t-;-fiq vaqr< erffi, ad *-dr 6-{ 3ngf,d 61 +.rqlaqOFFICE OF THE PR. COMMISSIONEII OF GST & CENTRAL EXCISE,

6/7 q.a.gr. Fflz, ts ml$ {ts,la.r.D.srREET RACE cotJRSE ROAD,

6lziqq{ -I8/COIMBATORE-18( For allotment details and vacancy notifications, visit us at cenexkovai.tn.nic.in )

APPLICATIoN FoR ALLoTMENT oF RESIDENTIAL ACCOMMODATION (SR 317.8.6)

ALLOTMENT YEAR 2O-TO 20-

1

a Name of the Applicant

b Employee Code

c Present Designation

dParticulars of post held(Permanent/ Quasi Permanent/ Temporary)

e Whether the applicant belongs to SC/ST Category

f Contact Details (Phone/ e-mail)

2

aEmoluments drawn on 1st January of theyear / On promotion Grade Pay (VI CPC) Basic Pay (VII CPC)

b Date of promotion (If on promotion)

C

Indicate the source from which emoluments are drawn if not from the

Consolidated funds of the Government of India

.l

a Type to which entitled/ APPlYing I II III IV IV VB

b Seniority date (As per applicable rules)

C Date of retirement

d Is the applicant willing to occupy the next lower class of residence Yes No

4

Pa"ficrlrrs of Government residence already alloted (if any):

Bv the Commissioner (Head of the Depart4g4t) By other Department

rypeltlttltttllv V VB Type I II III IV v lvsAddress: Address

5

a Does the Applicant stand debarred from Govt. residence? Yes I No

b If Yes, details thereof:

6

a

Does the applicant, his/her spouse, or dependent children own a house at the station of duty, and if so,

furnish particulars:

House No. & Street Name Relationship with owner and extend of ownership

bIf the reply to (a) above rs in the affirmative, whether the house is

rented out, and if so, the monthly rent received

C

If declared eligible for Government Accommodation, give reference ofletter and date by which so granted

7 Date of Joining Coimbatore station, if on transfer

Particulars of surety (should be a permanent employee) in case of temporary employees

Name, Designation & Emp. Code

Signature of Surety

DECI.ARATION BY THE APPLICANT

Certified that I have read all the rules governing the allotment ofresidence and declare that the particulars given by

me are correct and that the allotment to be made to me or already made shall be subject to these rules and subsequent

rules if any thereto

Name

Signature with date

DECI,ARATION BY THE ADMINISTRATIVE OFFICER IN CHARGE OF SERVICE BOOK

The particulars furnished by the applicant above have been verified and found correct

ADMINISTRATIVE OFFICER