer
Downloaded on Jul 1 2023 7:37PM Downloaded on Jul 1 2023 7:37PM Downloaded on Jul 1 2023 7:37PM
Please carry your original Medical Certifcate Please carry your original Medical Certifcate Please carry your original Medical Certifcate
along with this Yatra Permit along with this Yatra Permit along with this Yatra Permit
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