KARNATAKA HOUSING BOARD

Cauvery Bhavan, Bangalore

Application for registration of
Houses/Flats at Bangalore, Kengeri KHB Diamond

Application No. D-

House/Flat





Notification No. and date
KHB/Allot/121212 dated: 12-12-2012



Applicants Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Father/Husband/Wifes Name _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Date of Birth _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Age _ _ _ _ _ _ _ Gender

Address for communication _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _

Telephone No. _ _ _ _ _ _ _ _ _ _ _ _ Mobile No. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Name of the Nominee: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Relationship _ _ _ _ _ _ _ _

Please indicate any one number in the box of the sub category to which the
applicant belongs from the columns given below


SC ST BT/
Category I

Defence/Ex-
Serviceman

Central
Govt.
State
Govt.
Physically
Handicapped
Senior
Citizens
Others
1

2 3 4 5 6 7 8 9

1 BHK 2 BHK
619 - 654 Sq. ft 867 - 902 Sq. ft


Applicants Photo


M F

Annual Income

Rs. I.T. PAN No.
(if available)


Name of the Applicants Bank & Branch _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Bank A/C No.


IFSC
Code.

Payment details
Sl. No. Category Registration fee (non-
refundable) (In Rs)
Initial Deposit
(In Rs)
1. 1 BHK 500/- 1,50,000/-
2. 2 BHK 1000/- 2,00,000/-

Challan/D.D No.

Bank:
Challan/D.D Date

Branch:
Challan/D.D Amount

Place:

D.D to be drawn in favour of Housing Commissioner, Karnataka Housing Board,
Bangalore.
Place: Signature:

Date: Name:
_ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


ACKNOWLEDGEMENT

Application No. D

Received Application along with Registration Fee and I.D from

Sri/Smt.................................................................................for Rs. ............................

(In words) ......................................................................................................................

D.D/Challan No. ................................ Dated .......................... drawn on Bangalore.


Signature of the Applicant


Date Checked and Verified Signature of Authorised Official with seal