SINo Description of the particulars Remarks (0) Q) GB) 1 [Whether Government accommodation has béen provided fo We selifspouse lV, fusing the period at place of posting 2 2. Paying in house owned by me/vife/som/shildren father matherThusband within| radius of 8 KM from Headquarter sid 3 Yes/No 4 Staying in a hired accommodation within a radius of 8KM from Headquarter [Yes/No Staying in a hired accommodation within the limits of the Urban Local Body Municipal Corporation, Municipality, Notified Ares Council) of Headquarter Yes/No [Allowed to retain the Government accommodation ar my old place of posting Yes/No retain my family on payment of normal renUpenal rent for the period from sO Spouse is a State Government / Central Governmient or Reserve Bank of | india, Nationalized Bank or Regional Rural Banks, Co-operatives esiNo 7-_[QtBanization of Stale Government, autonomous body. local body, Public ‘ctor Enterprises, Government Societies, undertakings, comparies oe . Jame, Employer details & place of posting: 8 |Whether: ‘widow/widower/unmarried [Yes/No 9 My spouse is posted in the same Headquarter es/No 10 ly spouse is in receipt of House Rent Allowance ‘es/No Strike out which is not applicable. @ IFthe answer is yes, the period is to be mentioned in Column No.2, * Ithe answer is yes, the details ofthe employer & place ‘of posting of the spouse is to be mentioned in Column No.-2. "certify that the above panticulars are true to the best of my knowledge. local resid Signature of the Officer Designation: Date: Page 4 of 4