FORM OF AGREEMENT TO BE EXECUTED WHILE APPLYING FOR AN ADVANCE FOR THE PURCHASE OF __________________________________.

An agreement made on __________ day of _______ two thousand _______ between Sh./Smt. __________________ office of __________________________ ( hereinafter called the borrower, which expression shall include his heirs administrators, executors and legal representatives of the one part and the Governor of Haryana ( hereinafter called the Governor which expression shall include his successors and assignees of the other part). Whereas the Borrower has under the provisions of the Punjab Financial Rules ( hereinafter to as the said rules) which expression shall include any amendments thereof for the time being in force applied to the Governor of Haryana for a loan of Rs. _________________ (Rupees ____________________only) for the purchase of a ________________ and whereas the Governor has agreed to lend the said amount to the Borrower on the terms and conditions hereinafter contained.

Now it is hereby agreed between the parties hereto that in consideration of the sum of Rs. __________paid by the Governor to the Borrower ( the receipt of which the borrower hereby acknowledge) the Borrower hereby agrees with the Governor ( 1) to pay the Governor the said amount with interest calculated according to the said rules by monthly deductions from his salary as provided in the said rules and hereby authorises Governor to make such deductions ( 2) within one month from the date of these presents to expend the full amount of the said loan in purchase of _________________or if the actual price paid is less than the loan to repay the difference to the Governor forthwith and (3) to execute a document

hypothecating the _________________to the Governor as security for the amount lent to the borrower as aforesaid and interest in the from provided by the said his rules and it is hereby lastly agreed and declared that if ____________________________had not been purchased and Hypothecated as aforesaid within one month from the date of these presents or if the borrower within that period becomes insolvent or quits the service of the Govt. or dispose the Computer the whole amount of Loan and interest accrued thereon shall immediately become due and payable. In witness whereof the borrower and ________________for & on behalf of the Governor have hereunto sent their hands the day and year first before written.

Signature & Designation of Borrower (Signature of Witnesses) for and on behalf of the Governor of Haryana

(Signature and Designation of the Officer)

ANNEXURE IV
I, Anju Rani, Lecturer in English do hereby authorize the Accountant General, Haryana to recover from the death-cum- retirement gratuity, the amount which would become due to me on the date of my superannuation/ retirement, the balance of outstanding Rs. 5,50,000/advance, with interest in terms of the penultimate paragraph of the agreement dated the 2.2.2012. Date: Signature Name: Anju Rani Designation : Lecturer in English Certified that I hereby cancel the nomination made by me in respect of the death cum- retirement gratuity payable to me at the time of retirement. Signature Name : Anju Rani Designation : Lecturer in English Certified that I am not in a position to purchase car without Govt. Loan and that rest of amount , I shall bear from out of my personal savings. Signature Name : Anju Rani Designation : :Lecturer in English

AFFIDAVIT
I, Anju Rani, W/o Sh. D.R. Bansal, Resident of 2111, Sector 27-C, Chandigarh do hereby solemnly affirm and declare as under :1. That I am working on deputation as a Lecture in English in Govt. Sen. Sec. Girl School Sector 18, Chandigarh. 2. That I have not taken delivery of the personal vehicle Pulse Diesel car on account of which I apply for the advance and that I shall compete negotiations for the purchase of, pay finally and take possession of the per personal vehicle Pulse Diesel Car before the expiry of one month from the date of taking delivery or further that the insurance of the vehicle will be comprehensive. 3. That if I do not mortgage the personal vehicle with in one month from the date of drawl of advance, the Government is fully empowered to adjust entire salary ( all allowances & pay) towards the advance till it is fully recovered. 4. That I am unable to purchase the vehicle Pulse Diesel car without Government Loan. 5. That the purchase of vehicle Pulse Diesel Car will increase my efficiency in discharge of official duties. 6. That the information given above is complete and true.

Verification:-

Deponent

Verified that the contents of my above affidavit are true and correct to the best of my knowledge and belief and nothing has been concealed therein. Deponent

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