Application Form for Beneficiary Led Construction

Application Number MP034200425182107343

Applicant Name Rahisa
Date of Birth 01-Jan-1972
Gender Female
Mobile Number 7471169668
Email Address
Husband Name Lallan
Father Name Sheikh Khakhodi
Mother Name Sahidan
Employment Status Not Employed
Occupation NonWorking/noJob
Education Qualification No Education
Household Category EWS
Whether the family owns puccca house anywhere No
in India.
Average annual household income (in Rs.) 36000
Religion Muslim
Marital Status Widow
Category OBC
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 Kutcha
Roof Type Stone and Mud Roof

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 Present Address

House Number Ward No 17

State Name Madhya Pradesh
District Name Panna
City Name Panna, Municipality
Street Name Raniganj Mohalla Ghadi
Khana Ke Pass
Pincode 488001

Permanent Address

House Number Ward No 17

State Name Madhya Pradesh
District Name Panna
City Name Panna, Municipality
Street Name Raniganj Mohalla Ghadi
Khana Ke Pass
Pincode 488001

Address of the proposed house/Flat under PMAY-U 2.0

House Number Ward No 17

State Name Madhya Pradesh
District Name Panna
City Name Panna, Municipality
Street Name Raniganj Mohalla Ghadi
Khana Ke Pass
Pincode 488001

Details of family members

Name Relationship Gender Date of Birth Occupation

with Applicant

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 Rahisa Self Female 01-Jan-1972 Non-
Working/No Job

Bank Details

Account Number ********414

IFSC Code MAHB0001882
Bank Name BANK OF MAHARASHTRA
Branch Name PANNA

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.

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 Aadhaar Consent by the Applicant

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 : Rahisa
Mobile Number : 7471169668
Date : 30-04-2025 06:44:29
Place :
Digitaly signed by Applicant:

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 Self-Undertaking by Beneficiary under BLC

I Rahisa son/daughter/wife of Sheikh khakhodi, born on 01-Jan-1972 presently

residing in Ward no 17, Raniganj mohalla Ghadi khana ke pass ,Panna, Municipality,
Panna ,Madhya Pradesh Mobile/Contact 7471169668 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 atWard no 17, Raniganj mohalla Ghadi khana ke pass ,Panna, Municipality, Panna
,Madhya 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.

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 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 : Rahisa
Date : 30-04-2025 06:44:29
City : Panna, Municipality

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