APPLICATION FOR MARRIAGE LOAN

1. NAME

: SAMUEL J PRINCE. J

2. DESIGNATION

: JTO OFC O/D, TCH

3. OFFICE ADDRESS
EXCHANGE,

: STR, TELEPHONE
TIRUCHENDUR

4. WHETHER APPLYING FOR SELF/WARD : SELF

5. IF WARD, NAME OF THE WARD

6. RELATIONSHIP WITH OFFICIAL

:SELF

7. WHETHER THE OFFICIAL IS

CONTRIBUTING REGULARLY
TO WELFARE VOLUNTARY
CONTRIBUTION FUND
8. BASIC PAY OF THE OFFICIAL

:YES

:16,900

9. TAKE HOME PAY OF THE OFFICIAL

for last three months
: (40,228+21,742+21,826) /
3 = 27,932
10.DATE OF BIRTH OF THE OFFICIAL: 09-03-1980
11.PROBABLE DATE OF MARRIAGE:

11-02-2012

12.WHETHER Computer or Education LOAN

IS AVAILED FROM WELFARE IF SO,
NO
WHETHER recovery is PENDING.
I SAMUEL J PRINCE.J. declare that the particulars given above
are true to the best of my knowledge and belief. I authorize the
Accounts Officer concerned to deduct the amount of repayment of the
loan and interest from my monthly salary. If I am transferred outside
this Region, I also authorize the Accounts Officer to recover the
outstanding balance of loan in one lump sum from my last pay and
allowance.

SIGNATURE OF THE APPLICANT

STATION
DATE
CERTIFIED THAT THE ENTRIES IN COL.1 TO 11 ABOVE ARE
CORRECT.

SIGNATURE OF THE ACCOUNTS

OFFICER
NAME & DESIGNATION
WITH SEAL: