Allotment of Housing

Applicant Name:

Address:

Door:

Building:

Street:

Locality:

Area:

City:

State:

PIN:

Landmark:

Landline Telephone:

Mobile Telephone:

Email ID:

Date of Birth:

- -

Sex:

—Please choose an option—MaleFemaleTrans-Sexual

Marital Status:

—Please choose an option—UnmarriedMarriedSeparatedDivorcedWidow / Widower

No. of Children:

Total no. of persons who will occupy the premises (incl. Applicant): Adults: , Children:

S. No.

Full Name

Age

Occupation

Gross Income (PM)

Relationship to Applicant

1.

2.

3.

4.

5.

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? —Please choose an option—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.