Application Form for ILP

Temporary Inner Line Permit

Application Form

Please complete all mandatory fields marked with *.

Applicant Name : *

Parent/Guardian's Name : *

ID Proof: *

ID No. : *

Email :

Mobile No.: *

Period of Stay : *

Place of Stay in Manipur *

Purpose of Visit : *

Gate: *

Date of Birth *

Gender : *

Male

Female

Others

State : *

District : *

Police Station : *

Village/Street : *

Tehsil :

House No.:

	I agree to the following terms and conditions.
	a)I shall be responsible for the good conduct during my stay in the state of Manipur. b)I shall leave the State anytime, if the authorities direct. c)I shall furnish my whereabouts if called upon. d)In the event of any default on my part, I shall be liable for prosecutation by competent court.

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