CHANDIGARH HOUSING BOARD

CHANDIGARH HOUSING BOARD A CHANDIGARH ADMINISTRATION UNDERTAKING 8 Jan Marg, Sector 9-D, Chandigarh-160009, Phone No. 0172-4601822 to 4601828 Website : Application for registration and allotment of Two Bed Room Flats under Self Financing Housing Scheme-2016, on Lease hold basis in Sector 51-A, Chandigarh for General Public Notes: 1. Please read instructions and terms and conditions in the brochure carefully before filling this Application Form. 2. The applicant must mention his mobile/ landline telephone number. 3. Please ( ) in the appropriate box (es). 4. Incomplete Application is liable to be rejected. FORM NO. 2016 Affix latest passport size photograph duly attested by the Gazetted Officer/Notary Public (Size 3.5x4.5 cms.) FOR OFFICE USE ONLY a) Date of Draw of lots. f) Allotment Letter No.& date b) Regn.No. g) P/Slip No. & date c) Floor allocated h) Date of Physical Possession d) Dwelling Unit No. allotted 1. Applicant s Name (In Block Letters) 2. Father s Name (in Block Letters) 3. Husband s/wife s Name (in Block Letters) 4. Residential Address (in Block Letters) (i) Correspondence PIN CODE

(ii) Permanent PIN CODE 5 Mobile Number 6 7. Telephone Number Details of Initial Deposit: - Demand Draft No. Day Month Year Amount Name of issuing Bank Rs. /- 8. Date of Birth of Applicant DAY MONTH YEAR (Attach self attested copy of Birth Certificate or Matriculation Certificate in case the age of the applicant is less than 21 years.) 9. PAN Number, if any 10. Aadhar Card No. 11. Details of all legal heirs of applicant (including mother in case of male applicant). 1.. 2. 3. 4. 12. Do you claim any reservation as specified under the heading RESERVATION' in Para IV of the Brochure? (Tick ( 3 ) 'Yes' or 'No' Yes No If yes, tick ONLY ONE category out of those mentioned in clause 1and 2 under the heading RESERVATION' and the claim shall be duly supported by a proper certificate issued by the Competent Authority.

Tick only one appropriate category: Scheduled Caste Defence/ Ex-defence Other Backward Class Retired/ Retiring Employee Person with Disabilities Board Employee General 12A Please tick payment option Self Bank A Bank details for refund to be filed by applicant in case of self finance: B Bank details for refund to be filed by applicant in case of Bank finance: NOTE: i SC/OBC Certificate should be issued by the SDM, U.T., Chandigarh. ii iii iv For claiming reservation in serving Defence and the pensioners / family of the defence forces Employees of Board (CHB), attach proper Employer Certificate with dispatch number and date indicating your designation, date of appointment, date of retirement etc Certified copy of Discharge certificate/retirement Orders/PPO in case of claiming reservation under the pensioner s of defence forces and retired/retiring employees (RP) category. Physically Handicapped (PH) Certificate should be issued by the Medical Authority as defined under the Persons With Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act, 1995 and specified vide notification No.SW2/SW/PWD/2002/22 dated 6.1.2003 read with notifications No.FII(14)-88/9889 dated 1.7.1988, and No.SW- 2/SW/DP/2001/2116 dated 17.8.2001 and other notification issued by the Chandigarh Administration and Govt. of India from time to time. 13 Three specimen signatures of the applicant. 1. 2. 3. Place Date (Full Signature of the Applicant)

DECLARATION 1. That I or my wife/husband or any of my minor children do not own on Lease hold or lease hold or on hirepurchase basis or on the basis of an Agreement to Sell, GPA, WILL etc. a residential plot/house, in full or in part in the Union Territory of Chandigarh or in any of the Urban Estates of Mohali or Panchkula. (If, however, individual share of a person in the jointly owned plot or land under the residential house is less than 100 Sq.Yds, (83.62 Sq. meters) he/she will be eligible for allotment of a Dwelling Unit.) 2 That I have never been allotted a residential plot/dwelling unit in the Union Territory of Chandigarh or in any of the Urban Estates of Mohali or Panchkula, through Government/Semi Government/Statutory Corporation/Board/Municipal Committee/ Corporation /Registered Society like A.W.H.O. or a Cooperative House Building Society, in my name or in the name of my spouse or any minor children, 3. *That I am a bonafide resident of Union Territory of Chandigarh since OR *That the condition of being a bonafide resident of U.T. of Chandigarh on the date of opening of scheme is not applicable to me as per the proviso to Regulation 6(1) and proviso to Para III (2) under the heading 'Eligibility' at page of the scheme. 4. That I am a Citizen of India or I am an Overseas citizen of India. 5 *That I am disabled person suffering from permanent disability to the extent of % of the nature of. 6. **That my total family income from all sources is Rs. per month. 7. That I have carefully gone through and understood the terms and conditions of the scheme as laid down in the brochure of the scheme and the provisions of the Chandigarh Housing Board (Allotment, Management and Sale of Tenements) Regulations, 1979, as amended, and am eligible for the allotment of DU under the scheme. I do hereby undertake to abide by the terms of the scheme and Regulations and the terms and conditions of allotment, which may be altered by the Chandigarh Housing Board Chandigarh at any time and shall enter into such agreement with the Board and also furnish other documents required by the Board from time to time. I further undertake to accept any dwelling unit or any floor on different price, which may be allotted to me by the Board. 8. That I further undertake that I shall not claim any interest on the amount of the deposit made in consideration of allotment of dwelling unit under the scheme. 9. That I again undertake that if I ask for refund of the initial deposit: after the allotment of dwelling unit through second draw of lots but before the issue of allotment letter, the amount shall be refunded after forfeiting 10% of the initial deposit to Chandigarh Housing Board. 10. That the information furnished by me in the Application Form is correct and true and nothing has been concealed therein and I undertake that if the information furnished by me or furnished later on at any stage is found to be incorrect or false, the Board shall have the right to cancel the registration and allotment and to forfeit the entire amount paid, in addition to the penal consequences under the law. Place Date. (Full signatures of the applicant) * Delete whichever is not applicable. ** The term family shall mean the family consisting of a husband/wife and their dependent children

Form No.. CHANDIGARH HOUSING BOARD A CHANDIGARH ADMINISTRATION UNDERTAKING 8, JAN MARG, SECTOR 9-D, CHANDIGARH-160009 ACKNOWLEDGEMENT (To be filled by the applicant) Received from Mr/Mrs./Ms Son/wife/daughter of Shri, an application for registration and allotment of a Two Bed Room Flat under Self Financing Housing Scheme-2016 on Lease hold basis in Sector-51-A, Chandigarh for General Public along with Demand Draft No. Dated amounting to Rs. /- drawn on on account of Initial Deposit Money. (Name of Bank) Dated CHANDIGARH Authorised Bankers's Signature & stamp.

Form No.. CHANDIGARH HOUSING BOARD A CHANDIGARH ADMINISTRATION UNDERTAKING 8, JAN MARG, SECTOR 9-D, CHANDIGARH-160009 BID FORM FOR SUB-SCHEME 'B' (This form should be submitted in a separate sealed envelope along with the Application Form). 1. Name of applicant 2. Correspondence address 3. Application Form No. 5. E-mail i.d. : 4. I would like to be considered for Assured Allotment under Sub Scheme-B for First Floor (which is the lowest floor, since there is a provision for stilt-parking on the ground floor) and my bid is for Rs. (in figures). Rs. (in words). Date: (Full signatures of the applicant) * Kindly mention the Form No. and correspondence address on the front side of the sealed envelope.