081h

1293 KHYBER PAKHTUNKWHA GOVT: GAZETTE, EXTRAORDINARY, MARCH, 2018

Schedule Ill -

[(see rule 8(1)]

GOVERNMENT OF KHYBER PAKHTUNKHWA

ESTATE OFFICE
APPLICATION FORM FOR ALLOTMENT OF RESIDENTIAL ACCOMMODATION
FOR OFFICE USE

APPLICATION NO STATION____________________________ Photo

DIARY NO SECTION DATE__________________ Female

NOTE: i) Fill the form in Capital Letters preferably use typewriter (Optional)
Use only one box for one character
Please write N.A in the coloumn not applicable
Attach one photo with the form

PART-I TO BE FILLED BY PUBLIC OFFICE HOLDER GENERAL INFORMATION

Name of
Applicant
Father
Name
I I I I I I
Designation

BPSN0 I
(Regular)
Date of entry into govt. service with BPS

--------
y)
BPS-i MMM BPS-12
B PS-2 mmmmmmmm BPS-13
B PS-3 BPS-14

--------
BPS-4 BPS-15
BPS-S BPS-16

---------
B P5-6 BPS-17

---- -- -
MMMMMMMO
BPS-7 mmmmmmmm BPS-18
BPS-8 BPS-19
BPS-9 mmmmmmmm BPS-20
BPS-b BPS-21
BPS-il BPS-22

6 Civil Servant a Yes El No

7 Name of Department I I I I I I I I I I I I I I I I
8 C.N.l.C.No I I II I I I I I I I I I I I 9. Dateofbirth I I I I I I I I
10 Domicile Disttt/Agency
I I I I I I I I I I I I I
11 Phone No Cell No__________________________________

12 Sex a) Male b) Female 1 Marital Status a Married b Unmarried

Detail of family members: (Additional Sheet can be used for more than 5 members)

S.No Name Relation Age

FE IIIIIIIIIIIIIIIIIIIII

-El
El
—
El
 KHYBER PAKHTUNKWHA GOVT: GAZETTE, EXTRAORDINARY, 08" MARCH, 2018 1294

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D d m M y y y y

16 Date of entitlement for the category / class of residential accommodation

I I I
(B) PARTICULARS OF RESIDENTIAL ACCOMMODATION ALREADY ALLOTTED TO PGS

17 House/FIat No
] Block No Street No Sector
I
Mohallah
I I I I I I City

18 Date of occupation
I I I I I I
d d M m y y y y

19 Expected date of vacation / vacated the present accommodation on

I I I I I I I
PARTICULARS OF RESIDENTIAL ACCOMMODATION ALREADY ALLOTTED TO SPOUSE

20 House/FIat No Block No
ED Street No Sector
I
21.Mohallah
I I fl City
I El
22 Date of
1 occupation

d d M m y y y y

23 Expected date of vacation / vacated the present residential accommodation on

24 Please ensure that the following documents have been attached with application in the following order duly attested.

Yes No
Copy of C.N.I.0 of allottee (PGS)
Copy of last pay slip/last pay bill
One Photo pasted on top of form.
Appointment / transfer order

Dated Signature of P.G.S

PART-Il FOR USED BY THE DEPARTMENT (EMPLOVER OF THE PUBLIC OFFICE HOLDER)
Note: The application of employees of Provincial Govt. Servant should be forwarded by the Administrative
department concerned.

Da

Forwarded Mr. /Miss/Mrs______________________________________________________________________

is employed in this department since he/she holds a post under Government. His / her date of
retirement s_____________________
The above official has never been allotted any house / flat (if allotted please indicate the house / Flat No

The department in which the PGE is eligible to get residential accommodation from Estate Office Pool.

It is certified that the information given by the public office holder in proforma is correct.

Signature_____________________
Name

Designation and Department with complete Address (official stamp to be fixed)