1.
Name of Employee (IN BLOCK LETTER)
:
2.
Ministry/Department
in which working :
3.
Designation
:
4.
Office
Address
:
5.
Date
of appointment :
6.
Basic Pay
:
7.
Reservation
required from : Maximum (5 days):
8.
State,
if the accommodation is acceptable at short notice,:
if
accommodation is not available for the days applied for
9. State, if alternative dates are
acceptable :
10.
Have you availed the holiday home in the previous years ? :
If so, mention the year
11. Particulars of I.P.O. attached with
date :
12.
Mobile No & e-mail_id :
13. Declaration:
I
certify that the accommodation requested for will be occupied by me and my
family members noted below. I undertake to abide by the discipline of the
holiday home.
Name of the family
members showing their relations with the applicant be noted down serially.
Name
Relationship
Date:
Signature of the applicant
Note: The
staff applying for reservation must be on leave during the period applied for.
A certificate from the competent authority to this effect should be enclosed
with the application.
Signature of the Controlling
Officer
With Designation and Seal
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