Wednesday, 01 September 2010 05:30
Download Application for Quarter
|Department||General Administration Department|
|Title||Application for Quarter|
|Document Size||54.1 KB|
Text of the PDF document(for quick reference)
Application No. Application D ate APPLICATION FOR QUARTERS ( Put tick m ark (P)toselectwhicheverisapplicable ) Office Secretariat Head of Department District Others Category Space for Stamp Size Photograph (for Non-Government applicants) Principal Secy. / Comm.-cum-Secy / Addl. Secy / Jt. Secy / Dy. Secy / Under Secy Govt. of India Employee Employee of Board / Corporation / Private Essential Services Sports Person NGO Deputed to Govt. of India National/State Award Winner Media Person Others Specify details: 1. Personal Details (In Block Letters) B. Father's / Husband's Name E-mail _________________________@___________________________________________________________ 2. Present Posting Details (i) Designation___________________________ (ii) Department/Organisation ____________________________ (iii) Scale of Pay __________________________ (iv) Present Basic Pay ___________________________ (v) Gazetted Non-Gazetted (vi) Group A B C D 3. Marital Status : Single Married Widow Childless Widow 4. Health Status of Applicant /: Blind Cancer Paralysis Polio Heart Surgery Kidney Surgery None Dependant ( Give details and attach certificate as applicable) 5. Any quarter allotted to: Father Mother Spouse Son Unmarried Daughter None If allotted, Specify Qr. Type____ Qr. No______ Area _______________ Date of Allotment___________Order No.______/__________ 6. Any House at Bhubaneswar : Self Spouse Son Unmarried daughter None If yes, Plot No. ___________, Area _______________________, PO ________________ PIN _____________ 7. Applicant appointed under Rehabilitation Scheme? - Yes/No 8. Willing for joint accommodation? - Yes / No 9. Willing to avail lower type, in case entitlement is not available? - Yes / No 10. The area of choice in order of preference 1) 2) 3) 11.Whether any GA Quarter was previously allotted? - Yes / No If Yes, give details Qr. Type ____ Qr. No______ Area _____________Period: From_________ To________ Order No. _______/___________ Whether any penal action has been taken for non-vacation of quarters? Yes / No, (If Yes, Give Details) 12. Remarks: Signature of the Applicant The application of Shri / Smt/Ms. ______________________________ is recommended for consideration of new allotment / exchange of quarter. Signature of Secretary to Government / Date: Head of the Department / Head of Office/ Authorised Sponserer ( with seal ) Check List ( For office use only ) Necessary document(s) regarding category Affidavit of no allotment of quarters to near relatives Affidavit regarding no penal action for non-vacation of quarters Rehabilitation Scheme Appointment Order Affidavit of not having house at Bhubaneswar Stamp size photograph Medical Certificate Award Certificate Proof of Sportsperson Others Signature of Verifying Officer ( Acknowledgement ) Application No. & Date Date of Receiving the Application Received application of Shri / Smt/Ms.______________________________________, Designation ____________________ of ________________________________ for new allotment / exchange of quarters. Please refer your Application No. or GPF No. for further enquiry. Signature of Receiving Officer Following Documents are not available with your application 1. 2. 3. 4.
Last Updated on Friday, 17 December 2010 05:30