APPLICATION FOR ALLOTMENT OF GOVERNMENT RESIDENTIAL ACCOMODATION TO BE ANNEXED WITH THE WAIT LIST DRAWN FOR THE BLOCK YEAR 2009-10 TO BE FILLED BY APPLICANT 1. Name in Block Letters : 2. GPF / PRAN No. : 3. Basic Pay as on 1.7.2009 : Pay fixed in the VI Central Pay Commission i) Pay Band : Rs. ii) Pay in the Pay Band : Rs. iii) Grade Pay : Rs. iv) Basic Pay(Pay in the Pay Band + Grade Pay) : Rs. 4. Designation : 5. Office in which working (a) Department : (b) Office address at which posted & Telephone No. : 6. Permanent Residential Address : with Telephone No. & Cell No. 7. a) Date from which continuously employed on regular basis under Central/State Government in the entry grade including Foreign service, if any(i.e. Date of Priority) : b) If applied for Type V quarters date on which promoted to the pay band carrying the Grade Pay of Rs.7,600/- : 8. Eligibility Type as per classification of Pay Grade Pay (Tick the appropriate one) : Type I / Type II / Type IV / Type V (Located at Lawspet only) Type III (Lawspet / Olandai / Either) 9. Whether allotment of Quarters has been : made during the period from 01.08.2009 Yes / No to February 2010 in terms of Grade Pay 10. Pool under which you are applying : General (Tick the appropriate one) Scheduled Caste (Outlying Region refers to those who have Scheduled Tribe declared Home Town address at Karaikal / Physically Handicapped Mahe / Yanam as per the entry made in the P.C.S. Service Book are only considered under Outlying Region Outlying Region category) 11. Date of Retirement on Superannuation : 12. (a) Sex : Male / Female (1) / Female (2) (b) In case of female (Marital Status) (Unmarried-1, Married-2) : (Tick the appropriate one) ..2/- Department of Personnel and Administrative Reforms Chief secretariat Puducherry -2- 13. Whether Temporary or Permanent : Temporary / Permanent (Tick the appropriate one) 14. a) Are you / your spouse occupying Government accommodation allotted by the Department, if any (Tick the appropriate one) : Yes / No b) If yes, fill the name of allottee, : Quarter No. Type and Pool 15. a) Are your spouse employed under Central Government / State Government / Boards / Autonomous bodies etc. including foreign Service, if any. (Tick the appropriate one) : Yes / No b) If yes, office in which working i) Department : ii) Designation & date from which continuously employed on regular basis : iii) Pay fixed in the VI Central Pay Commission i) Pay Band : Rs. ii) Pay in the Pay Band : Rs. iii) Grade Pay : Rs. iv) Basic Pay (Pay in the Pay Band+Grade Pay) : Rs. 16. Service to which the applicant belongs : 17. a) Have you ever been debarred from allotment of Government residence : Yes / No (Tick the appropriate one) b) If yes, upto which date : c) If any rent outstanding against the applicant in respect of Government accommodation occupied previously and since vacated : 18. Do You /Your spouse/your dependant children own a house within the jurisdiction of local Municipality or any adjoining Municipality. If yes, give particulars of the house. (Tick the appropriate one) : Yes / No 19. Are you working in an office of Puducherry Administration : Yes / No (Tick the appropriate one) 20. Whether you belong to SC/ST/PH/OR/PCS/ : SC / ST / PH / OR / PCS / Others Others (Attested copy of the certificate in respect of SC/ST/PH should be enclosed) (Tick the appropriate one) ..3/- -3- DECLARATION 1. I am working in an eligible Office. 2. I agree to abide by the Allotment of Government Residence (Union Territory of Puducherry) Rules, 1981 as amended from time to time or relevant Allotment Rules applicable. 3. I am aware of the penalties to be imposed in the event of refusal of acceptance of allotment of accommodation of the entitled type or furnishing of false information. 4. I am also aware of the penalties to be imposed and disciplinary action to be taken in the event of subletting the Quarters allotted and overstayal as well. 5. I hereby undertake that I will not cultivate or involve in any immoral and unlawful activities in the Quarters and its premises. 6. I hereby undertake that in the event of allotment of ready built house / flat to me by the Puducherry Housing Board, etc. or the construction of house of my own or by my dependant family members is completed by raising HBA or by other means and on my retirement / quitting from service, I will vacate the quarters allotted to me immediately and handover the same to Government as per the existing rules in force. 7. I will intimate the change of the office address in the event of my transfer to any other office while in occupation of the Government Quarters, to the Under Secretary (Housing), Chief Secretariat and Executive Engineer, Buildings & Roads (Central) Division, PWD, Puducherry at once. . 8. I have not been allotted any quarters in the same type for which applied now during this block year for the period from 01.08.2009 to February 2010. Date: Signature of the Applicant. ..4/- -4- TO BE FILLED IN BY THE HEAD OF OFFICE: 1. Name of the Government Servant : 2. GPF / PRAN No. : 3. Designation : 4. Office / Department in which working : 5. Pay as on 1.7.2009 a) Pay fixed in the VI Central Pay Commission i) Pay Band : Rs. ii) Pay in the Pay Band : Rs. iii) Grade Pay : Rs. iv) Basic Pay (Pay in the Pay Band + Grade Pay) : Rs. 6. Date of regular initial appointment in : the entry grade 7. Total Qualifying regular service : Y - M - D 8. Date of retirement : 9. Home Town Address as verified with Service Book (Those who have declared Home Town : address at Karaikal / Mahe / Yanam are only considered under Outlying Region (OR) category) 10. Belongs to SC / ST / PH / OR / PCS : (Attested copy of the certificate in respect of SC / ST / PH should be enclosed) 11. Details of amount and date of HBA loan drawn for the construction of house either in the name of Government Servant or his dependant family members through Government or raised from any other banking or non-banking financial institution, etc. : Certified that particulars furnished by the Applicant have been verified with reference to records and found correct. Signature of the Head of Department / Office with Date and Office Seal : Name : Designation : Telephone No.: Endorsement No.:
