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Wednesday, September 1, 2010

HRA Claim Form

ANEXXURE


Certified to be furnished by a State/Central Government Servant claiming House Rent as per Government of India, Ministry of Finance O.M. No.11013/2/86-E (3)  Dt 23.8.86 and of even no. dated 19.3.87.


            1.         Certify that I have not been provided with any Government owned or hired accommodation during the period with effect from________________ in respect of which allowance is claimed.

            2.         I certify that I am residing in a house hired/owned by me/my wife/husband/son/daughter/father/mother/ of a Hindu Undivided Family in which I am a  co - percener.



            3.         I certify that I am incurring some expenditure on rent contributing towards rent as Property Tax or maintenance of the   house.

            4.         I certify that I am not sharing Government hired or owned accommodation allocated to my parent/child by the State/Central Government and autonomous public undertaking of semi Government, organizations such as Municipality / Port Trust etc. allotted, rent them to another Government Servant.

            5.         I certify that my husband/wife/children/parents who is/are sharing Government owned or hired accommodation with me allotted to another employees of the Central/State Government, Autonomous Public Undertakings or Semi-Government Organization like Municipality/Port Trust etc.

            6.         I also certify that my wife/husband has not been allotted accommodation at the same station by the  Central/State Government, Autonomous Public Undertakings or Semi -  Government Organizations such as Municipality, Port Trust etc.



Dated______________                                                  Signature       ___________________
                                                                                       Designation   ___________________



TO BE FILLED AND SIGNED BY THE HEAD OF OFFICE/DEPARTMENT


               Certified that Pi/Pu/Dr ________________________________________________
Is not provided with any Government owned or hired accommodation.






                                                                                       Signature of head of office/Department
                                                                                                               (with seal)

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