Dr. Bhimrao Ambedkar Panch Teerth Yojna - Application Form for Scheduled Caste

Tour Form (SC) - Application Format

1. Name

2. Father's Name

3. Date of Birth

4. Gender

5. Permanent Address

6. Attach Domicile Certificate

7. Mobile Number & E-mail

8. Do you belong to Scheduled Caste?

9. Annual Income

10. Are you a tax payer?

11. Are you physically & mentally healthy?

(Attach a medical certificate – not older than 6 months)

12. Have you availed this journey benefit earlier?

13. Two Emergency Contact Persons

14. Are you willing to comply with all rules during the journey?

Declaration