Form III A & N Administration Secretariat. (Application for Change of Accommodation under S.R. 317-B-15) Name......................... Present designation..................... Date of Retirement...................... Name of Pool .......................... Particulars of Accommodation presently occupied: Quarter No. Allotment Order No. & date. Locality/Colony Type of quarter Date of priority for Present type Date of Occupation Name of office/ Institution in which working at the time of allotment. Particulars for change desired (See instruction below) : Preference Road, Colony or locality. Design of construction Floor i.e. G/floor, 1st, 2nd, or 3rd Office/institution in which presently Working. 1st 2nd 3rd (Note: Specific quarter number should not be written) Copy of allotment order for the present quarter may be enclosed. Reasons for change requested. .............................. .............................. .............................. 8. Medical certificate to be enclosed if change sought on medical grounds. Declaration a) I have not availed of a change of residence earlier in the type of accommodation occupied by me under S.R.317-B.15. or under Rule 16 of the Allotment of A & N Administrative Residences (General Pool) Rules, 1991. b) This is the first application for such change. c) This application is in modification of the preference given by me vide serial No. ....... of the waiting list for the month of ..... 19 ./2001. Signature Designation Address ------------------------------------------------------------------------------------------------------ No. A & N Administration Deptt/ Office....... Port Blair dated the 2001. Forwarded to the Secretary (GA), A & N Administration, Secretariat, Port Blair. The facts stated above are correct. Signature.......... Designation......... Office Seal. ________________________________________________________________________ NOTE:- Change is allowed for the same type. Request for entitle type which is higher than the quarter allotted, should be made in Form I, which will be treated as application for fresh allotment.
