APPLICATION FORM FOR GRANT OF LICENCE FOR OCCUPATION OF GOVERNMENT PREMISES
To,
The Competent Authority under the West Bengal Government Premises (Regulation of Occupancy) Act, 1984 in
respect of Rental Housing Scheme under the Public Works Department.
Sir,
I am in the employment of the Government of West Bengal and I hold a specified post under it. I pray that a
licence under Section 4 of the West Bengal Government Premises (Regulation of Occupancy) Act, 1984 may kindly
be granted in my favour for the occupation of the Government premises at
____________________________________________________________________________________________________________________________________
__________________________________________________________________________________ .
I have read and understood the provisions of the aforesaid Act and I know that I shall have to abide by the
terms and conditions mentioned in Schedule I to the Act and such other terms and conditions as may be stipulated
by the Competent Authority.
I hereby declare that I do not possess any house/ flat/ residential accommodation either in my own name or
in the name of any of the dependent members of my family within the local limits of Kolkata Municipal
Corporation/ Bidhannagar Municipal Corporation.
I furnish all relevant particulars below for consideration of my application:
1. Name of the Applicant:
2. Designation of the post hold:
3. Headquarters of the post hold:
4. Department/Directorate/Office:
to which the post is attached
5. Date of joining the post:
6. Scale of pay:
7. (i) Present basic pay including:
Special pay, if any
(ii)Dearness Allowance:
8. Designation of Drawing & :
Disbursing Officer with full address
9. Date of birth according to :
Service Book
10. Date of Retirement according:
to Service Book
11. Name & Address of Treasury :
12. a. Spouse Name:
b. If the spouse is a Govt. Employee, his/ her Designation & Department:
Yours faithfully,
Counter signature of Drawing & Disbursing
Officer/ Head of Department/ Head of Office (Signature with date)
with official seal. Contact No.-i) Office:
ii) Mobile:
iii) E-mail:
* All pending applications shall be renewed at an interval of every 2(two) years failing which names shall be
struck off from the register. In other words, the Govt. employees who have not been allotted any flat against their
earlier applications within a period of two years from the date of submission of the application, should submit fresh
applications enclosing therewith receipt copies of their earlier applications (Clause- 3.3 of Order No.532
-CS/3R-4/14 dated 22.07.2015).
