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www.sahayam.in
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APPLICATION FOR THE ALLOTMENT OF GOVERNMENT SERVANTS QUARTERS IN KERALA
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1Name of Officer
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2Date of Birth
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3Whether belongs to SC or ST
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4Office or department on which employed
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5Pay and scale
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6Designation
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7Permanent or acting
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8Years of service for retire with date of retirement on superannuation
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9Permanent home address with Village, Taluk and District
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10Whether married
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11Whether wife is employed and if so particulars regarding name, designation, place of employment, pay and scale of pay
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12Whether the applicant own a house or other residential buildings within their headquarters cities or town within radios of 15 KM. From their own names or in the name of his/her husband /wife or in the name of their unmarried sons or daughters whether inherited or obtained otherwise including that under any hire purchase scheme .
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13Intended to live with family
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14Living alone or with family at present
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15Priority for allotment of quarters if any
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www.sahayam.in
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DECLARATION
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I declare that statement made above are true, I agree to abide by the rules and conditions for the occupation of the quarters now in force and also such earns and conditions and rules , which the Government may prescribed from the time to time in that regard.
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Signature of applicant: ……………………………………………………..
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Name: ……………………………………………………………………………....
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Certified that no departmental quarters are available to this situation
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Place :
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Date:
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For use in the office of the Collector
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Received on
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Registered on
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Type quarters vide folio No
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Priority verified and entered in Register (item no)
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Folio Officer
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Section Clerk
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Superintendent
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Date of issue of allotment order
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Date of cancellation of Registration
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No of quarters allotted
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Note: Preference will be given to SC/ST, EX-servicemen and widows
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