FORM VI APPLICATION FORM FOR ISSUE OR PERMISSION TO MORTGAGE PLOT/HOUES/SITE NO._________________ SECTOR/PHASE___________________ 1. Name of Allottee ___________________________________________________ 2. Name of Father/Husband____________________________________________ (of allottee) 3. Permanent Address ___________________________________________________ (of allottee) (Telephone No.) 4. Correspondence Address________________________________________________ (Telephone No.) 5. Details of up to date payment made to PUDA _______________________________ 6. Date of allotment/possession: ___________________________________________ 7. Whether the building plan _____________________________________________ is approved or not, if approve mention the Number and date. 8. Purpose of taking loan ____________________________________________ 9. Amount of loan required Rs. (a) For payment towards cost of Plot/House _________________________ (b) For construction of building _______________________________ (c) Any other purpose _______________________________ Total 10. Name of the institution from which loan is being obtained ________________________ (Signature) Note: Please specify whether the loan is required for payment towards cost of land/house, for construction of building on both or any other purpose. If loan is required for construction of building only, No Due Certificate from PUDA and certified copy of conveyance deed is furnished. The text and format of this form can be changed any time with the change in policy matters LIST OF DOCUMENTS TO BE SUBMITTED BY THE APPLICANT:- i) Attested copy of allotment/re allotment/change of ownership letter etc. (As proof of ownership). ii) Copy of the sanctioned building plan required for the construction purpose. iii) Affidavit (as per enclosed specimen). iv) NDC and certified copy of Conveyance Deed (where applicable). v) Consent of mortgage department/Organisation. ACKNOWLEDGEMENT SLIP Application received for permission to mortgage from Sh./Smt. ______________________________in respect of Plot/Site/House No. ____________ Sector/Phase________ on ________ File No. ______ and a sum of Rs. ______________ vide receipt No. _________________has been received. The applicant may contact the Estate Office on __________ to collect the document otherwise the documents will be despatched by post on __________. Signature of Diary Clerk Specimen of Affidavit to be furnished by the ALLOTTEE on a non judicial stamp paper of Rs. 15/- along with passport size photograph duly attested by Executive Magistrate or Magistrate Ist Class AFFIDAVIT I/We _________________________________ S/o, D/o, W/o Shri/Smt.________________ R/o ___________________ Aged __________ allottee(s)/owner(s) of Plot/Site/House No. ________________ Phase/Sector________________________ Area in Square Yards _________________ in Urban Estate ________________ do hereby solemnly affirm and declare as under:- 1. That I/We intend to obtain loan of Rs. _____________ (Rs. ___________________) for the payment of cost of site/plot and for the purchase Rs. _______ (Rs. _________________ in words) for the construction of the building thereon from __________________ which is a corporate body/cooperative society approved by authority/scheduled bank/LIC/Govt. of India of State Govt. 2. That I/We undertake to pay the entire balance amount due towards the cost of the land to PUDA (to be specified) within thirty days (30) from the date of sanction of loan. 3. That I/We after making full payment of site/plot, a conveyance deed will be executed on the prescribed format of PUDA and certified copy thereof will be submitted to PUDA within 15 days after execution of the same. 4. That I/We shall be bound to make the payment of additional price in respect of the plot/site as may be determined and demanded by Estate Officer PUDA as per the terms and conditions of allotment letter. DEPONENT(S) VERIFICATION: Verified that the contents of the above affidavit are true to the best of my/our knowledge and belief. No part thereof is false and nothing has been concealed therein. DEPONENT(S) Place: Date:
