Form No. Pradhan Mantri Awas Yojana- Housing For All (Urban) by 2022 “Radhaar/Voter ID Card/Any other ‘unique identification number or 3 certificate of house ownership from Revenue Authority of beneficiary’ ative istic ‘State: Name of City/ Town: deel: FORMAT- 4B: REQUIRED INFORMATION OF BENEFICIARY 1 Name of head ofthe family 2 Sex [Male: 01, Femate: 02) 3 Father'sname 4 Present Address & Contact Details (i) House/ Flat/ Door No. (i) Name of street (in city {iv) Mobile No. 5 Permanent Address {i) House/ Flat/ Door No. (i) Name of Street (iii) City (iv) Mobile No. 6 Ownership Details of Existing House {Own -01, Rent -02, Otherwise -03] 7. Type of House based on Roof type {Pucca (Cement Concrete }-01, Semi-Pucca (COI Sheet) -02, Kaicha (thatched, arpaulin)-03] 1g Number of Rooms in the Dwelling uit ‘excluding kitchen 8 AadhaarCard, if not available Voter iD Card/Any other unique identification number or a certificate of house ‘ownership from Revenue Authority of beneficiary's native district 10 Number & age of family members ‘Name & Relationship to Head of the Family | Gender | Age 11 Religion {tindu-02, Muslim-02, Christion-03, Sikh- 04, Jainism, Buddhism 06, Zoroastrianism-07, others (specify)} Page of 1 of 32 a 4 16 v7 18 19 20 2 2 23 24 25 caste [Generol-01, SC-02, 57-03, O8C-04) Bank Details Bank Account Number bb. Name of the Bank & Branch Number of Years of Stay in this Town/City {0 to 2 year -04, 1 to 3 years- 02, 3 to S yeors- 03, More than $ years-04] Size of existing dwelling unit (Carpet area in Sq.M) ‘Whether the family owns any house/ ‘residential land anywhere in india (Yes/ No) 0. If "YES" then location details (locality, city/ stote) If "YES" then extent of land in Sq.Mt Employment Status (Self Employed ~ 01, Soloried ~02, Regular Wage - 03, Labour - 04, Other ~05) ‘Average monthly income of household (in Rs.) Does the family have a BPL Card (Yes / No) 0. If yes, Provide BPL Card No Housing requirement of family (New House ~ 04, Enhancement ~ 02) In case of enhancement, please specify ‘enhancement required [One room/Kitchen/Bath/ Toilet or combination of these) Preferred component of Mission under which beneficiary needs assistance under HFA 4. Credit Linked Subsidy -02 ii, Affordable Housing in Partnership -02 i, Self Construct - 03 ‘Additional information to be collected from the ‘Marital Status of Applicant [Unmarried -02, Married -02, Widow -03, Widower -04, Divorce -05) Husband's Name (if Applicant is Married/ Widowed female) Land ownership & details (i) Name of the Pattadars) i) (i) Patta No. (ii) Dag No. Page of 2 of 3{iv) Land Area as in Patta (Ha) (v) Dimension of Land in metre 26 Type of House, based on Wall type {Pucca (Brick wall )-02, Semi Pucca (Half Brick with Ecra, Full Ecra wall) -02, Semi-Kutcha (C61, Plank walling, Aesbestos, Leirang taba) - 03, Kutcha (Phaklong, Plastic/ Polethene/ Tarpaulin) -04) ‘Whether the Applicant Owns a vehicle? (/N) IF YES; type of vehicle a” [2 wheeler -01, 3-wheeler-02, 4 wheeler Length Breadth (cor, van, SUV etc}-03, LCV, Heavy (mini truck, truck, tractor, bus/ minibus) -04] Photo of the Applicant in front of present house Signature/Thumb Impression of the Applicant (i) Copy of AADHAR Card (li) fF AADHAR not available, Copy Voter ID Card (ii) Income certificate {iv) Copy of BPLCard,ifany (0) Copy of Patta & Trace Map (ui) Copy of Bank Passbook (front page with name & A/CNo}) ‘TIN Number of the Applicant (From SECC Data) Signature of representative of ULB in-charge of the above information Place: Date: For Office (ULB) Use Only: Checklist for list of documents attached with the Application: Tick Page of 3 of 3