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Application Details

Application Number

1160036138
1160036138

Lottery Name

: MUMBAI LOTTERY 2016 ( M16 )

Scheme Code

Category Code

: GP-GENERAL PUBLIC

Income Group

: MIG-MIDDLE INCOME GROUP

Application Date

: 2016-07-06 16:00:59.279

Applicant Name

: MS SHRADHA SURENDRA BAVDHANKAR

Applicant DOB

: 14/06/1986

Pan No.

: APXPB0630D

328-PATRA CHAWL, GOREGAON MIG

Contact Details

**Signature of applicant

Mobile No

: 9920202655

Residence Tel No

Email

: shreyas20002@me.com

Office Tel No

Address

: RUSTOMJEE ELANZA, ROOM NO .3203, A- WING, NEAR INORBIT MALL, MALAD WEST, MALAD,P/NORTH WARD,MUMBAI
(SUBURBAN),MAHARASHTRA,INDIA,400064

Bank Details
Bank Acc No.

: 1221011504676

MICR code

: 400229138

IFSC code

: ICIC0001221

Bank

: ICICI BANK LTD

Branch

: LINK ROAD MALAD, MAHARASHTRA

Amount

50300

I hereby declare that the information given by me in this application form is true and correct.I acknowledge that if the information is noticed to be
false,it would result in cancellation of my application,cancellation of allotment of tenement if any, made in my favour,and liable for legal action
for making a false declaration.
I agree to abide the provisions of the Maharashtra Housing & Area Development Act.1976 and the Maharashtra Housing and Area
Development(Estate Management, Sale, Transfer and Exchange of Tenements) Regulation 1981,and Maharashtra Housing & Area
Development (Disposal of land) Rules-1981 as amended from time to time and shall execute all such agreements and instruments inrelation to
tenements/plot which may require me to do so.
That I will produce to the department within prescribed time limit the requisite prescribed documents e.g. Certificate of age/Certificate of
income/affidavit, Domicile Certificate of Stay in Maharashtra state, Certificate of Caste or other reserved categories and such other documents
as may be found necessary from the appropriate Competent Authority as and when called for to do so, for determination of my eligibility.

Place :

Signature of applicant :

Date :

Name of applicant :

For DD Only
Application Details

1160036138

Application Number

MHADA Copy

:
1160036138

Scheme Code

: 328-PATRA CHAWL, GOREGAON MIG

Category Code

: GP-GENERAL PUBLIC

Application Date

: 2016-07-06 16:00:59.279

Applicant Name

: MS SHRADHA SURENDRA BAVDHANKAR

Income Group

: MIG-MIDDLE INCOME GROUP

Pan No.

: APXPB0630D

DD Date

DD Number

Drawn On

DD Amount

: 50300
I hereby declare and accept the terms and condition of payments.

Applicant Signature

Signature of Authorized Officer

Application Details

1160036138

Applicant Copy

Application Number

1160036138

Scheme Code

: 328-PATRA CHAWL, GOREGAON MIG

Category Code

: GP-GENERAL PUBLIC

Application Date

: 2016-07-06 16:00:59.279

Applicant Name

: MS SHRADHA SURENDRA BAVDHANKAR

Pan No.

DD Number

DD Amount

APXPB0630D

Income Group

: MIG-MIDDLE INCOME GROUP

DD Date

Drawn On

50300
I hereby declare and accept the terms and condition of payments.

Applicant Signature

Signature of Authorized Officer

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