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Annexure 'A': Application Form For Claiming House Rent Allowance

This document contains an application form for claiming house rent allowance. [1] It requests information such as the applicant's name, designation, pay, landlord details, rental accommodation details, monthly rent paid, and amount of HRA claimed. [2] It must be certified by the head of office or department that the claim is in accordance with rules and that required certificates have been obtained. [3] The head of office may then sanction the claimed HRA amount.

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Anil kumar
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7K views

Annexure 'A': Application Form For Claiming House Rent Allowance

This document contains an application form for claiming house rent allowance. [1] It requests information such as the applicant's name, designation, pay, landlord details, rental accommodation details, monthly rent paid, and amount of HRA claimed. [2] It must be certified by the head of office or department that the claim is in accordance with rules and that required certificates have been obtained. [3] The head of office may then sanction the claimed HRA amount.

Uploaded by

Anil kumar
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ANNEXURE 'A'

APPLICATION FORM FOR CLAIMING HOUSE RENT ALLOWANCE

1. Name
2. Designation & Department in
which employed.
3. Pay (including personal pay,
special pay, dearness pay, merit
pay, if any ) indicate amount of
gross pension and pension
equivalent of death-cum-
retirement benefit if the claimant
is a re-employee pensioner.
4. Name of Land Lord and complete
address of the rented house.
5. Details of accommodation taken
on rent (No. of rooms, Kitchen,
W.C. and bath. Varandah etc. be
shown separately.)
6. Monthly rent paid.
7. Amount of House Rent allowance
claimed as admissible under rules.
8. Whether certificates required
under rules are attached.

Signature :

Designation :

Department:

*
Applicable in case of officers drawing pay more than 1000/- P.M.

For use in the office of the Head of Office/Head of Department.

Certified that :--

(1) I have examined the claim for House Rent allowance and I am satisfied that the claim
is a accordance with the rules. The certificates prescribed by Government have been
obtained from the Government Servant.

(2) House Rent Allowance of Rs. .............................. in hereby sanctioned.

SIGNATURE
(Head of Office/Head of Deptt.)
Designation

No.................... Dated................

Copy forwarded to XEN/Collector/Dy. Secretary, General Administration Department,


Jaipur for allotting Government accommodation, if available.

Signature................................................

Designation.............................................

E:\dop\Forms\Form - H.R.A..doc
CERTIFICATE
I Certify that :--

1. I do not own a house and I am not living in a


house belonging to or owned by me
father/mother/wife/children,
Substitude by the following :--

2. I am living in a rented house situated within


municipal limits of (name of city/town)
...................... (given house number and
full address) and paying a monthly rent of
Rs. .................... to
Shri..............................
(name of land lord) (to be filled in by officers
drawing pay more than Rs.1000/- P.M.)

3. I have not been provided with Government


accommodation.
OR
I was provided with Government
accommodation but refused it or surrendered
the same after occupying it and I now hereby
give an undertaking that I shall ask for
Government accommodation for a period of 5
years from the date of allotment of
surrender of Government accommodation
which is ...................................................

....................................(Mention date)
(strik out whichever is inapplicable)

4. No portion of accommodation in respect of


which house rent allowance is claimed is
sublet or occupies by adult (S) other that
those belonging to my family or who are
wholly dependent upon me.
(If the case is covered by exception below
rule ? the fact should be mentioned in this
Certificate)

5. I am also owner or a joint owner of an


ancestral house, no portion of which has
been let out on rent, and that
accommodation in my possession or
available for my use, the details of which are
given below is not adequate according to my
status and size of the family.

Signature

Designation

Department

Date : _______________________

No. : Date :

Forwarded to the Registrar/Asst. Secretary, Department of personnel (B- ) Govt. Sectt., for
necessary action.

SIGNATURE

E:\dop\Forms\Form - H.R.A..doc

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