Government of India Directorate of Estates Subject: Application for Advance Booking of Accommodation at OOTY HOLIDAY HOME

This is an application form, and not booking confirmation. Confirmation letter is issued separately on receipt of DD.

Booking Request Details Booking Request ID: 29102 Dated: 19-09-2010 Type: DOUBLE BED ROOM NON-AC Booking Period Applied From :11-10-2010 To: 13-10-2010 Check Out: 14-10-2010 (FN) No. of Nights: 3 Nature of Visit: PERSONAL Request Sent to: DOE-CHENNAI Applicant's Particulars Guest Category: CENTRAL GOVERNMENT SERVING ID Card/PPO No.: AC06701 Name: SHAMBHULAL DHAKER Designation: SCI/ENGR 'SF' Office: SAC/ISRO AHMEDABAD E-mail: sldhaker@sac.isro.gov.in 07926914535 Phone: Fax: Mobile: 09913343575 Address for Communication
SCQAD/SAC/ISRO AHMEDABAD-15

Details of Visitors Name
MR SHAMBHULAL DHAKER MR KARTIK MR MOHIT MRS RAMLILA DHAKER

Age
47 8 14 41

Relationship
SELF SON SON WIFE

Payment Details (Demand Draft - Not Refundable) DD No.: 127198 Date: 17-09-2010 Bank: SBI
Declaration

Amount (in Rs): 189

(A) I declare that the accommodation asked for in the Guest House/Holiday Home, will be occupied by me/family members and guests, as declared above. I will be responsible to make good any loss/damage to property,fixtures,fittings,furnishings during the booking period.I undertake to vacate the accommodation as per check-out time specified above. I will not overstay without the written permission of the Alloting Authority,otherwise I/family members/my guests will be liable to pay market rate of License Fee as damages as decided by Dte. of Estates and face physical eviction from the occupied premises. I am aware that i will not be entitled to claim refund of the advance booking amount and i will not ask for the refund in case the requested accommodation is not utilized by me,after submission of this application. (B) I declare that the information given above is correct and nothing has been concealed/misprinted. I shall also abide by the terms and conditions governing this allottment as given on the website of Dte. of Estate. I also undertake to take meals, etc. in the Holiday Home/Hostel, if catering arangement is available and to pay the applicable charges directly to the caterer/ Caretaker.I undertake that I will not withdraw my application for booking .In case the cheque (given by me as advance payment) is dishonoured for any reason, I authorize my DDO to deduct equal amount from my salary and remit the same to the Dte of Estates, on receipt of their damand.

Date

Place To be verified by the Administrative Office of applicant

Signature of Applicant

(Applications not verified by the Adminstrative office of applicant will not be entertained)

(a) Certified that Shri/Smt./Kum. SHAMBHULAL DHAKER Designation SCI/ENGR 'SF' (b) Office Category (Please Tick):
Central govt. Ministry / Department Central PSU/Semi Govt. Office Office of State Govt/ U.T. Admn

is a permanent employee of this office. ,
Other (Please specify) Retd. employees annex copy of PPO

,

(c) The certified copy of the tour program, specifying the period and place of official journey is enclosed. (if applicable)

Endorsement No

Date

Signature with Office Seal
)

This application is to be despatched with DD (drawn in favour of ASSISTANT ESTATE MANAGER, CHENNAI to the Allotting Authority mentioned below: SH. M. H. BATCHA , ASSTT. ESTATE MANAGER FIRST FLOOR, SHASTRI BHAWAN, HADDOWS ROAD, CHENNAI
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