273

1.2 Scheme Name

1.3 Income Group No. : 1.4 Reservation Category No. : 2. Applicant Details First Name 2.1 Applicant Name(In Marathi) 2.2 Applicant Name(In English)

M H P POWAI BUILDING NO. 22 B HIG-HIGHER INCOME GROUP 15-GP-GENERAL PUBLIC : Father's/Husband's Surname Name

Mr.

PUNDALIK

DIWAKAR

SOHANI

2.3 Date of Birth (dd-mm13-12- 2.4 2.5 Marital : : Service : Married yyyy)(same as on PAN card) 1971 Occupation Status 3. Present Residential address along with Pin code 60, MAHAVIR SUKH BLDG. , 2ND FLOOR, 207, DR.B.A. ROAD, 3.1 Address : DADAR (E). MUMBAI 3.2 Pin Code : 400014 4. Details of Bank Account of Applicant 4.2 MICR No. of 4.1 Bank Account No. : 003510110001289 : 400013075 Bank 4.4 Bank Branch 4.3 Bank Name(based NAIGAON CROSS : BANK OF INDIA Name(based on : on MICR no) ROAD MICR no) 4.5 IFSC Code of : BKID0000035 Bank 4.7 Bank Branch 4.6 Bank Name(based NAIGAON CROSS : BANK OF INDIA Name(based on : on IFSC code) ROAD IFSC code) 5. Contact Details 5.1 Mobile No. : 9004017747 5.2 E-mail Address :

5.3 Residence 5.4 Office : 022 - 24164290 : 022 - 24024353 - 313 TelePhone No. TelePhone No. 6. EMD Details 6.1 EMD Amount : 50000 6.2 Application Fee Amount : 50 6.3 Total Amount : 50050 7. Whether the applicant and / or his / her spouse or minor children owns a house or a flat or a residential plot of land, or holds on hire purchase basis or on Rental basis from Maharashtra Housing Area Development Authority a house, or a flat or a residential plot of land or membership of any,registered or proposed Co-operative housing Society in his or her name as the case may be in the jurisdiction of Municipal Corporation of Greater Mumbai? If so, give details of such house or flat or plot. No 8. Details about agriculture Land 8.1 Survey No. : 8.2 Address :

8.3 Area : 8.4 Village : 8.5 Taluka : 8.6 District : 9. Nature and details of Business 9.1 Name & Address : of the Establishment 10. Details of Service A.H.S. F/NORTH , MUNCIPAL OEEICE, SOLID WASTE DEPT. , 10.1 Name & Address : 3RD FLOOR R.NO.38, BHAU DAJI ROAD, MATUNGA of the Employer (E).MUMBAI 400019. 11. Income Details 11.1 Average monthly income of the applicant during the previous 12 25000 (per : months(01-04-2011 to 31-03-2012):A month) 11.2 Average monthly income of the applicant's spouse during the previous 30000 (per : 12 months(01-04-2011 to 31-03-2012):B month) 11.3 Total Monthly Income(A+B) : 55000 11.4 PAN No.(must be same as physical copy submitted) :AXRPS8028G 11.4(A) Confirm PAN No. :AXRPS8028G 11.5 PAN No. of Spouse :AXRPS8029H 12. Details about present Accomodation: 12.1 Whether rental or on ownership basis :Rental 12.2 In whose name the tenancy or ownership stands :SELF 12.3 Whether the applicant has intention to reside in the tenement itself? : Yes 12.4 Whether the applicant has intention to settle at the place where he intends to : Yes purchase the tenement? 12.5 How long has the applicant been staying in Maharashtra. :40 Years 12.6 Whether applicant or his/her spouse has applied in any other scheme? : Yes 12.7 Whether applicant will be submitting the application physically in the bank or In Bank : will be sending by post? 13. Statement 1 Vide Regulation No. 19 Name of Employed Exact Ration person If since Total Full relationship Ration card staying Age employed, (with Monthly residential with card no date of with details present Earnings address applicant issue Applicant employer) 60, MAHAVIR SUKH BLDG. , 2ND K.E.M. FLOOR, PRACHI 36 SPOUSE 1997 35000 HOSPITAL 207, DR.B.A. ROAD, DADAR (E). MUMBAI

SAKSHI 10

CHILD

60, MAHAVIR SUKH BLDG. , 2ND FLOOR, 207, DR.B.A. ROAD, DADAR (E). MUMBAI

14. Declaration 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 in relation 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 : MATUNGA Date :21-05-2012

FORM NO. 1 (See regulation 9(1)) MUMBAI HOUSING AND AREA DEVELOPMENT BOARD (A Unit of MHADA) Application for Residential Accommodation I, the undersigned, hereby apply for the following scheme, Application Details Application No. : 3000343030 1. Scheme Details 1.1 Scheme Code No. : 273 1.2 Scheme Name : M H P POWAI BUILDING NO. 22 B

1.3 Income Group No. : HIG-HIGHER INCOME GROUP 1.4 Reservation : 15-GP-GENERAL PUBLIC Category No. 2. Applicant Details Father's/Husband's First Name Surname Name 2.1 Applicant Name(In Marathi) 2.2 Applicant Mr. PUNDALIK DIWAKAR SOHANI Name(In English) 2.3 Date of Birth (dd-mm13-12- 2.4 2.5 Marital : : Service : Married yyyy)(same as on PAN card) 1971 Occupation Status 3. Present Residential address along with Pin code 60, MAHAVIR SUKH BLDG. , 2ND FLOOR, 207, DR.B.A. ROAD, 3.1 Address : DADAR (E). MUMBAI 3.2 Pin Code : 400014 4. Details of Bank Account of Applicant 4.2 MICR No. of 4.1 Bank Account No. : 003510110001289 : 400013075 Bank 4.4 Bank Branch 4.3 Bank Name(based NAIGAON CROSS : BANK OF INDIA Name(based on : on MICR no) ROAD MICR no) 4.5 IFSC Code of : BKID0000035 Bank 4.7 Bank Branch 4.6 Bank Name(based NAIGAON CROSS : BANK OF INDIA Name(based on : on IFSC code) ROAD IFSC code) 5. Contact Details 5.1 Mobile No. : 9004017747 5.2 E-mail Address :

5.3 Residence 5.4 Office : 022 - 24164290 : 022 - 24024353 - 313 TelePhone No. TelePhone No. 6. EMD Details 6.1 EMD Amount : 50000 6.2 Application Fee Amount : 50 6.3 Total Amount : 50050 7. Whether the applicant and / or his / her spouse or minor children owns a house or a flat or a residential plot of land, or holds on hire purchase basis or on Rental basis from Maharashtra Housing Area Development Authority a house, or a flat or a residential plot of land or membership of any,registered or proposed Co-operative housing Society in his or her name as the case may be in the jurisdiction of Municipal Corporation of Greater Mumbai? If so, give details of such house or flat or plot. No 8. Details about agriculture Land 8.1 Survey No. : 8.2 Address : 8.3 Area : 8.4 Village : 8.5 Taluka : 8.6 District : 9. Nature and details of Business 9.1 Name & Address : of the Establishment 10. Details of Service A.H.S. F/NORTH , MUNCIPAL OEEICE, SOLID WASTE DEPT. , 10.1 Name & Address : 3RD FLOOR R.NO.38, BHAU DAJI ROAD, MATUNGA of the Employer (E).MUMBAI 400019. 11. Income Details 11.1 Average monthly income of the applicant during the previous 12 25000 (per : months(01-04-2011 to 31-03-2012):A month) 11.2 Average monthly income of the applicant's spouse during the previous 30000 (per : 12 months(01-04-2011 to 31-03-2012):B month) 11.3 Total Monthly Income(A+B) : 55000 11.4 PAN No.(must be same as physical copy submitted) :AXRPS8028G 11.4(A) Confirm PAN No. :AXRPS8028G 11.5 PAN No. of Spouse :AXRPS8029H 12. Details about present Accomodation: 12.1 Whether rental or on ownership basis :Rental 12.2 In whose name the tenancy or ownership stands :SELF 12.3 Whether the applicant has intention to reside in the tenement itself? : Yes 12.4 Whether the applicant has intention to settle at the place where he intends to : Yes purchase the tenement? 12.5 How long has the applicant been staying in Maharashtra. :40 Years 12.6 Whether applicant or his/her spouse has applied in any other scheme? : Yes 12.7 Whether applicant will be submitting the application physically in the bank or In Bank : will be sending by post? 13. Statement 1 Vide Regulation No. 19 Name of Exact If Employed Total Ration Ration Full Age person relationship employed, since Monthly card no card - residential

staying with Applicant

with applicant

details

(with Earnings present employer)

date of issue

address

PRACHI 36

SPOUSE

K.E.M. 1997 HOSPITAL

35000

SAKSHI 10

CHILD

60, MAHAVIR SUKH BLDG. , 2ND FLOOR, 207, DR.B.A. ROAD, DADAR (E). MUMBAI 60, MAHAVIR SUKH BLDG. , 2ND FLOOR, 207, DR.B.A. ROAD, DADAR (E). MUMBAI

14. Declaration 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 in relation 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 : MATUNGA

Date :21-05-2012