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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
--Select District--
AJMER
ALWAR
BANSWARA
BARAN
BARMER
BHARATPUR
BHILWARA
BIKANER
BUNDI
CHITTORGARH
CHURU
DAUSA
DHOLPUR
DUNGARPUR
HANUMANGARH
JAIPUR
JAISALMER
JALORE
JHALAWAR
JHUNJHUNU
JODHPUR
KARAULI
KOTA
NAGAUR
PALI
PRATAPGARH
RAJSAMAND
SAWAI MADHOPUR
SIKAR
SIROHI
SRI GANGANAGAR
TONK
UDAIPUR
City
--Select City--
Block
--Select Block--
Local Address
Mobile No.
Email Address, if any
Relationship with Stranded Resident
--Select Relationship--
Brother
Daughter
Father
Friend
Guardian
Husband
Mother
Others
Sister
Son
Wife
Details of Stranded Resident/ Person Outside India
Foreign Country Name
Region/ Oblast
--Select Region/ Oblast--
Cherkasy
Chernihiv
Chernivtsi
Dnipropetrovsk
Donetsk
Ivano-Frankivsk
Kharkiv
Kherson
Khmelnytskyi
Kyiv
Kirovohrad
Luhansk
Lviv
Mykolaiv
Odessa
Poltava
Rivne
Sumy
Ternopil
Vinnytsia
Volyn
Zakarpattia
Zaporizhzhia
Zhytomyr
Full Name
Father/ Husband Name
Gender
Male
Female
Age (Years)
Resident of (in Rajasthan)
Urban Area
Rural Area
District (in Rajasthan)
--Select District--
AJMER
ALWAR
BANSWARA
BARAN
BARMER
BHARATPUR
BHILWARA
BIKANER
BUNDI
CHITTORGARH
CHURU
DAUSA
DHOLPUR
DUNGARPUR
HANUMANGARH
JAIPUR
JAISALMER
JALORE
JHALAWAR
JHUNJHUNU
JODHPUR
KARAULI
KOTA
NAGAUR
PALI
PRATAPGARH
RAJSAMAND
SAWAI MADHOPUR
SIKAR
SIROHI
SRI GANGANAGAR
TONK
UDAIPUR
City (in Rajasthan)
--Select City--
Block (in Rajasthan)
--Select Block--
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.
Please Select the Declaration.
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