FORM–I
Form of application for registration of plot
(See Regulation 6[1]):
1. Applicant’s full name (in block letters) :
2. Address :
(a) Permanent :
(b) Present :
3. Occupation :
a) Name of the Establishment/ office :
b) Nature of job on which employed, if any....
4. Present pay including allowance: ....
a) Total annual income of the applicant for the last financial/calendar year(Certificate
to be entered)
5. Category for which applied (Whether reserved, certificate in proof to be enclosed)
6. Amount of deposit made (Whether by cash or pay order/demand draft
No......Dated.........Challan No.............
7. Locality to which application relates :
8. Period of residency in the State of goa (Certificate to be attached)
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I, solemnly affirm and state:
a) I have satisfied myself that I fulfil the conditions laid down in Regulation 3 of the Goa
Housing Board (Registration, Allotment and Sale of Plots) Regulations, 1982, and as
amended by regulations, 2001.
b) The statements made above are true to the best of my knowledge and belief.
(Applicant’s Signature)