Request Form for User Registration
(Form C)
User Details
User ID Guwahatiresidency5
Name Lipika Das
Gender Female Date of birth 31/05/1963
Designation Owner Email id hotelguwahatiresidency@[Link]
Mobile 9435101172 Phone no 7670014114
Nationality INDIA
Hotel / Guest House / Dharamshala / Institute / Individual House / etc. Details
Name Guwahati Residency
Capacity 14
Address Nayanpur Road, Ganeshguri - 781005
State ASSAM City/District KAMRUP
Accomodation type Hotel
Accomodation grade Others
Email id hotelguwahatiresidency@[Link]
Mobile 9435101172
Phone no 7670014114
Owner's Details
Name Lipika Das
Address House No 44, Amulya Bhawan, Sati Jaymoti Road, Chabipool, Guwahati - 781008
State ASSAM City/District GUWAHATI
Email id hotelguwahatiresidency@[Link]
Mobile 7670014114
Phone no 9435101172
_______________
Signature of the Applicant
Date--------------------
Place--------------------
_______________
Name and Signature of Hotel / Guest House / Dharamshala / Institute / Individual House / etc.
Date--------------------
Place--------------------
Registration office address
Office Name : FRO KAMRUP CITY
Address : Security Intelligence, Guwahati, Police Reserve, Near Sishu Sarothl, Sirubari, Guwahati, Assam
City/ District : KAMRUP
State : ASSAM
Pin Code : 781016
Phone Number : 000000
