N.F.
RAILWAY
Application for Enlistment of name in the seniority list for allotment of Quarter in MLG area under
General Pool of Chairman, C.H.C. MLG
(A) Type of Quarter. (B) Category for Registration……………………………….
Applied for .................... (Essential/Non-essential/SC&ST/Type-I to Type-II, Lower
type to Higher type including Optional area/PS)
(1) Name in Full
(Block letter) ……………………………………………………………....
(2) Designation & Office ………………………………………………………………
(a) Controlling Officer ……………………………………………………………....
(3) Working under &place
of working ………………………………………………………………
(4) Date of Birth ……………………………………………………………....
A. EMO No. ………………………………………………………………
B. PF/NPS No. ………………………………………………………………
C. Mobile No. ………………………………………………………………
(5) Date of regular Rly. Appointment to (a)…………………. (b) ………………….
service as (Group “D”) (Group “C”)
A. Date of Normal
Retirement ………………………………………………………………
B. Date on entitled
Type II, III, IV etc. ………………………………………………………………
(Please tick which is
applicable)
(6) Present Pay, Scale & GP ………………………………………………………………
(7) Quarter for which area (a) Popular Area (i) MLG Area ……… (ii) PNO Area….....
(PNO/MLG) opted for (iii) Both Area ………. (Please write Yes or No)
(Bifurcation on MLG area or PNO area will be AT Road)
(8) In case priority opted for (a) Essential
(i) Date of Entry ……………………………………………….
(b) Non-Essential
(i) Length of Non-fortuitous (Regular) Service: Y….. M….D…..
(c) Transferee
(i) Particulars of transfer O/O No. ………………… Date………
issued by ……………stn………..from………...to…………..
(ii) Date of Arrival/Joining to PNO/MLG……………….
(iii) Particulars of Qr. If enjoyed at previous station with allotment
references.
Type of Qr……….O/O No…………………..Date………….
issued by ………………………………………………………
(iv) Date of vacation of Qr. at previous station……………………
(v) Whether permission for retention obtained if the Qr. not
vacated. Period of retention………Month/w.e.f………………
(d) SC/ST
(i) Whether staff belong to SC/ST………………………………..
(ii) Certificate No………………….……….Date…………………
issued by……………………………………………………….
[2]
(e) Type-I to Type-II
(i) Date of promotion from Gr.D to C on regular basis…………..
O/O No. ……………………………..…Date…………………
issued by……………………
(ii) Length of Non-Fortuitous (Regular) Service as Group-D
Y…… M…… D …… and as Gr. C Y…… M…… D ……
(f) Lower to Higher type
(i) Opted for higher type…………………………………….
(ii) Allotment ref. of existing Qr. No. ………………. Type……..
Area………… O/O No. ……………………….. Date………..
issued by …………………..
Type-III Type-IV
(iii) Pay scale for entitlement ……………….. ………………
(iv) Date of entry in scale ……………….. ………………
Please Note:
Copy of pay slip and copy of appointment letter or memorandum regarding grade pay have to be
enclosed (compulsory). Without requisite documents the application will not be entertained and
treated as cancelled. Incomplete and unfilled application will not take in consideration.
(9) Whether having own house of Qr. No. ……………… Area …………………………….
Guwahati Municipal Corporation
O.O No. ………………… Area …………………………
NB: Strike out the columns not applicable.
(10) Declaration to be I do hereby certify that the above particulars furnished by me are true to the
furnished by the best of my knowledge and belief and I further undertake that in the event of
Applicant any entry above is found incorrect or not in order, my application shall liable
to be cancelled at any stage before or after allotment of quarters.
Date ……………………….
Place ……………………… Signature of the Applicant.
Mobile No…………………….
(11) Certificate furnished by the Cadre/Personnel Branch Officer:-
It is certified that the particulars furnished by Shri/Smt/Miss
…………………………………..Designation ……………………….. through the above Performa, have
been verified with his/her record available in this office and found correct.
Date…………………. Signature of the Cadre/Personnel Branch Officer
(With Office Seal)
N.B.: In case Personnel Officer is not available, the respective Controlling Officer who dealt with P.
Case and other personnel matters of the applicant will be trated as Personnel Branch Officer and he
should certify column-11 above as like as Personnel Branch Officer. The authority for
certification/verification of service particulars should not be below the rank of Gazetted Officer.
No: ……………………………… Date …………………..
(12) The service particulars filled by the applicant Shri/Smt/Miss……………………………..
Designation…………………………….. duly verified by the P. Branch Officer with his/her service
records available with them is hereby forwarded to Chairman, Central Housing Committee, Maligaon
for further necessary action.
Signature of the Controlling Officer
(With Office Seal)
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This application format is applicable for General Pool Quarters under Chairman, CHC, Maligaon
