Application Details

Application Number

2160054789
2160054789

Lottery Name

: KONKAN LOTTERY 2016 ( K16 )

Scheme Code

Category Code

: GP-GENERAL PUBLIC

Income Group

: LIG-LOWER INCOME GROUP

Application Date

: 2016-01-26 12:24:09.343

Applicant Name

: MR PARSHURAM BABU OMKAR

Applicant DOB

: 21/09/1992

Pan No.

: AAZPO3674K

263-VIRAR BOLINJ

Contact Details

**Signature of applicant

Mobile No

: 8898245318

Residence Tel No

Email

: omkarparshuram@gmail.com

Office Tel No

Address

: 301 ,SIDHARA MANDIR NEAR KANNADA SCHOOL DHANGAR WADI GILBERTHILL ROAD ANDHERI
WEST MUMBAI -400058,ANDHERI,K/WEST WARD,MUMBAI
(SUBURBAN),MAHARASHTRA,INDIA,400058

Bank Details
Bank Acc No.

: 20078230219

MICR code

: 400002003

Bank

: STATE BANK OF INDIA

Branch

: ANDHERI WEST

Paid Amount

: 10300

IFSC code

SBIN0004650

I hereby declare that the information given by me in this application form is true and correct.I acknowledge that if the information is noticed to be
false,it would result in cancellation of my application,cancellation of allotment of tenement if any, made in my favour,and liable for legal action for
making a false declaration.
I agree to abide the provisions of the Maharashtra Housing & Area Development Act.1976 and the Maharashtra Housing and Area
Development(Estate Management, Sale, Transfer and Exchange of Tenements) Regulation 1981,and Maharashtra Housing & Area
Development (Disposal of land) Rules-1981 as amended from time to time and shall execute all such agreements and instruments inrelation to
tenements/plot which may require me to do so.
That I will produce to the department within prescribed time limit the requisite prescribed documents e.g. Certificate of age/Certificate of
income/affidavit, Domicile Certificate of Stay in Maharashtra state, Certificate of Caste or other reserved categories and such other documents
as may be found necessary from the appropriate Competent Authority as and when called for to do so, for determination of my eligibility.

Place :

Signature of applicant :

Date :

Name of applicant