umrah packages form MILLATH HAJ SERVICES
1A, Habibullah Road,T.Nagar,Chennai 600 017.
Telefax : +91-44- 2834 5696 / 28345786
4 cm X 6 cm
Colour Photo
with White
Back ground
1) FULL NAME IN CAPITAL LETTER'S
    ( As mentioned in the Passport )		 :
2) FATHER'S NAME :
3) MOTHER'S NAME :
4) HUSBAND'S/WIFE NAME :
5) PLACE OF BIRTH :
6) DATE OF BIRTH :
7) BLOOD GROUP :
8) MAHARAM'S NAME
    ( For Lady Application )		 :
9) MAHARAM'S RELATIONSHIP :
10) MAHARAM'S PROFESSION AND ADDRESS :
11) ADDRESS OF APPLICANT
      ( As stated in Passport )		 :
12) ADDRESS FOR CORRESPONDANCE :
13) NATIONALITY :
14) PASSPORT NO. DATE AND PLACE OF ISSUE : VALID UPTO:        
15) EMIGRATION CHECK : REQUIRED         NOT REQUIRED
16) B.TQ/LERMS : ELIGIBLE             NOT ELIGBLE
SIGNATURE OF THE APPLICANT
DECLARATION BY THE APPLICANT

Dear Sir,

I, the undersignedwish to join your group for Haj 200.... which is leaving Chennai on or about

I have read and understood all the terms and conditions of the above tour and I hereby agree to abide by the same.

I have furnished my personal particular and other details in the application forms to the best of my knowledge and belief. Please enroll my name in the tour and intimate my Registration Number at the earliest.

Cash / Cheque / D.D No dated for Rs( Rupees ) is attached herewith and agree to pay the amount as per your terms.




DATE
SIGNATURE OF THE APPLICANT
B.T.Q / TERMS

I hereby declare that I will abide by the rules and regulation of Reserve Bank of India and agree to surrender my exchange amount under Foreign Travel Scheme to Millath Haj Service, Chennai for my travel expense abroad for Haj Pilgrimage. I will not carry any prohibted or contraband ariticles or any other items that has been declared unlawful by the Indian or Saudi Governments.



SIGNATURE OF THE APPLICANT WITH DATE
DECLARATION OF APPLICANT FOR NOMINEE
1) NAME AND ADDRESS OF NOMINEE :
2) RELATIONSHIP WITH APPLICANT :
3) SIGNATURE OF NOMINEE IN PERSON :

I hereby appoint the above mentionedd person as my nominee, as per your conditions to receive my belongings and balance money, if any, in case of my death.

And I also state that in case. I die after commencement of the Tour, Millath Haj Service can arrange my burial in the same where I die, according to the Rules and Regulations of that Country.




SIGNATURE OF WITNESS
SIGNATURE OF THE APPLICANT WITH DATE