e-Intimation of Stranded Residents of Rajasthan State

marked fields are mandatory to be filled

Details of Local Resident/ Reporting Person/ Caller

Full Name

Father/ Husband Name

Gender

Male Female

Age (Years)

Resident of

Urban Area Rural Area

District

City

Local Address

Mobile No.

Email Address, if any

Relationship with Stranded Resident

Details of Stranded Resident/ Person Outside India

Foreign Country Name

Region/ Oblast

Full Name

Father/ Husband Name

Gender

Male Female

Age (Years)

Resident of (in Rajasthan)

Urban Area Rural Area

District (in Rajasthan)

City (in Rajasthan)

Local Address (in Rajasthan)

Mobile No. 1 with Country Code (In Foreign Country)

Mobile No. 2 with Country Code, if any (In Foreign Country)

Mobile No. 3 (Indian), if any

Email Address, if any

Passport No.

Occupation/ Work in Foreign Country

Address in Foreign Country

Last Known Location in Foreign Country

Recent Colour Photo, if available (JPG only, Max 100KB)

Upload File

Last Known Latitude in Foreign Country, if any

Last Known Longitude in Foreign Country, if any

Staying in Foreign Country since (please specify date, if available)

Any other important details, if any

Self-Declaration

1. I hereby declare that the information provided by me herein is true to the best of my knowledge and belief.
2. I am also aware that if the information provided herein by me is found misleading/ false, I will be liable to be prosecuted under relevant provisions of IPC and Rajasthan Epidemic Act.

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