Application Details Application Number

5000064184

Lottery Name Scheme Code Category Code Income Group Application Date Applicant Name Applicant DOB Pan No. Contact Details

: MHADA LOTTERY FOR 2013 ( 13 ) :

293-PLOT NO.1 CHARKOP, KANDIVALI (W), SECTOR 8 Please paste photo here

: GP-GENERAL PUBLIC : LIG-LOWER INCOME GROUP : 2013-05-16 22:17:47.605 : MRS NANCY JOHN CRASTA : 08/05/1973 : AGHPC7930L

**Signature of applicant

Mobile No Email Address

: 9819103785 : nancythecool@hotmail.com : NANCY CRASTA, C/O SARAJONI KAMATH,

PLOT NO 124, ROOM NO 25, SAI SIDDHI CO-HOUSING SOCIETY GORAI 2 BORIVALI WEST,

Residence Tel No Office Tel No

: :

Bank Details Bank Acc No. MICR code IFSC code Bank Branch

Payment Details

: 029010100108300 : 400211008 : UTIB0000029 : AXIS BANK : GHATKOPAR

DD Number DD Date DD Amount Drawn On

: : : 15100 :

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 : Date : Signature of Authorized Officer :

Signature of applicant : Name of applicant :

Application Details
Application Number
:

5000064184

Applicant Copy

Scheme Code Category Code Application Date Applicant Name Pan No. DD Number DD Amount

: 293-PLOT NO.1 CHARKOP, KANDIVALI (W), SECTOR 8 : GP-GENERAL PUBLIC : 2013-05-16 22:17:47.605

Income Group

: LIG-LOWER INCOME GROUP

: MRS NANCY JOHN CRASTA

: AGHPC7930L
: : 15100

DD Date Drawn On

: :

Applicant Signature

Signature of Authorized Officer