Application Details

Application Number :

4000389640

Lottery Name Scheme Code Category Code Income Group Application Date Applicant Name Applicant DOB Pan No.

: MUMBAI LOTTERY-MAY2012 ( MUMLOTMAY2012 ) : 273-M H P POWAI BUILDING NO. 22 B : GP-GENERAL PUBLIC : HIG-HIGHER INCOME GROUP : 23-May-2012 : MR BHAGWANT PANDHARINATH BHARGAWE : 25/06/1955 : AAGPB5389K Photograph

Contact Details
Mobile No Residence Tel No Office Tel No Email
: 9769540878 : 022-25441504 : : BHARGAWEBHAGWANT@GMAIL.COM : 203, CHINTAMAN DIWAKAR SOC. PLOT NO. 10 OPP. BRAMHIN SEVA SANGHA
BRAMHIN SOC. NAUPADA THANE WEST

Address

Bank Details
Bank Acc No. MICR code Bank Branch IFSC code Bank Branch
: 60029434575 : 400014075 : BANK OF MAHARASHTRA : KOPRI COLONY, THANE : MAHB0000151 : BANK OF MAHARASHTRA : KOPRI COLONY, THANE

Payment Details
DD Number DD Date DD Amount Drawn On
: : : 50050 :

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 in relation 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 : Date :

Signature : Name :

Signature of Authorized Officer :

Applicant Copy Application Details

Application Number
:

4000389640
Scheme Code Category Code
: 273-M H P POWAI BUILDING NO. 22 B : GP-GENERAL PUBLIC : HIG-HIGHER INCOME GROUP

Application Date Applicant Name

: 23-May-2012 : MR BHAGWANT PANDHARINATH BHARGAWE

Income Group

Pan No.
DD Number DD Amount

: AAGPB5389K
: : 50050

DD Date Drawn On

: :

Applicant Signature

Signature of Authorized Officer