HAJ COMMITTEE OF INDIA HAJ APPLICATION … COMMITTEE OF INDIA HAJ APPLICATION FORM FOR HAJ - 1438 (H) - 2017 (CE) 3. NAME OF COVER HEAD (Male adult only) (iii) General 1. CATEGORY:

HAJ COMMITTEE OF INDIAHAJ APPLICATION FORM FOR HAJ - 1438 (H) - 2017 (CE)

3. NAME OF COVER HEAD (Male adult only)

(iii) General 1. CATEGORY:

(i) Reserved-A (Age 70+)

a) Fourth Timer b) Fifth Timer

(ii). If Reserved- B, give Cover Numbers and Passport Numbers as under:

(i). If Reserved- A (Age 70+) give details of companion:

Name

Relationship

Cover No. Cover No.

(ii) Reserved-B (Fourth Timer / Fifth Timer )

(Tick (√) as appropriate)

2014 2013

2015 2014

2016 2015

2016

Passport No. Passport No.Year Year

AZIZIYA

2. ACCOMMODATION CATEGORY OPTED

GREEN

(Tick (√) the desired)

Gender: Male Female

Date of Birth Place of BirthDD Y YM M Y Y

4. APPLICANT’S DETAILS (As per International Passport)

Passport Number Place of Issue

Date of Issue Date of Expiry DD DD YY YY MM MM YY

Mother's Name

Spouse’s Name

Father's Name

YY

Given Name

Surname

7. NAME OF MEHRAM WITH RELATION (for female pilgrims only)

Name

Relationship

Passport Number Signature / Thumb Impression of Mehram

6. DETAILS OF NOMINEE OF APPLICANT: Name

Relationship

Address

Signature / Thumb Impression of Nominee

Telephone / Mobile No.

District

Pin Code

State

Father’s / Husband’s Name

5. PRESENT RESIDENTIAL ADDRESS:

Mobile Number Email ID :

District State

Pin Code

0

Qualification: Marital Status: Married Unmarried Occupation: Blood Group:

12. Are you NRI : Yes No 13. Opting JOHFA Meeqat (only for Shia pilgrims): Yes No

Yes No 8. Are you a permissible Repeater (Mehram / Companion of Age 70+ applicant) :

9. COVER HEAD’S BANK ACCOUNT DETAILS : Bank Name Branch Name Branch Code Account No. IFSC Code

11. Language opted for Haj Guide (Tick (√) any one): English Hindi Urdu Tamil TeluguKannada Gujarati MalayalamAssameseBengali Manipuri

I certify that the information furnished above is true and correct.

SIGNATURE / THUMB IMPRESSION OF THE APPLICANT

Yes No 10. Do you want to perform ADAHI (Qurbani) through IDB :

(FOR OFFICE USE ONLY)

All entries in the above HAF have been checked and found in order. Certified that the applicant is eligible to register for Haj-1438 (H) - 2017 (CE).

Data entry by: HAF checked by: Executive Officer, State / UT Haj Committee

DATE OF RECEIPT SERIAL NO. COVER NUMBERSEATS

ADULT INFANT

EMBARKATION POINT

SERIAL NUMBER OF HCoI

PHOTOGRAPH Paste your recent

passport size colour photograph

havingWHITE

BACKGROUND(Size:3.5cm x 3.5 cm)

GENERAL INSTRUCTIONS FOR FILLING HAJ APPLICATION FORM (HAF)

A) Before filling the HAF, read the Guidelines for Haj-2017.

B) HAF should be filled in ENGLISH BLOCK LETTERS only.

C) HAFs for Haj-2017 can be submitted from .01.2017 till 24.01.2017. 02

D) Column-wise instructions:

Column 1 : Tick the applicable category .

Reserved Category–A refers to applicants of age 70+ with companion,

Reserved Category–B refers to applicants applying for the Fourth time (and Fifth time

from Gujarat, Kerala, Uttarakhand, Maharashtra, Madhya Pradesh, Delhi, J&K and

Haryana),

All other applicants are covered in General category. Reserved category applicants

have to give additional information regarding companion and previous year's Cover

No./Passport No.

Column 2 : Tick the desired accommodation category. Details in para 16 of Guidelines.

Note that for Haj-201 , the Haj amount payable for Green category was 6

Rs.2,1 ,000 (approx) and for Aziziya it was Rs.1,85,000 (approx)9

Column 3 : Enter name of Cover Head who has to be an adult male. He shall be responsible for

all communications / payments / refunds. All members of a Cover must be close

family members.

Column 4 : Fill applicant's details as per passport.

Qualification should be one of the following:

Aalim / Mufti, Graduate, Matriculation (SSC), Post Graduate, Primary, Under

Graduate (HSC)

Occupation should be one of the following:

Business, Cultivation Doctor, Government Service, House Wife, Professional,

Private Service, Retired, Student, Others.

Column 5 : Fill complete and correct postal address / mobile number / e-mail id.

Column 6 : Fill complete details of nominee of the applicant.

Column 7 : Fill details of Mehram, in case of lady pilgrims only.

Column 8 : If applicant is a permissible Repeater (refer para 2 of Guidelines) tick Yes, otherwise No.

Column 9 : Fill details of bank account of Cover Head.

Column 10 : If all applicants of the Cover want to perform Adahi (Qurbani) through IDB, tick Yes,

otherwise No.

Column 11 : Tick mark only ONE language for Haj Guide.

Column 12 : If applicant is an NRI, tick Yes, otherwise No.

Column 13 : If applicant is a Shia pilgrim opting for Johfa as Meeqat, tick Yes, otherwise No.

E) Submit complete HAF to State / UT Haj Committee concerned, with following enclosures, as applicable. -

i) Original International Passport / Self attested photocopy of valid International

Passport (as applicable) ,

ii) Proof of address : If address is same as in the Passport no additional document is

required. Otherwise a Photocopy of any one of the following is to be attached.-

Ration Card, Driving License, Electricity Bill, Telephone Bill, Water Bill, Gas

connection, Election Commission Photo ID card, Income Tax Assessment order,

Employee's Identity Card, Aadhar Card,

iii) Original Bank pay-in-slip,

iv) Copy of cancelled cheque / bank passbook,

v) Solemn Declaration (as applicable).

(PAY-IN-SLIP to deposit Rs.300/- per pilgrim and maximum of Rs.1,500/- only)

HAJ COMMITTEE OF INDIA

Bait-ul-Hujjaj (Haj House), 7-A, M.R.A. Marg (Palton Road), Mumbai - 400 001.

Branch : Code :BANK COPY

HAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE) COLLECTION - DETAILS

ACCOUNT NUMBER : 35398104789 “HAJ PILGRIM PROCESSING FEE ”

PASSPORT NUMBER OF COVER HEAD

Name of Cover Head

Date of Deposit : - 2017 Mobile Number

PARTICULARS OF THE PAYMENT :

Sr. No. NAME OF THE PILGRIM ADDRESS OF COVER HEAD CASH NOTE AMOUNT IN RS.

x 500 =

x 100 =

x 50 =

x 20 =

x 10 =

x 5 =

Amount (In words) Rupees ___________________________________________________________________ Total Rs. =

Transaction ID (Bank journal No.)

Branch Stamp with Signature Deposited by

Branch : Code :HCol COPY


ACCOUNT NUMBER :


Name of Cover Head




x 500 =

x 100 =

x 50 =

x 20 =

x 10 =

x 5 =




Branch : Code :PILGRIM COPY


ACCOUNT NUMBER :


Name of Cover Head




x 500 =

x 100 =

x 50 =

x 20 =

x 10 =

x 5 =




State Bank of India

NOTE- photo copy of pay-in-slip may also be used for deposit of amount. If any difficulty, please contact SBI, Mumbai Main Branch. (Mob. No. 09930766530, Tel. No. 022-2262 3971)

35398104789 “HAJ PILGRIM PROCESSING FEE”

35398104789 “HAJ PILGRIM PROCESSING FEE”

HAJ COMMITTEE OF INDIA

Bait-ul-Hujjaj (Haj House), 7-A, M.R.A. Marg (Palton Road), Mumbai - 400 001.

Branch : Code :


ACCOUNT NUMBER : 318702010406010 “HAJ PROCESSING FEE ACCOUNT”


Name of Cover Head

Date of Deposit : - - 2017 Mobile Number



x 500 =

x 100 =

x 50 =

x 20 =

x 10 =

x 5 =

Amount (In words) Rupees _________________________________________________________________ Total Rs. =



Branch : Code :PILGRIM COPYHAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE)

COLLECTION - DETAILS

ACCOUNT NUMBER : 318702010406010 (HAJ PROCESSING FEE ACCOUNT)


Name of Cover Head




x 500 =

x 100 =

x 50 =

x 20 =

x 10 =

x 5 =




(PAY-IN-SLIP to deposit Rs.300/- per pilgrim and maximum of Rs.1,500/- only)

Branch : Code : BANK COPYHAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE) COLLECTION - DETAILS

ACCOUNT NUMBER : “HAJ PROCESSING FEE ACCOUNT”318702010406010


Name of Cover Head




x 500 =

x 100 =

x 50 =

x 20 =

x 10 =

x 5 =

Amount (In words) Rupees ________________________________________________________________ Total Rs. =



Union Bank of India

NOTE- photo copy of pay-in-slip may also be used for deposit of amount. If any difficulty, please contact UBI, Null Bazar Branch. (Mob. No. 09820199314, Tel. No. 022-2377 3081)

HCol COPY

Documents

HAJ COMMITTEE OF INDIA HAJ APPLICATION … COMMITTEE OF INDIA HAJ APPLICATION FORM FOR HAJ - 1438 (H) - 2017 (CE) 3. NAME OF COVER HEAD (Male adult only) (iii) General 1. CATEGORY: