Transcription of ( Applications not verified by the administrative …
1 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. HOW TO APPLY SECTION FOR DETAILS)Name of the Holiday Home where booking required :1. Applicant's NameDesignation:2. where working3. Office : email ID:From to_ ( of booking required :(Max. 5nights in season, 10 nights in off-season) Checkout date Checkout of visit : Official visit** /Private visit/ LTC ( to Terms and Conditions of allotment) 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.)
2 Visitors'Names and relationship:10. Details of Advance payment:(Non-refundable after confirmedbooking)Bank DD. No. Dated :will be collected personallyQ maybe dispatched by ordinary postDECLARATION BY THE APPLICANTI certify thatthe accommodationasked for in the Holiday Home will be occupied by me or my dependent familymembers. Iundertaketo vacatethe accommodationon (FN)and will notoverstay without priorwritten permissionof EM/AEM,Dte. of Estates,failing which I will liable topay market rate of licencefee as damages and other legal action etc. I shall not claim refund incase the accommodationbooked isnot utilizedby undertake thatI will not withdrawmy application for booking.
3 In case the cheque(given byme as advancepayment)is dishonouredfor any reason,I authorizemy DDO to deductequal amount frommy salaryand remitthe same tothe Die of Estates,on receiptof certify that the information given aboveis correct and that nothing has beenconcealed. I shall abideby theprescribed Rules/orders/1'erms andconditions, covering this undertake to take and payfor the meals if arrangement exists andto pay the prescribed charges directly to the caterer..I am aware of the terms and conditions of thebooking as givenon :Place Signatures of the applicantVerification by the Administration DivisionGs:2:2009( Applications not verified by the administrative office of applicant will not be entertained)Certified that (a) a permanentemployee of this office.
4 (b) This officeis a (PI. tick the appropriate BOX in table given below) (c) (PLEASE FILL IFAPPLICABLE) He/Shehas beenauthorized by this office to perform official journey from (dates)to at (city name) (Enclose certified copy of tourprogram).Central PSU/ffice of StateOther (pl. specify)Retired Central Govt. employeesMinistry annex copy of PPO/ PensionerDepartmentemi CardfficeTo be sent to the Allotting AuthoritySignatureswith Office Seal(err#TiTT f 14 f ? 1/1 IHQrr -o f d J#ht tjT;7'FF47 EFi T Zoi fur fa ri3T ^ iA ZY 9Tm td)TTritttm aFrrr3m*1 . 3Tr -,;T7r .. r r/fa^TT^T/ rF^rr r rr* 3. *Mioq ITT tic f ..T^f-^0 ..4. 3 TFcfM ^T tfic f.
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