Annexture
CERTIFICATE TO BE FURNISHED BY A GOVERNMENT EMPOLYEE FOR GRANT OF
HOUSE RENT ALLOWANCE
Particular furnished by the Applicants
Sl. Description of the particular Remarks
No
1 Whether Government accommodation has been provide to the self/ spouse Yes / No
during the period of posting
2 Staying in house owned by me /wife /husband /son /daughter /father / mother Yes / No
/ within a radius of 8 K.M from Headquarter
3 Staying in house owned by me /wife /husband /son /daughter /father / mother Yes / No
/ at a Urban Local Body ( Municipal Corporation, municipality, Notified Area
Council) within a radius of 8 K.M from Headquarter
4 Staying in a hired accommodation within a radius of 8 K.Ms from the Yes / No
Headquarter
5 Staying in a hired accommodation at a Urban Local Body ( Municipal Yes / No
Corporation, municipality, Notified Area Council) within a radius of 8 K.M from
Headquarter
6 Allowed to retain the Government accommodation at my old place of posting Yes / No
to retain my family on payment of normal rent / penal rent for the period @
from………………………………….. To……………………………………………………
7 I am Married /Unmarried /Widow / Widower
8 My spouse is a Government Servant Yes / No
9 My spouse is posted in the same Headquarter Yes / No
10 My spouse receipt of HRA Yes / No
My wife / husband is in service and the following are the particular of her /his employment:
11
A) Name and Address of her / his Office………………………………………………………………………….
…………………………………………………………………………..
……………………………………………………………………………..
*strike out which is not applicable
@ If the answer is yes, the period is to be mentioned in
Certify that the above particulars are true to the best of my Knowledge.
Present local residential address Signature of the applicant
Designation
Date
