HOUSING BOARD

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CHANDIGARHB, lan Marg, Sector 9-D, Chandigarh ... recogn zed University. ... payable in favour of "Chandigarh Housing Bo
CHANDIGARHBo r, 7l a2n- 4M6aArIgA, S2 e6 c t o r 9 - D , C h a n d i g a r h HOUSING BOARD

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Name F a t h e r 'N s ame P e r m a n e nAt d d r e s s Correspondence Address E d u c a t i o n qa ul a l i f l c a t i o n (Attachp.oofs) Dateof B rth (attachedproof) A g e{ a so n 0 1 . 0 1 . 2 0 1 8 ) E x p e er n c e ,i f a n y (Attachproofs) Particuar of fee Declaration

l c e r t i f yt h a t t h e f o r e g o i n gi n f o r m a t i o n5 c o r r e c a t n d c o m pe t e t o t h e b e s to f m y k n o w l e d g e a n d b e le f a n d n o t r n gh a s b e e nc o n c e a l e d / d i s t o r t el fda.t a n y t i m e ,l a m f o u n dt o h a v ec o n c e ae d / d l s t o r t eadn y r n d t e r i ai n f o r m a t i o nm; y d p p on t m e n ts r t a be iab e to surnmaryterm natlonwithoLrtnot ce. Date:

Signatu re ot Candtdate

Place:

Secretary, C h a 1 1 d l B a lrlho u s n g B o a r d , Chandigarh.