Allotment of Housing Fields marked in Red are mandatory. Basic Details Applicant Name: Address: Door: Building: Street: Locality: Area: City: State: PIN: Landmark: Landline Telephone: Mobile Telephone: Email ID: Date of Birth: - - Sex: ---MaleFemaleTrans-Sexual Marital Status: ---UnmarriedMarriedSeparatedDivorcedWidow / Widower No. of Children: Total no. of persons who will occupy the premises (incl. Applicant): Adults: , Children: Details of family members / relatives of the Applicant who will be staying with the applicant: S. No. Full Name Age Occupation Gross Income (PM) Relationship to Applicant 1. 2. 3. 4. 5. Addtional Details If Retd., Date of Retirement: Retirement Benefits Obtained: Current Income: Present Accomodation: My Own. Present Market Value: On Rent. Monthly Rent (Incl. Maintenance): On Lease. Lease Details: Others. Details: Is the applicant going to sell/give up the present accommodation? If not, what is the applicant going to do with it, if he/she is allotted accommodation. Are all the relations mentioned under Item No.2 above, presently staying with the applicant? ---YesNo If not, how many Adults: , Children: Give complete details of present accommodation i.e., number of rooms, area etc.: Do you or any of your family members own a vehicle ? Give details: (Two Wheeler/Four Wheeler) Do you have a telephone at the present residence ? Give details: Declaration: The information furnished above is true to the best of my knowledge and belief. I hereby give an undertaking that my application can be rejected on the information furnished me being found to be false or incorrect. I further agree that even if the flat should be allotted to me and therefore at any time the information furnished by me is proved to be false or incorrect, I shall voluntarily vacate the premises and give vacant and peaceful possession of the premises to the Anjuman. Gross income should include business and service income, dearness and other allowances, property and investment income, if any, of all the earning members of the family. The Managing Committee reserves the right to call for original certificates of income from employees. You maybe required to come to Anjuman Office and fill / sign on a printed copy of your application.