Application for NOC to Society / Information for verification to Police

From Licensor / Owner :

Name : ______________________________
Current Res. Address : _________________________________
_________________________________
Tel : (O) __________________ (Res) : ____________________
Email : _______________________________________________________________
Occupation Self-employed/Salaried/Others (Specially) : ________________________
Nationality : ______________________
To,
The Chairman / Secretary : ___________________________________CHS Ltd. OR Ad-hoc; Committee
of __________________________ (Proposed Society) OR _________________________ (Builder)

Dear Sir,
I/We am/are making NOC/consent for giving on Leave & License for __________ months (From
_____________ to _____________) my/our flat / shop no. __________ on the ___ floor of ‘_’ wing of
Building no./name __________________________________________ of the society. The Signature of
the Licensee has been attested by me here below. The copy acknowledge by you will be forwarded to
Andheri / MIDC / Meghwadi / Jogeshwari / Powai / Goregaon Police Station for verification and
submitted back to the society.

The personal details of the tenant provided by him / her is as here below :

Name : ____________________________________________________
Current (previous) Res. Address : _______________________________
___________________________________________________________
Tel : (O) ________________________ (Res.) : _____________________
Email : _____________________________________________________
Qualification : _________________ (School / collage) ___________________________________
Occupation Self-employed / Salaried / Other (specify) ___________________________________
Name of Company / firm __________________________________________________________
Address of Workplace : ___________________________________________________________
_______________________________________________________________________________
Nationality : __________________ Mother Tongue : ____________________________________
Other Languages Known : ______________________________________________
Native Place & Address ___________________________________________________________
_______________________________________________________________________________
Police Stn. Area of previous residence : _______________________________________________
Reason for coming to Zone-X area : __________________________________________________
Reference :
In Zone X-area (1) Name ______________________ Address : ____________________________
_______________________________________________________________________________
Tel : (O) ___________________ (Res.) : ___________ Email : ____________________________
Out of Zone X-area (1) Name ____________________________ Address _________________
_______________________________________________________________________________
Tel : (O) ____________________ (Res.) : ________________ Email _______________________
Whether Agreement has been registered with the sub-registrar ? Yes ______/ No ______________
Relatives / Acquaintances ;
In Zone X-area (10 Name _____________________________ Address : ____________________
_______________________________________________________________________________
Tel : (O) _______________ (Res.) : _________________ Email : __________________________
Family details : (Photographs of all members attached)

1 2 3
Photographs Photographs Photographs
of relative of relative of relative

Name ____________________ ___________________ _________________

Age ___________________ ___________________ _________________
Relation __________________ ____________________ _________________
Occupation __________________ ____________________ _________________

4 5 6
Photographs Photographs Photographs
of relative of relative of relative

Name ____________________ ___________________ _________________

Age ___________________ ___________________ _________________
Relation __________________ ____________________ _________________
Occupation __________________ ____________________ _________________

Details of Estate Agency / Agent through whom the flat / shop has been given on leave & license ;
Name of Agency ____________________________ Registered : Yes / No
Name of Authorised Person : ____________________________ Address _________________
_____________________________________________________________________________
Tel : (O) __________________ (Res.) : ________________ Email : ______________________

_______________________ _______________________
Signature of Owner Signature of Licensor

__________________
Signature of Licensee/ Occupant

Documents attached : 1) NOC from area police station of previous residence 2) Photo Identity (Election
Card, PAN Card, D/ License, Passport, etc. 3) Ration Card 4) Xerox of L/L Agreement 5) Leaving
Certificate from last School / College attended. 6) Tenant office letter.