You are on page 1of 2

NAGALAND INNER LINE PERMIT

Home Department, Government of Nagaland


APPLICATION FORM : DOMESTIC TOURIST

Application No. 24010791 Application Date 20-01-2024

APPLICATION DETAILS

First Name MITHUN

Last Name DEBNATH

D.O.B 03-03-1991

Gender Male

Mobile Number 9615141075

Alternate Number

Email janina.mdn@gmail.com

PRESENT ADDRESS PERMANENT ADDRESS

Address Deorachara Address Deorachara

Post Office Deora Cherra Post Office Deora Cherra

Police Station Kailashahar Police Station Kailashahar

District NORTH TRIPURA District NORTH TRIPURA

State TRIPURA State TRIPURA

Pin Code 799279 Pin Code 799279

PERMIT DETAILS

Permit Category Tourist Districts to visit DIMAPUR, KOHIMA

Visit from 21-01-2024 To 31-01-2024

Purpose of visit Visiting Some Places.

Proof of Identity Aadhaar ID no. 968170302515

Local Contact / Travel Agency / Place of Stay

Name SANAT DEBNATH Phone 9436597245

Address Lumding, Assam

Uploaded Documents

ID Proof (Front)
ID Proof (Back)

You might also like