FORM OF UNDERTAKING
For issuance of “NO Demand Certificate”
in respect of House Building Advance (HBA), Car
Advance and Scooter Advance
I (Name of the retiring employee) ____________________________
Passport size
Phone/Cell number_______________________________ photograph of
Designation_____________________________________ the applicant
S/O, D/O, W/O S/Sh______________________________
R/O___________________________________________
(Permanent residential address)
(Address after retirement)_______________________________________________
Department_____________________________________
CPIS Employee Code________________ do hereby undertake the
following:-
1. That I was appointed in Government Service on_______. My date
of birth is ___________________ and I am retiring from
Government Service on Superannuation Pension/ Retiring
Pension/Special Pension on_________(Copy of order /retirement memo enclosed)
2. That I have neither drawn any House Building Advance (HBA)
beyond 09/1985 nor any Car/Scooter Advance from Finance
Department except an amount of Rupees_________(in words)
/___________________ (in figures) as House Building Advance
and/or Car/Scooter Advance sanctioned vide Government Order
NO______________ dated__________ (copy enclosed)
3. That the amount of House Building Advance and Car/Scooter
Advance drawn vide aforementioned Government Order has been
liquidated in full by me as conveyed by the Accountant General,
J&K vide his No_____________ dated__________(copy enclosed).
4. That in case of any outstanding on account of House Building
Advance and Car/ Scooter Advance is found against me hereafter,
I shall be personally responsible for liquidation/refund of the said
outstanding amount together with interest thereon under rules.
5. That I do hereby undertake to furnish guarantee from two
Government Servants, equal or higher in rank, not retiring within
two years of service from the date of this undertaking.
6. That No Departmental Enquiry/Criminal/judicial proceedings or any
other case(s) is/are pending against the undersigned.
7. That in the event of any disclosure regarding misrepresentation of
facts or falsehood, I shall be liable to any legal action under law in
force for such misrepresentation or falsehood.
8. Verification
I____________________________________
S/O___________________________________________________
R/O___________________________________________________
affirm that above contents of this undertaking are true and correct
to the best of my knowledge and belief and nothing material has
been cancelled therein.
Signature of the Government Servant.
Date__________
Place__________
Countersigned by the DDO of the retiring Employee
Date__________
Place_________
Note: In case the DDO is himself a retiring officer, his Form of Undertaking shall be
countersigned by the next higher officer of his office.
FORM OF GUARNTEE
I (Name of guarantor)________________________________
S/O___________________________________________________R/O______
____________________________________________,
do hereby stand guarantee for the payments and out standings, if any, found
against the retiring Government Employee, namely_____________
Which may be recoverable or outstanding from him/her on account of House
Building Advance and Car/Scooter Advance after issuance of No Demand
Certificate in his/her favour. I also do hereby undertake to indemnify the
Government against all the losses that may occur or the Government may
incur or suffer in the event of any amount found outstanding or due from the
above named Government Employee.
Name of the Guarantor________________
Space for photograph of the
S/O, D/O, W/O______________________ guarantor duly attested
Phone/Cell number___________________
Designation_________________________
CPIS Employee’s Code
Department_________________________
Date of Birth_________________________
Date of Retirement___________________
Permanent residential address ___________
Present residential address______________
Signature of the Guarantor____________
Date________
Place________
Countersigned by the DDO of the guarantor
with seal & Signatures
Date__________
Place__________
