Form-W5 Housing Subsidy - Rubber Board Labour Welfare Division Application Form For Housing Subsidy For Plantation Workers (Other Than Ne Sector) Page 2
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2
3RUBBER BOARD Labour Welfare Division
Application Form PART-B
(To be filled by the applicant)
Tick the applicable boxes.
Have you applied for housing subsidy earlier? Yes
If so, Application
No
No. & Date
c1- Housing Subsidy
Registered owner of the
Applicant
Spouse
Jointly with spouse
Land
property in which the
Area
construction is proposed
Parent
Possession of Govt. property
(Ha)
Name of owner
of the property
Relationship with
the applicant
Survey No.
Village
Ward/House No.
Taluk
District
State
Pin Code
Rubber Board Office near
the construction site
Present Level of construction
of the house building
Does the applicant/spouse possess any other
house in own name? Yes
No
if yes, furnish details of property/ownership
Location/Route to the house construction
site, nearest bus stop etc.
Whether financial assistance received
Yes
No
from other agencies/sources
If yes, Name of agency/ source
Amount received Rs.
Estimated Cost of construction of house Rs.
How long (in years) are you in
possession of the this property
Whether Electric Connection is Obtained?
Yes
No
Name of Local authority
(Panchayat/Municipality/Corporation)
The details furnished above are completely correct to the best of my knowledge and belief.
If any information furnished is found false, I agree to refund the amount received
Name:
Signature of Applicant:
Date:
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