Application Form for Grant of House Rent Allowances to the Government Employees by the Government I hereby undertaking that: 1. I had applied for allotment of accommodation but not allotted any. 2. I am not residing in any residential accommodation provided by the Government Department/Estates Department /Municipality during the period in question. 3. I do not possess a house of my own within the municipality limit of the city of ____________ not has a house in the name of my husband/parents/wife or any other member of the family within whom I am living. 4. If I am allotted any accommodation subsequently, I will cease to draw the allowance. 5. I put in a rental Accommodation let me by Shri ________________________ R/o_____________________________________@ Rs._______________________ per month. 6. If anything Contrary to the above is provided I shall be liable to refund the amount drawn for the period in question and shall also be liable to appropriate disciplinary action. Signature ___________________________ Designation__________________________
