1.Departure Country:* Select Afghanistan Algeria Angola Anguilla Antigua and Berbuda Antilles and Aruba Argentina Armenia Aruba Australia Azerbaijan Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bonaire Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Chad Chile China Colombia Congo Republic of Cote dIvoire Croatia Cuba Curacao Cyprus Czech Republic Democratic Republic of Congo Denmark Djibouti Dominica Ecuador Egypt Equatorial Guinea Equitorial Guinea Eritrea Ethiopia Fiji Finland France Georgia Germany Ghana Greece Guatemala Guinea Guyana Hungary Iceland Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kingdom of Eswatini Korea Republic of (South) Kuwait Kyrgyzstan Laos Latvia Lebanon Liberia Lithuania Madagascar Malawi Malaysia Maldives Mali Malta Mauritania Mauritius Mexico Morocco Mozambique Myanmar Namibia Nepal Netherlands New Zeland Nigeria North Macedonia Norway Oman Pakistan Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Romania Russia Rwanda Saba Saudi Arabia Senegal Seychelles Sierra Leone Singapore Sint Maarten Slovak Republic Slovenia Somalia South Africa South Korea South Sudan Spain Sri Lanka St Denis St Eustatius St Lucia St Vincent Grenadines St. Kitts & Nevis Sudan Suriname Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Trinidad and Tobago Tunisia Turkey Turkmenistan UAE Uganda Ukraine Union of Comoros United Kingdom USA Uzbekistan Venezuela Vietnam Zambia Zimbabwe

2.Mission:* Select

3. Departure City:* Select DUBAI Jeddah Sharjah

4. Flight Detail:* Select 08-NOV-2020 16:59 | AI 1946 | KANNUR 08-NOV-2020 16:59 | AI 1946 | MUMBAI

5. Nationality: * Select Indian Others

7. Passport Number/OCI Card Number:*

8. Vaild Email ID:*

9. Name:*

10. Age:*

11. Gender:* select Male Female Other

12. Compelleing Case Type:* Select Those facing deportation by foreign governments Migrant Workers/Labourers who have been laid off Non-Permanent Residents/Short-Term Visa holders faced with expiry of visas Those faced with medical emergency/seeking treatment for terminal illness Pregnant Women/Elderly Those required to return to India due to death of a family member Tourists/visitors stranded abroad Students if their educational institutions/hostels are closed Company Labour Married couples where one spouse is an OCI card holder and other is an Indian national Eligible foreign nationals as per MHA

13. Category Type:* Select Student Professional Workers Tourists Visitors Deportees Amnesty Crew Fishermen Others Seafarers

14 Domicile State:* Select Jammu & Kashmir Himachal Pradesh Punjab Chandigarh Uttarakhand Haryana Delhi Rajasthan Uttar Pradesh Bihar Sikkim Arunachal Pradesh Nagaland Manipur Mizoram Tripura Meghalaya Assam West Bengal Jharkhand Odisha Chhattisgarh Madhya Pradesh Gujarat Daman & Diu Dadra & Nagar Haveli Maharashtra Andhra Pradesh Karnataka Goa Lakshadweep Kerala Tamil Nadu Puducherry Andman & Nicobar Islands Telangana Ladakh Not Specified

15. District:* Select

16. Contact number abroad:*

17. Contact number India:*

18.Covid test status:* Select Yes NO

19.Type of Covid test:* Select Not Applicable RT-PCR Rapid antibody

20.Profession/Skill I-set:*

21.Address in India:*

22.Address in Abroad:*

23.Remarks:

UNDERTAKING

(To be filled in by passenger seeking a booking in Flight No from to on

1. I am a citizen of the Republic of India/ I am an Overseas Citizen of India/I am a foreign national eligible as per MHA OM No. 25022/24/2020/F.V/F.I dated 12 June 2020.
2. I am in possession of a valid Indian passport No./OCI Card No./Travel Document No.
3. I wish to return to India under ‘Vande Bharat Mission’.
4. I have registered with for returning to India.
5. I shall follow all protocols framed by Government of India under ‘Vande Bharat Mission’.
6. I am willing to undergo mandatory quarantine upon my arrival in India as per the SOP of 24 May 2020.
7. I am willing to pay for all expenses with respect to my airfare and quarantine in India.
8. I certify that I am domiciled in the State of in India.
9. I will not take onward domestic flight without completing mandatory quarantine.
10. I voluntarily give my consent to travel by the repatriation flight under ‘Vande Bharat Mission’ while fully being aware that I may be inadvertently exposed to any infection, including Covid-19.
11. If any of the above conditions are found to have been not met by me, I agree not to be allowed to board the flight.

      I , in possession of a valid Indian passport No./OCI Card No./Travel Document No accept to adhere to all the conditions mentioned in the undertaking and carry a signed printout of the same to be handed over at Check-in counter at departure airport.
I certify that the information provided by me above is true and complete to the best of my knowledge.