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APPLICATION FORM FOR BOOKING IN CENTRAL GOVT.

HOLIDAY HOMES
(PL. DO NOT USE THIS FORM IF APPLYING FOR BOOKING TO DoE DELI II/CHENNAVSIM LA. PL.REFER HOW TO APPLY SECTION FOR DETAILS)

Name of the Holiday Home where booking required : 1. Applicant's Name 2. Ministry/Deptt./Office where working 3. Office address: 4. Resi. address: email Mob.No. ID: Designation:

From to_ (nights 5.Period of booking required :


(Max. 5 nights in season , 10 nights in off-season) Checkout date Checkout Time 6.Purpose of visit : Official visit ** / Private visit / LTC (PI. refer to Terms and Conditions of allotment) 7.Type of Room reqd ( pl. tick ): 2-Bed / 4-Bed * / VIP/Dormitory * (* Avlble at Shimla , Agra, Nainital, ooty) 8. No. of Visitors : Self / Dependent Family Members / Guests ( Total No)

9. Visitors ' Names and relationship: 10. Details of Advance payment : (Non-refundable after confirmed booking) Bank DD. No. Dated Rs.
I1.Confirmation : will be collected personally Q may be dispatched by ordinary post

DECLARATION BY THE APPLICANT


I certify that the accommodation asked for in the Holiday Home will be occupied by me or my dependent family members. I undertake to vacate the accommodation on (FN) and will not overstay without prior written permission of EM/AEM, Dte. of Estates , failing which I will liable to pay market rate of licence fee as damages and other legal action etc. I shall not claim refund in case the accommodation booked is not utilized by me. I undertake that I will not withdraw my application for booking . In case the cheque (given by me as advance payment) is dishonoured for any reason, I authorize my DDO to deduct equal amount from my salary and remit the same to the Die of Estates, on receipt of their demand. I certify that the information given above is correct and that nothing has been concealed . I shall abide by the prescribed Rules /orders/ 1'erms and conditions, covering this booking/ allotment . I undertake to take and pay for the meals if arrangement exists and to pay the prescribed charges directly to the caterer. . I am aware of the terms and conditions of the booking as given on website.

Date :

Place Signatures of the applicant

Verification by the Administration Division


G s:2 :2009 ( Applications not verified by the administrative office of applicant will not be entertained) is a permanent Designation Certified that (a) Shri/Smt. employee of this office. (b) This office is a (PI . tick the appropriate BOX in table given below) (c) (PLEASE FILL IF APPLICABLE) He/She has been authorized by this office to perform official journey from ( dates)
to at (city name) (Enclose certified copy of tour program).

Central Govt. Ministry / Department

entral PSU/ utonom .Orgn./ emi Govt. ffice

ffice of State ovt/ T. Admn.

Other (pl. specify)

Retired Central Govt. employees to annex copy of PPO/ Pensioner d. Card

To be sent to the Allotting Authority

Signatures with Office Seal

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