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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