1.I certify ( that I have applied for the Municipal accommodation with the prescribed procedure but ) have not been provided with/ (have refused the allotment of) Municipal accommodation during the period in respect of which the allowance is claimed.
2.I certify that I am residing in a house hired/owned by me/my wife/ husband/ son/ daughter/ father/ mother/s Hindu Undivided family in which I am a coparcener.
3.I certify that I am incurring some expenditure on rent.
Contributing towards rent.
** I certify that the rental value of the house owned by me/owned by a Hindu Undivided Family in which I am a coparcener and in which I am residing in ascertainable in the manner specified in para 7 of O.M. No. F.2(37). EII (B)/64 dated 27-11-65/ @ I certify that I am paying/ contributing toward house or property tax.
4.I certify that I am not sharing accommodation allotted to my parent (child by the State /Central Govt. an autonomous public undertaking or semi-Government organization such as municipality, port trust etc. allotted rent free to another Govt.servent.
5.I certify that my husband/wife/children/parents who is/are sharing accommodation with me allotted to another employees of the central/state Govt./autonomous public undertakings or semi-Govt. organizations like municipality, port trust etc.is/are not in receipt of house rent allowance from the Central/State Govt. autonomous public undertaking or Semi-Government or organisations like municipality, Port Trust, etc.
6.I also certify that my wife/husband has not been allotted accommodation at the same station by the Contral/State Govt. an autonomous public undertaking or semi-Govt. organisations such as Municipality, Port Trust, etc.
The words shown in brackets may be omitted if the municipal servants is not eligible for Municipal Accommodation or if his case is covered by Notes under paragraph 4(b) of the O.M. dated 27-11-65 or where it is not obligatory for him to apply for Municipal accommodation for eligibility for house rent allowance in term Ministry of Finance O.M. No. 11011/1/E, II (B) 75 dated 25-2-77
** To be furnished by a Municipal Servant living in his own house or in a house owned by a Hindu undivided Family in which he is a coparcener.
* To be furnished by another Govt. servant being the wife/husband, son, daughter, father or mother of the municipal Servant owning the house who is sharing accommodation with the latter.