Contact number:

Name of applicant:

District: --------- East South East North East West Central South New Delhi South West North North West Shahdara

Address of Office or place of engagement:

Type of service: ------ Shops, dealing with foods, groceries, fruits & vegetables, dairy & milk booths, meat & fish, animal fodder, pharmaceuticals, medicines and medical equipments Banks, Insurance offices and ATMs Telecommunications, Internet services, broadcasting and cable services, IT and IT enabled services Delivery of all essential goods including foods, pharmaceuticals, medical equipments through e-commerce Petrol pumps, LPG, CNG, petroleum and gas retail and storage outlets Power generation, transmission and distribution units and services Cold storage and warehousing services Private security services Manufacturing units of essential commodities Production units or services, which require continuous process Person going for COVID-19 vaccination

From Date:

Till Date:

Time: 10 PM - 5 AM in the night only

ID Proof: (maximum file size: 4MB)

Any other document like Visiting Card, Shop/Business License, etc. :
(maximum file size: 4MB)

I acknowledge that I am fully aware that in case the information furnished by me is found to be incorrect, I shall be liable for prosecution under section 177 & 191 of the Indian Penal Code.