Number of visitors * Select number of visitors Single Entry 2 Group/Family Members 3 Group/Family Members 4 Group/Family Members 5 Group/Family Members 6 Group/Family Members 7 Group/Family Members 8 Group/Family Members

Visitor 1 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 2 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 3 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 4 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 5 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 6 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 7 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Visitor 8 Name

Gender Select Gender Female

Age Age Group Less than 10 yrs 10 - 18 yrs 18 - 25 yrs 25 - 40 yrs 40 - 50 yrs 50 - 60 yrs 60 - 65 yrs 65+ yrs

Location Select location Kalyan (W) Kalyan (E) Dombivli Ulhasnagar Ambernath Badlapur Other

Other location

Email address

Vehicle Type Vehicle type Two wheeler Four wheeler No Vehicle

Vehicle Number

I hereby declare that, I have no symptoms of COVID 19, nor I am currently diagnosed with COVID 19.

I hereby declare that I have installed and updated information on my Arogya Setu app.

I hereby declare that the information given in this booking is true and correct to the best of my knowledge and belief. In case any information given proves to be false or incorrect, I shall be responsible for the consequences.

Note:

• You would be required to show this pass to the security guard at both entry & exit gates.
• Please take a photograph of the QR code and keep it in your phone in case there are connectivity issue.
• In order to follow social distancing norms, stores may ask customers to wait outside for sometime even after their entry slot time has started.
• Entry won't be allowed after the chosen time slot is over. Please be punctual!!
• Please wear your mask and maintain adequate distance from others. Avoid touching surfaces in common areas. Use hand-washes provided at various points as often as possible.
• Metro Junction Mall holds the right to reject entry if the customer exhibits high temperature, shows any other COVID 19 symptoms or is not following social distancing norms or is not wearing mask, etc.
• Metro Junction Mall management has the final right to amend and redirect any bookings based on the prevailing situation.
• Please bring any original id card for verification.
• Please write to infodesk@westpioneerindia.com or call 8291188743 for Customer Support