GOVERNMENT OF NCT OF DELHI LAND & BUILDING DEPARTMENT VIKAS BHAWAN : NEW DELHI-2 Application for accommodation under Govt. of NCT of Delhi Govt. residence (General Pool) Rules. Part-I (For office use only) Type for which Category under which Priority No. Remarks Applied applied Part-II (To be filled up by the applicant) Please read instructions carefully before filling the form. Incomplete application will be rejected without any further reference. Please fill up the form neatly/ preferably in BLOCK LETTERS. Fill up dates as Day (01-31), Month (01-12) & Year (2002) in the format. Please tick wherever required to do so. 14. Indicate the pool for which you are applying: Pools Available General Pool SC Pool ST Pool Type Eligible Basic Pay Range Cut off date Please Tick The type Pool(s) under which applied GP/SC/ST I 2550-3049 31.12.95 II 3050-5499 31.12.90 III 5500-8499 31.12.90 IV 8500-11999 31.12.85 V & above 12000 & above ----- Note: a) Employees employed after the cut off date need not to apply. b) Cut-Off dates for SC/ST/Ph. Handicapped/ Medical Ground are not applicable. 15 Are you applying on Medical Grounds? (T.B., Cancer, Heart ailments, blind, Deaf, Orthopaedically Handicapped). If yes, enclose the photocopies of Ration card/ Latest Medical Papers from Government Hospital Yes No 16. Address of place of duty of the Applicant 17. Permanent address ( if any) Phone: Phone: 18. If you wish allotment in specific localities only, please indicate three options giving Locality where allotment is to be considered. (Refer to Instruction no.1) A B C Declaration by the Applicants: A. I agree to abide by the Allotment of Government Residences (General pool in Delhi) rules, 1977 as amended from time to time or relevant allotment rules applicable. B. I am aware of the penalties, which can be imposed in the event of refusal of acceptance of allotment of accommodation of the entitled type under SR-317-B-10 or furnishing of false information, subletting/misuse of the premises under SR-317-B-21. Date: Signature of the Applicant: Part-III To be forwarded by the employee's office 1. No accommodation has been allotted by the Directorate of Estates/ Govt. agency to the applicant whose basic pay is ___________________________as on 1.1.2002. 2. Certified that particulars furnished by the applicant have been verified from records and found correct. It is also certified that the applicant is employed in an eligible office and has not been debarred from allotment of general pool accommodation. Signature with date: _________________ Name ___________________________. Designation ______________________. Office Seal Phone............
