NO. 002048 Form "A" APPLICATION FORM FOR ALLOTMENT OF GOVERNMENT RESIDENCE (CHANDIGARH ADMINISTRATION GENERAL POOL) AT CHANDIGARH To The Secretary House Allotment Committee, Chandigarh Administration. Subject : Application for the allotment of house (Chandigarh Administration General/Transit Accommodation Pool) at Chandigarh. Sir, The undersigned applies for the allotment of a.......................................... type house at Chandigarh. l. Name in Block letter 2. Designation 3. Father's/Husband's Name 4. (a) Date of birth (b) Date of retirement : 5. Place of duty & Present Address (a) Official Address : (b) Residential Address : 6. (a) Date of Joining Govt. Service : (b) Pay and special pay on that day : (c) Scale of pay. (d) Designation/Group on that day. 7. Whether permanent/regular or not. 8.Particulars of the Government house under the occupation of applicant or his/her spouse : 9.Whether the applicant or his spouse or any of his dependent children owns, any house in the Union Territory of Chandigarh, Panchkula or Mohali. (a) if yes, give details thereof i.e. House No., Sector, Place, Area, Rental Value etc. (b) Is the applicant ready to pay double the normal licence fee. 10. Whether the applicant has applied for any other category house : 11. Whether the applicant has ever been debarred for allotment of government residence. (a) If yes, give details thereof. 12. (a) Date since when he Is entitled for the type of house applied for. (b) Basic Pay & Special pay on that day (c) Scale of Pay (d) Designation & Class (Group) on that date. 13. Whether pay was ever reduced or he was ever demoted after the date since when he is entitled for the type of house applied for. 14. Present pay/Designation on the date of application. (a) Basic pay & Special Pay. (b) Scale of pay. (c) Designation / Group of service. DECLARATION 1. I Certify that 1 have been serving In the office of the Chandigarh A Government or State Government or Punjab and Haryana High Court or on foreign service, except for periods of leave without pay since ................................ (in case there is any break, this may be specified ). 2. I certify that 1 have not been debarred from allotment of any type of house. If. debarred give reasons for debarration alongwith he Allotment..............................dated. .................................. with which previous house was allotted. If government house was surrendered. No. of house. Type of house and sector with date of action may be indicated. 3. I certify that I have not applied for any other type of house. 4. I agree to abide by the Government Residence (Chandigarh Admn. Pool) Allotment Rules 1996 amended from time to time. 5. I certify that my stay in the Government service is continuous from date of entitlement, as shown in column No. 12. During the said period my pay was neither decreased due to demotion or any other reason nor demoted from the post. 6. I certify that the particulars given above are true and correct to the best of my knowledge and belief and nothing has been concealed thereform. In case the particulars given above are found incorrect. I shall be liable for disciplinary action in addition to cancellation of allotment of my house. 7. I undertake to intimate within seven days that fact of my retirement/transfer to any other office (whether eligible or ineligible) failing which I render myself for cancellation of the house under my occupation. Yours faithfully, (Signature of the applicant) Endst. No. Dated : Forwarded in original to the Secretary, House Allotment Committee, Chandigarh Administration. 1) a) It is certified that the particulars mentioned above by the applicant are correct. b) That his/her stay as declared in Cot. No. 12 (to be certified i. e. Form ............................ making him/her entitled for the allotment of ........................ type house as applied for has been verified from his/her service record and is correct. c) That she/he has been drawing the basic pay of Rs.......................... plus special pay of Rs......................... from .................... and has been holding the post if ........................ class/group I/II/III/IV post from ........................ and it was not decreased due to demotion or any other reason at any time since the date of his/her entitlement. 2) It is certified that as per records of this office he or his spouse or any of his dependent children owns/does not own any house at Union Territory of Chandigarh, Panchkula or Mohali. 3) It is certified that the applicant has not applied for any other type of government residence. 4) It is certified that the applicant has never been debarred for allotment of government residence due to any reason. (Head of Department) With Seal. Note :- The Head of office should not forward any application unless he has satisfied himself about the particulars filled in by the applicant.
