8/8/2019 Application Form of Rohtak

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S C 0 0 0 0 0 0 2 2

S C 0 0 0 0 0 0 2 2Roht ak

HARYANA URBAN DEVELOPMENT AUTHORITY 

Urban Est at e Sect or  

HARYANA URBAN DEVELOPMENT AUTHORITY 

Whether earnest money financed Yes No

Note: Self addressed envelope attached with the application form may be returned alongwith this application form duly filled in by the applicant.

O H A KR T6

No.of Joint Applicants(other than first applicant)

Male Female

*In case of multiple applicants give their details in a separate sheet as per performa at Annexure-I.

Marital Status Single Married Widow Widower  

6

Yes

Yes

8/8/2019 Application Form of Rohtak

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Annexure I:

Sr.No.

JointApplicantName

JointApplicantSurname

Joint ApplicantFather's/Husband's Name

Joint ApplicantFather's/ Husband'sSurname

AddressLine 1

AddressLine 2

AddressLine 3

State Pin Code Signature

Details of Joint Applicants

1.

2.

Annexure II:

Additional Information to be filled in by the applicants under G.S.R.Q. (Haryana Govt. Employees only)

1. I.........................................................................son/daughter/wife of Sh............................................................................... am/wasemployed as.......................................................... in ......................................................................... Department on regular basis.

2. Certified thati) I am/was an official of class...............................................ii) The maximum of my scale of pay is Rs................................................iii) I fall in category .................................................................................................. (Refer eligibility condition 12(ii). My date of joining

is/was ............................................... & date of superannuation is/was .............................................iv) There is no plot/house in my name & spouse's name or in the name of any dependant member of my family in any Urban Estate

developed by Haryana Urban Estates Deptt. or HUDA in Haryana State.v) I have not been allotted at any time a plot of land out of Haryana Govt. servants reserved quota or discretionary quota, or any

other reserved category in any Urban Estate developed by Haryana Urban Estates Deptt. or HUDA in Haryana State.3. I attach herewith an affidavit in terms of para 2 above as per item number 12 (iii) of terms and conditions.

4. I attach herewith a certificate of employment from the concerned office (HOO/HOD) of Haryana Govt/ Board/ Corporation etc.Note : Applicant must be regular employee of Haryana Govt/ Board/ Corporation etc.

Date ............................... Signature of Applicant

To,The Estate Officer Haryana Urban Development AuthorityRohtak

Dear Sir,I/We request that I/We may be allotted a residential site as stated on reverse side in Sector 6 Rohtak. I/We agree to confirm to abide by the terms & conditionsas contained in the Haryana Urban Development Authority Act, 1977 and in the rules and regulations applicable there under.I/We also declare and confirm that I have never been allotted any residential plot directly by HUDA in the Urban Estate, Rohtak for which I have applied. Onallotment I shall produce an affidavit to this effect.*I/We also declare and confirm that I/We own no residential plot/house in my/our name(s) or in the name(s) or my/our dependent family member(s)/Spouse inany Urban Estate of Haryana if applying under any reserve category. On allotment I shall produce an affidavit to this effect, failing which my earnest moneymay be forfeited.

 Also, I/We have carefully gone through the terms and conditions for allotment mentioned in the brochure and I/We agree to abide by these terms andconditions.

Yours faithfully,Date ____________ 

* Conditions applicable for applicants under reserved categories. Signature of Applicant(s)

Note :1. For application downloaded from the website or its photocopy, an additional fee of Rs. 100/- alongwith earnest money in single draft be deposited

failing which the application will be rejected and will not be considered in the draw of lots.2. For detailed terms & conditions please refer to the information Brochure available on the HUDA Website:3. Applicants under GSRQ category need to provide additional details as given in Annexure-II.

www.huda.gov.in

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