Covid 19 Pandemic Emergency Identity Card

1. Name of the Empoloyee/Vendor*

Fill in CAPITAL LETTERS ONLY

1. Father/Husband's Name

Fill in CAPITAL LETTERS ONLY

1. Department

Indicate Department

1. Designation

Indicate your designation

1. Type of Vendor

Vegetables/Milk/etc

1. Vehicle No.

Indicate Vehicle No

1. Type of Vehicle

2. Two Wheeler

3. Three Wheeler

4. Four Wheeler

Enter type of vehicle

1. Village and mandal*

Selling village and mandal

1. Aadhar No.*

please put space after four numbers as XXXX XXXX XXXX

1. Residece Village

1. Mandal

1. District

1. Mobile Number*

1. Upload Photo*

Accepted file types: jpg, png, pdf.

Please upload a good quality image

1. Signature of Issuing Authority*

Accepted file types: jpg, png, pdf.

Please upload a good quality image

1. Stamp of Issuing Authority*

Accepted file types: jpg, png, pdf.

Please upload a good quality image

1. Issuing Authority Mobile Number*

To conform your Identity