Application Form for Beneficiary Led Construction
Application Number AP035150125099466016
Applicant Name Golla Dorasanamma
Date of Birth 01-Apr-2000
Gender Female
Mobile Number 9550640518
Email Address
Husband Name Golla Narendra
Father Name Putta Lakshmaiah
Mother Name Putta Rukmini
Employment Status Labour
Occupation Others
Education Qualification No Education
Household Category EWS
Whether the family owns puccca house anywhere in No
India.
Average annual household income (in Rs.) 80000
Religion Hindu
Marital Status Married
Category SC
Special Focus Group No
Preferred component of Scheme BLC
No of years residing in the present city/town More than 10 Years
House Ownership
Type of existing house based on roof type
Roof Type
Present Address
House Number Jatlakonduru
Street Name Jatalkonduru Panchayat
Manubolu M
City Name
District Name Sri Potti Sriramulu Nellore
State Name Andhra Pradesh
Pincode 524405
Permanent Address
House Number Jatlakonduru
Street Name Jatlakonduru Panchyat
Manuvolu M
City Name
District Name Sri Potti Sriramulu Nellore
State Name Andhra Pradesh
Pincode 524405
Address of the proposed house/Flat under PMAY-U 2.0
House Number Jatlakonduru
Street Name Jatlakodnuru Panchayat
Manubolu M
City Name
District Name Sri Potti Sriramulu Nellore
State Name Andhra Pradesh
Pincode 524405
Name of Development Authority
Name of Town/Village
Details of family members
Name Relationship Gender Date of Birth Occupation
with Applicant
golla dorasanamma Self Female 01-Apr-2000 Others
golla narendra Husband Male
Bank Details
Account Number ********650
IFSC Code sbin0006112
Bank Name STATE BANK OF INDIA
Branch Name MANUBOLU
Have you availed benefit under any Central/State No
sponsored Schemes such as AMRUT 2.0, SBM-U 2.0
DAY-NULM, NHM, PM Surya Ghar: Muft Bijli Yojna,
Ayushman Bharat,Ujjwala Yojna, Ujala etc.
Note 1: All details should be filled up as per Aadhaar only.
Note 2: Consent for Aadhaar Authentication:
a) I hereby state that I have no objection in authenticating myself with Aadhaar based
authentication system and give consent to provide my Aadhaar number, Biometric
and/or One Time Password (OTP) data for Aadhaar based authentication for the
purposes of availing benefits of owning a pucca house under Pradhan Mantri Awas
Yojana - Urban 2.0 (PMAY-U 2.0). I understand that the Aadhaar number, Biometrics
and/or OTP provided for authentication shall be used:
i. for authenticating my identity and
ii. for de-duplication with the previous housing Scheme, PMAY-U 2.0 (all verticals
including Interest Subsidy Scheme) and also for de-duplication with other housing
schemes such as PMAY (Gramin), any State sponsored housing schemes etc.
b) I understand that PMAY-U 2.0, Ministry of Housing and Urban Affairs, Government
of India shall ensure security and confidentiality of my personal identity data provided
for the purpose of Aadhaar based authentication.
c) I hereby declare that the information provided hereunder is correct.
Name : golla dorasanamma
Mobile Number : 9550640518
Signature of Applicant
Date : 22-01-2025 09:55:31
Place :
Pradhan Mantri Awas Yojana – Urban 2.0 (PMAY-U 2.0). Self-Undertaking by
Beneficiary under BLC
I golla dorasanamma son/daughter/wife of putta lakshmaiah, born on 01-Apr-2000
presently residing in jatlakonduru, jatalkonduru panchayat manubolu M ,, Sri Potti
Sriramulu Nellore ,Andhra Pradesh Mobile/Contact 9550640518 by solemnly affirm and
declare as under:
1. That there is no pucca house in my name or any family member name in any part of India.
2. That I belong to EWS category, as my annual household income from all sources is up to <strong>
3,00,000/- (Rupees Three Lakh Only).
3. That I am the owner of the land/property with valid documents where the construction is proposed
situated atjatlakonduru, jatlakodnuru panchayat manubolu m ,, Sri Potti Sriramulu Nellore ,Andhra
PradeshThe said land is free from all legal disputes and is suitable for the construction of house under
the PMAY-U 2.0 Scheme.
4. That I or my family member have not availed benefits under any other housing Scheme of the
Government of India or State Government in last 20 years.
5. That I am willing to contribute my share of money for the construction of my house under PMAY-U
2.0, within stipulated time period i.e. Twelve (12) Months from the date of receipt of first instalment
under the PMAY-U 2.0 Scheme.
6. That I shall use the house constructed under PMAY-U 2.0 Scheme only for residential purpose and
shall not use for any other activities.
7. That I shall not sell-out/transfer the house constructed under PMAY-U 2.0 Scheme for a period of
Five (5) years from the date of completion of my house.
8. That I have not applied/availed benefit under any other vertical of PMAY-U 2.0
9. That I shall adhere to all terms and conditions of the PMAY-U 2.0 Scheme.
I hereby declare that all the above information provided by me in the application form is true and
correct to the best of my knowledge and belief. I also understand that non-compliance with respect to
eligibility or submission of false information will lead to legal consequences, including but not limited
to, disqualification from the Scheme and recovery of any benefits already received under PMAY-U 2.0
Scheme.
Name : golla dorasanamma
Date : 22-01-2025 09:55:31
City :
