FORM OF ALLOTMENT OF SERVANT QUARTERS

IN CSD STATE, GHATKOPAR.

1 Name of Servant:

2 Name of Servant’s Husband / Wife:

3 Temporary Address:

4 Permanent Address:

5 Police Verification Report date (Copy to be enclosed):

6 Ration Card No (Copy to be enclosed):

7 Photo of self & family members with name, relation & age:

Photo-1 Photo-2 Photo-3 Photo-4 Photo-5

Name _________ _________ _________ _________ _________

Relation _________ _________ _________ _________ _________
Age _________ _________ _________ _________ _________

8 I hereby confirm that,

i) No relative / friend will stay with me.
ii) No three / four wheeler will be parked in CSD Estate.
iii) I will obey instructions / orders given by Authorities from time to
time.

Encl: a/a

Signature of Servant

Countersigned by
Officer / Allottee