Ts Double Bed Room Application

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2BHK/Pradhan Mantri Awas Yojana - Housing for All (Urban)

1. District

2. Mandal/ULB

3. Village

4. Colony

5. Name of the Beneficiary

6. Sex [ Male:01, Female:02, Transgender:03]

7. Father's name/Husband Name

8. Age of the beneficiary

9. Present Address and Contact Details

i. House/Flat/Door No.

ii. Street No/Village Name

iii. Mandal/District

iv. Mobile No.

10. Permanent Address

i. House/Flat/Door No.

ii. Street No/Village Name

iii. Mandal/District

iv. State

11. Ownership details of existing house

[ Own-01, Rent-02, Otherwise-03]

12. Type of the house based on roof type

ii. Semi-Pucca
( A s b e s t ors/ S t e e l S h e e t , T i l e d ) -02,
iii. Katcha (Grass/tatched, Tarpaulin, Wooden) -03

13. Number of rooms in the dwelling


Unit excluding kitchen
14. Voter ID Number of the Beneficiary

15. Aadhaar Card number of Beneficiary

16. Number & age of family members

Relationship to Head of the Family Gender Age Aadhaar card/ Voter ID/Any other Unique identification
& Name number or a certificate of house ownership
from Revenue Authority of beneficiary's native city.
17. Religion

[Hindu-01, Muslim-02, Christian-03, Sikh-04, Jainism-05,


Buddhism-06, Zoroastrianism-
07, others(specify)]
18. Caste

[General-01, SC-02, ST-03, OBC-04, Minority-05]

19. Sub Caste

20. Meeseva Caste Certificate Number

21. Bank Details

a. Bank account number

b. Name of the Bank & Branch

c. IFSC Code of Bank

22. Number of Years of Stay in this


Town/City
[0 to 1 year-01, 1 to 3 years-02, 3 to 5 years-03, More than 5 years-04]

23. Size of existing dwelling unit

(carpet area in square meters)

24. Whether the Person with disability


(Yes/No?)
25. Whether the person belongs to Ex- Servicemen/ Widow of Ex-Service men [Yes/No]

26. Marital Status

(Married-01, Un-Married-02, Single/Divorced-03)

27. Whether the family owns any house anywhere in


India
(Yes/No)
a) If yes, then location details

(Locality/City/State)

b) If yes, then extent of land in Sq.mtrs

28. Employment Status

(Self Employed-01, Salaried-02, Regular


Wage-03, Labour-04, Other-05)
29. Average monthly income of household (in Rs.)

30. Food Security Card Number

31. Income of the Family

32. Meeseva Income certificate Number

33. Housing requirement of family

(New House-01, Enhancement-02)

34. Beneficiary Photo (For Capture or


Upload )

Signature of the Applicant

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