Post on 18-Apr-2020
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
HAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE) COLLECTION - DETAILS
ACCOUNT NUMBER :
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 :PILGRIM COPY
HAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE) COLLECTION - DETAILS
ACCOUNT NUMBER :
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
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 :
HAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE) COLLECTION - DETAILS
ACCOUNT NUMBER : 318702010406010 “HAJ PROCESSING FEE ACCOUNT”
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 :PILGRIM COPYHAJ COMMITTEE OF INDIA HAJ 1438 (H) - 2017 (CE)
COLLECTION - DETAILS
ACCOUNT NUMBER : 318702010406010 (HAJ PROCESSING FEE ACCOUNT)
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
(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
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
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