(i) I am living in quarter owned by Government or any statutory body.[cite: 1]
(ii) I am not living in quarter owned by Government or any statutory body and I have to incur expenditure towards rent for accommodation.[cite: 1]
(iii) I am living in own house and I have to incur expenditure towards maintenance of house.[cite: 1]
B.[cite: 1]
(i) I am not married[cite: 1]
(ii) I am married[cite: 1]
(a) And my wife/husband is not in service under the Government of India/any State Government/any Government undertaking/any Statutory Bodies/Local Bodies/Educational Institution etc.[cite: 1]
(b) And my wife/husband is in service under the Government of India/any State Government/any Government undertaking/any Statutory Bodies/Local Bodies/Educational Institution etc. and following particulars are furnished in respect of her/him.[cite: 1]
1. Name and Designation: [cite: 1]
Address of Office: [cite: 1]
2. Present pay per month: Pay in Pay Band: Rs.
Grade Pay: Rs.
Basic Pay: Rs. [cite: 1]
3. H.R.A. drawn by her/him per month: Rs. [cite: 1]
Employee's Details:[cite: 1]
Name and Designation:
Department/Office: [cite: 1]
Present pay per month (Pay in Pay Band & Grade Pay): Rs. [cite: 1]
H.R.A. drawn by her/him per month: Rs. [cite: 1]
Remarks (if any): [cite: 1]
Date:
.................................................. Signature of Govt. Employee[cite: 1]
