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Applicant Information: Press CTRL + P To Print This Form After Submission

1) The document is an application form for registration with the Uttar Pradesh Housing and Development Council (UPRERAPRJ). 2) It collects information such as the applicant's name, address, contact details, payment options, and documents to be submitted. 3) The applicant declares that the information provided is true and correct and agrees to the rules, accepting that the application can be cancelled if any information is found to be false.

Uploaded by

Ashish Verma
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© © All Rights Reserved
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128 views3 pages

Applicant Information: Press CTRL + P To Print This Form After Submission

1) The document is an application form for registration with the Uttar Pradesh Housing and Development Council (UPRERAPRJ). 2) It collects information such as the applicant's name, address, contact details, payment options, and documents to be submitted. 3) The applicant declares that the information provided is true and correct and agrees to the rules, accepting that the application can be cancelled if any information is found to be false.

Uploaded by

Ashish Verma
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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9/18/2020 Form | FormZero

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Rera Registration No : UPRERAPRJ-787484

1. Applicant Information

Last Name Middle Name First Name*

VERMA ASHISH

2. Father's Last Name Father's Middle Name Father's First Name*

VERMA VS

Is there a Joint Applicant? *

No

3. Date of Birth * 6. Sex*


Male Female
31-03-1991 Other
(of main applicant)

Relationship with Nominee *


Name of Nominee*
Wife
RADHIKA

5. Payment Options*
Cash Down Installments
Payment

7. Reservation Category (Certificate to be uploaded later)

Reservation Code * Horizontal Reservation Code *

03 OBC N: None

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9/18/2020 Form | FormZero

8. Permanent Address
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Flat No/ House No (if any)., Street Name, Village Name (if any)*

HOUSE NO 91,ADARSH VIHAR DAHELI SUJANPUR

Landmark, Tehsil (if any), District, City, State*

NEW PAC LINES ,KANPUR NAGAR ,UTTAR PRADESH

Pincode

208015

9. Correspondence Address

Same As Permanent Address? *

Yes

10. Contact Information

a) Mobile No.* b) Email ID

9457825841 [email protected]

11. KYC Information

a) Pan Card No b) Aadhar Card*

APPPV6744L 796195930323

12. Refund Details

Bank Account No.* Name of Bank*

0301104000058195 INDUSTRIAL DEVELOPMENT BANK OF INDIA LTD

Branch Name* IFSC Code of Bank*

Koregaon park IBKL0000301

Note: Successful Applicants have to submit the linked declaration on Rs. 10 Notarized Stamp Paper in favour of UP AWAS
EVAM VIKAS PARISHAD after the draw results.

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9/18/2020 Form | FormZero

Details of Enclosures& Attachments


SUBMIT SAVE Cancel

I declare that I will submit the following in this application process:*


a. Pan Card b. Aadhar Card c. Passport Size Photo d. Signature Image e. Refund Details

* मै /हम एतद् ारा घोषणा करता/करती/ करते ँ /ह , िक उपरो सूचना मेरी जानकारी म स है ,
इसम कुछ भी िछपाया नहीं गया है और न ही इसका कोई भाग ग़लत है | यह भी िक मने आवासीय
योजना हे तु ई-पु का म उ खत सम िनयम व शत को भली-भां ित पढ़ िलया है तथा इस बात
से सहमत ँ /ह िक यिद उ िनयम एवं शत का उ ंघन पाया जाता है तथा आवदे न प म मेरे ारा
भरी गयी सूचनाओं म िवसंगित/िवचलन पाया जाता है , तो ऐसी दशा म उ0 0 आवास एवं िवकास
प रषद को िबना िकसी पूव सूचना के, पंजीकरण हे तु जमा धनरािश ज करते ए आवदे न प /
आवंिटत स ि को िनर करने का पूण अिधकार होगा | I/We hereby declare that above
information provided by me is true to the best of my knowledge & nothing is
concealed by me & no part is incorrect. It is also certified that I have read all rules &
regulation provided in brochure for residential scheme & I agree to abide by them.
In case if it is found that any information provided by me in application is
false/incorrect then 'U.P. Awas Evam Vikas Parishad' shall have all the rights to
seize my registration amount & disqualify my candidature & cancel my application
without even hearing me.

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