(See Rule 9) APPLICATION FORM PRESCRIBED UNDER THE RULES REGULAMING THE GRANT OF ADVANCES TO GOVERNMENT SERVANTS FOR BUILDING, ETC., OF HOUSES 1, (@) Name ( in block letter ) os (6) Designation es (©) Scale of pay Es (a) Present pay as defined in rule 33 of the Orissa Service Cod:/ Fundamental Rules 9 (21) (a). ‘ (© Amount of net monthly pay (after all deductions are effected). 2. (a) Department or office in which employed. (6) Administrative Department (©) Station where posted 3, Please state— | @ Your permanent | | Post, ifany, and the name of office and Department covcera- It your wife/ ed. | Date cn | _usbund [Date of birth which you | Goverment Whether you are a permanent or ‘noa-permanent State Goverament Servant and the length of (B) Do you bold | and age of | “etiend | servant ? If to, service rendered under permanent eppoint- (next birth day| the age of | _ give her/ the Goverament ment under SByears | aimed Con'ral Government tion, ete. OF ony other State Government ? Ifs0, sive particulars. 1 | 2 Peeceeeee tae | 5 | 4. Do you or does your wife/husband/minor child already own a house ?[ See rule 2 (@)1 If So, please state— Station where it is Floor area Re:sons for desiring to own another situated with exact Cinq. ft.) | Its approx. valuation] house or enlarging living accommo address dition in an existing house, as the case may be 42 5. Do you require the advance for building in a new house ? If so, please indicate— Estimated cost Approx. fi-ot area No. of years in which of the house proposed 7 | Amount of | the advance with tode constructed | Costof | Costof | Total advance interest is propored Cinsg. ft.) land building required | to be repaid 1 | 2 Serre rae) 5 | 6 | Note—Entries in columns 2—4 will have to be supported by spceificstion, estimetes ( in enclosed form and plin at the apprepriste sage ). (8) Where you are already in possession of the land ? If so, please indicate— Name of the Whethe you with | Are of plot | Nams of Musisizal or ott toca ot town where fosetde there, | ~ Cinsa. sds.) | authrity (i? any) in wase itistocated | after retirement ? Hurisdistion fs located 1 | 2 3 | 4 | | (@ IFno plot of land is already in your possession, how and when do you propose to acquire one ? State the approximate plot area ( in sq. yds. ) proposed to be required. 6. Do you require the advance fot enlarging living accommodation in an existing house ? If's9, Please state— | | ‘Number ot| | tan addi at Particulars of add tion desired ‘Number of year rocms inthe {Total for) storey is | ‘Amount | in which the house exclid+| area of | proposed to be 7 er advance with inglavae | th: vom | added isth> | No. of | Floor | Estimate | advance interest tory, bath |(insq.fts)) foundation | rooms | arca in | cost | desired — | Proposedo te room and strong oa. ft repaid kitchen) one it | fa [os eae 8 ore—A plan of the house should ee mpany the applicution3 7. Do you requite the advance for repaying Ioan(s) taken earlier for purchasing! constructing house ? If so, please state— | ‘Name and address of Number of Floor area | Plinth area | Total cost of} patties from whom loan | Amount |¥Sats i Which Exact | of the ‘of the | the house | were t.ken and the | of | the advaace location of | joyse (in | house in | including | amount outstanding in | agvance | With interest the house | snare feet) | Square fect | land their favour on the date | required | '8 Proposed of applic:tion tg be repaid a eal Pee nose (ae Rs. Rs. Not£—A plan of the house and specification used in constructions should accompany the application 8. Do you require the advance for purchasing a ready made house or flat— (a) (if so, and in case you already have a house in view please state— ] ] Naber of : yerrs. in Floor areq| Plinth are : Apprexi+| Ishi the Exit ofthe “| of the. | Approxi: |Municipal tpt ee ohta| aSrthen | aGleare [aan | Name and me ptee| mous |“aance off> | “square | square | of the | of the owner tobe | advance | interest is house | fee) | feet” | howe | house paid” | required | proposed | tobe repaid 3 a [a] [ec els ‘pets | | | a | Pope (ii) Haye you satisfied yourself that the transaction would result in your acquirin: and undisputable title to the house ? H y : | | Nor®—A plan of the hou ¢ should accompany the application :4 (@) Ifyou do not already have a house in view, how, when and where do you propos? to acquire one ? Indicate— The Approx, amount up to whe’ The Approx. amount No. of years in. waich the you will be Prepared to kuy a of advance advance with interest is house required Proposed to be repaid 1 2 : 3 | Note —D-tails specified against item § (a) above should be furnished in this case also as 600m as possi- ble and if any before th> full amount of the advance can be drawn. 9. Is the land on which the house stands or is proposed to be constructed, free holds or lease hold, state— How much of the | Whether conditions of the lease | Premium The term of | terms has already ‘permit the land being paid for | Annual _rent the Tease expired orizuedtoGverament | fe plot | ofthe pit ; 7 ; bach 3 Rs. Rs. ‘Nore—A copy of lease/sa le-deed should accompany the application— 10. (@) Is your title to land/house undisputed and free from encumbrances 7 (®) Can you produce, if required original documents (sale or lease-deed) in support of your title If not, state reasons thereof indicating whit other documzniaty proof if any ela you furnish in support of your claim? [ See items 5 (6), 6 and 7 above:} (c) Does the locality in which the plot of land/house is situated, process (essential sorvices like roads, water-supply, drainage, sewerage, strect lighting, etc. (please furnish a site plan with complete address ).3 11. In case you happen to be due to retire from service within 20 years of the date of this application and are eligible for the grant of a gratuity or death-cum-retirement gratuity, do you agree by giving a declaration in the Agreement Form that the Govern- ment shall bé entitled to recover the balance of the said advance with interest remaining unpaid at the time of your retirement or death preceding retirement from the Whole or as specified Part of the gratuity that may be sanctioned to you? 12. If rule 5 (6) applicable to your case ? If so, state— @ The name, designation, scale of pay, office/department, etc., of the perma- nent Government servant, who is Willing to stand surety for you; (ii) The date on which the proposed surety is due to attain the age of 55 years. DECLARATION I Solemnly declare that the information furnished by me in reply to the various item indicated above is true to the best of my knowledge and belief. 2, [have read the rules regulating the grant of advances to Goverument servants for building, etc., of houses and agree to abide by the terms and conditions stipulated cherein, 3. Tcertify that*— (® My wife/husband is not a Government servant, my wife/husband who is a Government servant, has not applied for and/or obtained an advance under these rules. (i) Neither { nor my wife/husband has applied for and/or obtained an advance or loan from any other Goyerament sOurce for the acquisition of a house. ‘Signature of the applicant Statioii. : Date., 5 Designation... Department/ofiice in which employed (To be completed by the sanctioning authority) ao . Station... seeneee teres Date. Forwarded to the Works Department. The facts stated inthe application have been ified aud found correct.........- ee " 3 Strike out the ternative (8) not applicable. (To be completed by the Works Department) Scrutinised the plan and estimate along with the details furnished in by the above applicant. An advance of Rs.........-(RUPCES..0-.....2.. e ) only may be sanctioned for the work s ecified above, ‘ Signature Designation... Department. . (Order ofthe sanctioning Authority ) Sanctioned an advance of Rs...... ++... (Rupees. Bare aa 3), vnly to theapplicaat. I have satisfied myself on the basis of moathly deduction, etc. made from the applicant's salary that this amount is well within his repaying capacity. ‘Signature Designation... Name of the Department. “Name of the sighining officer should also be indicated in block letters below his signature, OGP—MP-XI ( Finanee ) !—-20,000—-24-6-1996 ,