APPLICATION FOR GRANT OF CGI SHEETS UNDER RURAL HOUSING SCHEME

To

The Deputy Commissioner

East Siang District,

Pasighat.

Sir,

I am furnishing below my particulars for grant of CGI sheets under Rural Housing Schemes for the year _________________________.

1. Name (in block letters) :

2. Father/Husband’s Name :

3. Occupation of Father/Husband :

4. Details of Family members :

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

5. Village (Permanent Address) :

6. Circle/Sub-Division :

7. Whether CGI sheets obtained

earlier under the schemes :

8. Whether any members of the family

availed/obtained CGI sheets under

the programme :

9. Whether belongs to SC/ST

(enclosed the certificate in proof) :

RECOMMENDATION Signature of Applicant)

Signature of Gaon Bura

(with seal)

Date

CO/EAC/SDO/ADC

Place : (with seal)