APPLICATION FOR CG POOL MARRIED ACCOMMODATION

Date of Priority _____________

TO BE FILLED BY APPLICANT

1. Name and No. (in Block letters, surname first):

2. Designation & Basic pay :

3. Date of Birth :

4. Date of Reporting Ship/Station :

(copy of reporting Gx. Enclosed)

5. (a) Ship / Establishment :

(b) Office address :

6. Date of ante seniority :

7. Type of Accommodation applied for :

8. Date of retirement / superannuation :

9. (a) Are you / is your spouse occupying :

Accommodation allotted by Directorate
of Estate / Department Pool

(b) if yes fill the name of allottee :

10. (a) Are you debarred from allotment of :

Govt. residence

(b) if yes, upto which date ? :

11. Date of Marriage :

 -2-

DECLARATION

1. I agree to abide by the allotment of Coast Guard Pool Married Accommodation

orders as amended from time to time or relevant Govt. rules as applicable.

2. I am aware of the penalties to be imposed in the event of refusal of acceptance

of allotment of accommodation of the entitle type of furnishing of false information.

Signature of the applicant

Date: __________

II

TO BE FILLED BY THE FORWARDING OFFICER / COMMANDING OFFICER

1. Certified that the particulars furnished by the applicant have been verified from
records and found correct. It is certified that the applicant is eligible for Coast Guard
Pool Accommodation.

2. It is certified that the applicant is entitled to Coast Guard Pool Accommodation.

ICGS Samarth
C/O CGDHQ-11
Goa-403 803 for Commanding Officer

Date : ___________

File No. : 103/01

Forwarded to:-

The Commander
(for Accommodation Officer)
No. 11 Coast Guard District (Goa)
4th Floor Old MPT Bldg
Mormugao Harbour
Goa-403 803
 APPLICATION FOR CG POOL MARRIED ACCOMMODATION

Date of Priority _____________

TO BE FILLED BY APPLICANT

1. Name and No. (in Block letters, surname first): RAJBIR SINGH, P/ADH,
01075-T

2. Designation & Basic pay : 14,600.00

3. Date of Birth : 15 JUL 1966

4. Date of Reporting Ship/Station : 07 MAR 2016

(copy of reporting Gx. Enclosed)

5. (a) Ship / Establishment : ICGS SAMARTH

(b) Office address : ICGS SAMARTH, C/o

CGDHQ-11 GOA

6. Date of ante seniority : NIL

7. Type of Accommodation applied for : III TYPE

8. Date of retirement / superannuation : 31 JUL 2023

9. (a) Are you / is your spouse occupying : --

Accommodation allotted by Directorate
of Estate / Department Pool

(b) if yes fill the name of allottee : --

10. (a) Are you debarred from allotment of : --

Govt. residence

(b) if yes, upto which date ? : --

11. Date of Marriage : 15 FEB 1989

 -2-

DECLARATION

1. I agree to abide by the allotment of Coast Guard Pool Married Accommodation

orders as amended from time to time or relevant Govt. rules as applicable.

2. I am aware of the penalties to be imposed in the event of refusal of acceptance

of allotment of accommodation of the entitle type of furnishing of false information.

Signature of the applicant

Date: __________

II

TO BE FILLED BY THE FORWARDING OFFICER / COMMANDING OFFICER

1. Certified that the particulars furnished by the applicant have been verified from
records and found correct. It is certified that the applicant is eligible for Coast Guard
Pool Accommodation.

2. It is certified that the applicant is entitled to Coast Guard Pool Accommodation.

ICGS Samarth
C/O CGDHQ-11
Goa-403 803 for Commanding Officer

Date: ___________

File No. : 103/01

Forwarded to:-

The Commander
(for Accommodation Officer)
No. 11 Coast Guard District (Goa)
4th Floor Old MPT Bldg
Mormugao Harbour
Goa-403 803
 APPLICATION FOR CG POOL MARRIED ACCOMMODATION

Date of Priority _____________

TO BE FILLED BY APPLICANT

1. Name and No. (in Block letters, surname first):

2. Designation & Basic pay :

3. Date of Birth :

4. Date of Reporting Ship/Station :

(copy of reporting Gx. Enclosed)

5. (a) Ship / Establishment :

(b) Office address :

6. Date of ante seniority :

7. Type of Accommodation applied for :

8. Date of retirement / superannuation :

9. (a) Are you / is your spouse occupying :

Accommodation allotted by Directorate
of Estate / Department Pool

(b) if yes fill the name of allottee :

10. (a) Are you debarred from allotment of :

Govt. residence

(b) if yes, upto which date ? :

11. Date of Marriage :

 -2-

DECLARATION

1. I agree to abide by the allotment of Coast Guard Pool Married Accommodation

orders as amended from time to time or relevant Govt. rules as applicable.

2. I am aware of the penalties to be imposed in the event of refusal of acceptance

of allotment of accommodation of the entitle type of furnishing of false information.

Signature of the applicant

Date: __________

II

TO BE FILLED BY THE FORWARDING OFFICER / COMMANDING OFFICER

1. Certified that the particulars furnished by the applicant have been verified from
records and found correct. It is certified that the applicant is eligible for Coast Guard
Pool Accommodation.

2. It is certified that the applicant is entitled to Coast Guard Pool Accommodation.

ICGS Samarth
C/O CGDHQ-11
Goa-403 803 for Commanding Officer

Date : ___________

File No. : 103/01

Forwarded to:-

The Commander
(for Accommodation Officer)
No. 11 Coast Guard District (Goa)
4th Floor Old MPT Bldg
Mormugao Harbour
Goa-403 803