Application For Retention Of General Pool Residential Accommodation-Directorate Of Estates-Government Of India Form Page 2
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1
213.
Do you / your spouse / your dependent children own a house, a plot of land / member of a housing society
within the jurisdiction of Local Municipality or any adjoining municipality? If yes, please indicate
a) Owner’s Name
c) Relationship with
b) House
Applicant
Address
d) Rental Income
14. In case eligible for alternative accommodation, please
YES
NO
indicate whether Hostel accommodation is required ?
15. Has the request been made within one month of the
YES
NO
relinquishment of the charge at the last station of posting ?
16. Full Name & Postal address of the
person nominated to convey the
acceptance and take possession of
alternate accommodation is required
17. Name & address of the person
authorized to deposit License Fee
18. Address of Place of Duty of the Applicant
19. Permanent address (if any)
Phone
Fax
Phone
E-mail
UNDERTAKING
As soon as I am transferred from the State / Union Territory mentioned above, I undertake to inform the
Directorate of Estates / Regional Office concerned about such transfer giving full particulars of accommodation
in occupation of my family members within 15 days of such transfer. I also undertake to intimate Directorate of
Estates / Estate Manager, if I purchase / acquire residential premises and also intimate if the income from own
house if revised.
Date: __________________
Signature of the Applicant: _____________________
TO BE FILLED IN BY THE FORWARDING OFFICE
Department Code
Endorsement No.
Date
Office Name
Forwarded to the Directorate of Estates / Estate Manager / Assistant Estate Manager. The above facts have been
verified from records.
Signature with Date : _______________________________
Name
____________________________________
Office Seal
Designation
____________________________________
Phone
____________________________________
E-mail
____________________________________
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