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. PL.REFER HOW TO APPLY SECTION FOR DETAILS)

Name of the Holiday Home where booking required :

1. Applicant's Name Designation:

2. Ministry/Deptt./Office where working

3. Office address: Mob.No.

4. Resi.address: email ID:

From to_ (nights

5.Period of booking required :

(Max. 5 nights in season , 10 nights in off-season) Checkout date Checkout Time

6.Purpose of visit : Official visit ** / Private visit / LTC (PI. refer to Terms and Conditions of allotment)

7.Type 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. Visitors ' Names and relationship:

10. Details of Advance payment : (Non-refundable after confirmed booking)

Bank DD. No. Dated Rs.

I1.Confirmation : will be collected personally Q may be dispatched by ordinary post

DECLARATION BY THE APPLICANTI certify that the accommodation asked for in the Holiday Home will be occupied by me or my dependent family members. I

undertake to vacate the accommodation on (FN) and will not overstay without prior written permission of EM/AEM,

Dte. of Estates , failing which I will liable to pay market rate of licence fee as damages and other legal action etc. I shall not claim refund in

case the accommodation booked is not utilized by me. I undertake that I will not withdraw my application for booking . In case the cheque

(given by me as advance payment) is dishonoured for any reason, I authorize my DDO to deduct equal amount from my salary and remit

the same to the Die of Estates, on receipt of their demand. I certify that the information given above is correct and that nothing has been

concealed . I shall abide by the prescribed Rules /orders/1'erms and conditions, covering this booking/ allotment . I undertake to take and pay

for the meals if arrangement exists and to pay the prescribed charges directly to the caterer. . I am aware of the terms and conditions of the

booking as given on website.

Date : Place Signatures of the applicant

Verification by the Administration DivisionGs:2 :2009 ( Applications not verified by the administrative office of applicant will not be entertained)

Certified that (a) Shri/Smt. Designation is a permanent

employee of this office. (b) This office is a (PI . tick the appropriate BOX in table given below) (c) (PLEASE FILL IF

APPLICABLE) He/She has been authorized by this office to perform official journey from ( dates)

to at (city name) (Enclose certified copy of tour program).

Central Govt. entral PSU/ ffice of State Other (pl. specify) Retired Central Govt. employees

Ministry / utonom .Orgn./ ovt/ to annex copy of PPO/ Pensioner

Department emi Govt. T. Admn. d. Cardffice

To be sent to the Allotting Authority Signatures with Office Seal

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