Yes No

Single Joint

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Permanent Address

Present Address

Application form Payment Details

*Do you undertake that you will pay the balance cost (Sale price minus EMD) of the House/Flat/Resedential Plot/ SCR as would be fixed by the Board: Yes No

*Do you or any of your family members own/owns/a House/Flat/Resedential Plot/ SCR in BHUBANESWAR Municipal Corporation/ Municipality/ NAC area ,where the Housing scheme is proposed to be undertaken, (Family means Husband,wife & minor childern.): Yes No

*Do you under take to submit the legal Affidavit: Yes No

Applicant's Bank Account Details For Refund Purpose

Declarations

I undertake that the following persons are the member and dependants of my family and related to me as noted in statement below.

That Present Annual Income of my family from all sources is Rs.
(Rupees In Words: ) Only.


Documents Attached

i) *Identity Proof –Copy of voter Id/PAN Card/Driving licence      
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ii) Residential Proof –Telephone bill/Electricity bill/Water bill.     
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iii) Copy of document in support of claim under specific category (Not required for general category)     
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iv)* Original Affidavit in prescribe format(Affidavit format is available at oshb website)     
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v)* Copy of receipt in support of payment     
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vi)* One Passport size Photograph


I agree to abide by the conditions contained in the Orissa Housing Board Act, 1968, the extant Rules and Regulation and Board decisions framed there under or any other order, instruction duly issued by the Board from time to time. In case of voluntary withdrawal from the scheme for any reason whatsoever, I will not claim any interest on the deposited amount. I have read the contents relating to the terms and conditions of allotment of one HIG Flat/ MIG Flat/ EWS Flat/ HIG core House/ MIG Core House/ LIG Core House/ Plot, in detail as mentioned in the Brochure and hereby agree to abide fully by the terms and conditions and accordingly, put my signature on this.

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