| Name of the applicant (in block letters) |
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| Sex |
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Designation and Office in which the applicantemployed
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Whether permanent, if not, date of first regularappointment in Municipal Service and total period of regularservice
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Amount of advance applied for and number ofinstalments in which the advance may be recovered
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| Residential address |
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| Permanent address |
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| Date of birth |
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Scale of pay in the present post underFundamental Rule 9(21)
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| Gross monthly salary (with details) |
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Nature of deduction from gross pay and theamount deducted
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| General Provident Fund - |
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| (a) Subscription |
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| (b) Recoveries towards temporary advance |
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| Festival Advance |
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Conveyance advances for bicycle/motorcycle/Scooter/ motor car
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| House building advances |
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| Towards other miscellaneous advances |
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| Khadi, Handloom Cloth/Postal Life Insurance |
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Salary Savings Scheme under Life insuranceCorporation
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| Typewriter advance |
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Dues recoverable towards the Co-operative CreditSociety or Bank
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Other miscellaneous advances such as flood,cyclone, etc.
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| Net salary received |
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| Percentage of the net salary in the gross salary |
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| Income from other resources |
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| Date of marriage |
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For whose marriage the advance is applied for(self/ daughter/son)
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| Date of birth of the son/daughter |
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Name and occupation of the son or daughter forwhose marriage advance is applied for
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If the advance is for the marriage of themunicipal employee himself/herself, whether father or mother ofthe applicant is a municipal employee.
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If so, has any of them applied for the advanceor has been sanctioned an advance for this marriage
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Are with the Finance and Finance MunicipalServants and if so, have both of them applied for advance forthe same marriage or have been sanctioned an advance for thesame marriage, (a certificate shall be obtained from him/herthat he/she has not applied for the advance as the case may befor the same marriage)
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Whether the applicant has already applied for orwas sanctioned any marriage advance or any application for theadvance rejected previously
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| Amount of such advance |
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Number and date of order in which such advancewas sanctioned
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Whether any amount of such advance isoutstanding repayment. (Principal and interest to be shownseparately).
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| Details of surety |
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| Name of surety |
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| Designation |
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| Office in which employed |
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| Residential address |
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| Permanent address |
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| Permanent post |
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If not permanent, period of regular service inthe officiating post or posts
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| Date of birth |
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| Scale of pay |
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| Pay as defined under Fundamental Rule 9 (21) |
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| Gross salary (details to be specified) |
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| Net salary |
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Whether he has stood surety for anothermunicipal employee for the grant of advance
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I hereby declare that the particulars furnishedabove are true to the best of my knowledge and belief.
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