Application Form For Allotment Of Guest Accommodation

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RAJYA SABHA SECRETARIAT
APPLICATION FORM FOR ALLOTMENT OF GUEST ACCOMMODATION
From
_____________________________________, ex-MP
To
The Chairman,
House Committee,
Rajya Sabha.
Subject:
Allotment of guest accommodation in V.P. House/
North Avenue/South Avenue.
Sir,
I require guest accommodation in suite/flat V.P. House/North Avenue/South
Avenue for my personal occupation from ________________ to ______________
My particulars are furnished below :-
(i)
Name
:________________________________
(ii)
Age:
: ________________________________
Father’s/Husband’s Name
(iii)
: ________________________________
(iv)
Profession
: ________________________________
(v)
Details of membership in
: From __________To _____________
Rajya Sabha
(vi)
Permanent Address with
:________________________________
Contract telephone number
________________________________
_________________________________
(vii)
Guest accommodation, if any, occupied previously :-
(a)
Flat/suite No.
: ________________________________
(b)
Period of occupation : ________________________________
(viii)
This is to certify that the above accommodation is for my personal
occupation.
Place: ___________________
Signature of ex-M.P. : _________________
Date : ___________________
Name of ex-M.P. : ____________________
I.C. No. : __________________________
UNDERTAKING BY THE SPONSORING MEMBER
I hereby certify that particulars given above by my guest are correct and
hence allotment may be made.
I will comply with the terms and conditions
applicable for guest accommodation. The same will also be adhered to by my guest.
I shall be responsible for ensuing payment of all dues in respect of the guest
accommodation and its vacation on expiration of the allotment period.
Place: ________________
Signature of M.P. : ______________________
Date : ________________
Name of M.P. : _________________________
I.C. No. : _____________________________

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