Forms all

MLR REQUEST FORM
Tele No. (Dept) ……………….. Present Ration ………… Date of Birth ……………………
Name ………………………….. Rank ………………………. No ……………………………
Dept …………………………… Div Officer …………………………………………………….
Request to see the Commanding Officer/Executive Officer through proper channel
regarding: (i)

To draw MLR w.e.f. AM/PM ……………………………………..

(ii)

Permission to stay ashore on off duty days at MLR address
(IN CAPITAL LETTERS)
…………………………………………………………………….
…………………………………………………………………….
…………………………………………………………………….

Tele No. (R)/ C/o ………………………………………………………..
Certificate: (i)
Reported on board on Pmt Duty/Ty Duty/Ex Leave vide Gx No.
__________________ dated _______________
(ii)

I am married/unmarried

(iii)

I am staying with family at duty station

(iv)

I am with parents (if applicable)

(v)

I am liable for disciplinary action of making false declaration

(vi)

I will intimate Regulating Office in case of change of MLR address

(vii)

I am staying within the Municipal limited of Delhi Area
(Delete / tick as applicable)

Dated : ……………………………

Sailor’s Signature

The sailor has been warned for making any false declaration.
Div Officer’s Remarks Rec / Not Rec
Dated ………………………………..
Genform No. ……………………………….. dated ……………………………..
(Enclosed a copy of Reporting Gx)

I

DEPARTMENT ___________________
RATION

______________________

INS INDIA OUT GOING ROUTINE
NAME ___________________ RANK________________ NO. __________________
TRANSFERRED TO INS ___________________ FOR _____________________
ON/TY/PMT/DUTY/ON COMPLETION OF TY DUTY VIDE INDIA GX NUMBER
_________________ DATED ____________ W.E.F. ______________ EXO FOR S/COY
& MCPO ADDL ___________________________________________________ DIV
OFFICER

____________________

DEPT

OFFICER

_______________________

BLOCK IN CHARGE _____________________MESS SECY ____________________
ACCOM OFFICE __________________ MAINTENANCE OFFICE ________________
CDR OFFICE _________________ PAY OFFICE ____________________ CLOTHING
OFFICE ________________ SICK BAY __________________________ SD SECTION
_____________ ARMOURY _________ GUNEERY OFFICE _________ LIBRARY
____________________

LIQUOR

CANTEEN

_______________________

DIV

MCPO/CPO________________ RPO (VICT) _____________________________ NO
OF DEP I-CARDS HOLDING __________________ MCAA (SECY) ____________

MC-AT-ARMS (D) ________________ REGULATING OFFICER __________________

NOTE:- To be returned to Regulating Office duly completed before the date of transfer.

NOMINATION FOR INSURANCE BENEFITS
FROM NAVAL GROUP INSURANCE FUND
As per instruction contained in
NHQ letter BA/GIS/39(PC)
dated 06 Mar 97.
1.
No ____________ Rank ___________ Name ________________________ hereby
nominate the person/persons below and confer him/her/them the right to receive any amount that
may be sanctioned from Naval Group Insurance Fund in the event of my death whilst in service.
_________________________________________________________________________
For Married Personnel
(a)
Parents
25% of insurance benefits (Parents/dependant Brother/Sister)
Name(s) & Address of Nominee/
Age & Relationship
Amt Payable %
or Nominee
(i)
(ii)
(iii)
(b)
Nucleus Family
For
balance
(wife/son/daughter/adopted children)

75%

Name(s) & Address of Nominee/
or Nominee

of

insurance

benefits

payable

Age & Relationship

Amt Payable %

Age & Relationship

Amt Payable %

(i)
(ii)
(iii)
OR

(c)

100% to Nucleus Family
Name(s) & Address of Nominee

(i)
(ii)
(iii)
_________________________________________________________________________
(d)

For Unmarried personnel
100% for parents/dependents Brother/Sister
(a)
(b)
(c)

This nomination super cades the nomination made by me earlier which stands cancelled.
_____________________
Signature of individual
COUNTERSIGNED

REQUISITION FORM
Date of
Journey

Time

Type of
Vehicle
Required

Purpose and
authority for
Movements

Signature
and Name,
Rank & Unit

1.

Vehicle Report at: _______________________________________________

2.

Vehicle Report on: ______________________________________________

3.

Contact Number: _______________________________________________

4.

Train No/Flight No: ______________________________________________

MARRIAGE DECLARATION FORM

Affix a recent
passport size
colour
photograph with
spouse
1.

Particulars of the Sailor: -

Name:
___________

_______________________

Rank

:

Religion
:
_______________________
________________________
2.

________________
Native

P.No.

Place

:

Particulars of Sailor’s Father: -

(a)
Name
in
__________________

full

___________________________

(b)

Religion

(c) Address :
(i)
House
No.
____________________

Name

_________________________

(ii)

Vill

(iii)
Post
_________________________________
_____________________

(iv)

Teh

(v)
Nearest
____________________

(vi)

Distt

P.S.

(vii)
State
_____________________
3.

__________________________

______________________________

(viii)

PIN

Particulars of Marriage: -

(a)
Date
of
marriage
__________________________

and

under

what

rites

performed

(b) Performed at residence ____________________________________________
(c)
Vill/Town
___________________

________________________

(d)

(e)
Post
___________________________
____________________________
(g)
Distt
__________________________
___________________________
4.

Particulars of Wife: -

Nearest

P.S.

(f)

Teh

(h)

State

(a)
Maiden
__________________
(b)
D.O.B.
_____________________

Name

_______________________

___________________________

(d)
Native
Place
_____________________

_____________________

Present

Name

(c)

Religion

(e)

Vill/Town

(f)
Post
___________________________
__________________________

(g)

(h)
Distt
__________________________
__________________________

(j)

Teh
State

-25.

Particulars of Wife’s Present: -

(a) Father’s Name ______________________ (b) Mother’s Name
___________________
(c) Residential address :
(i)
House
No.
____________________

Name

_________________________

(ii)

Vill

(iii)
Post
_________________________________
_____________________

(iv)

Teh

(v)
Nearest
____________________

(vi)

Distt

6.

P.S.

__________________________

Particulars of Children: -

(a) _________________________________
_________________________________
7.

(b)

Name & address of the important persons (living only): -

(a) Name _________________________ Age ______ Address
______________________
(b) Name _________________________ Age ______ Address
______________________
To be completed only by Hindu sailors who have contracted marriage in the state of
Maharashtra or Gujrat.
(a)
Whether
the
marriage
__________________________________________

is

registered

(b)
Date
of
registration
_____________________________________________

of

marriage

(c)
Marriage
registration
__________________________________________________
(d)

Place

of

_________________

registration
State

__________________________
Date _____________________
Witness

of

marriage

No.

_______________________Distt

__________________________

Pin

Certified that the information
Furnished above is correct

Divisional Officer Sign
II

The above named sailor has been warned that making false declaration is serious
offence. Certified that the sailor is not in receipt of CILQ.
INS India
New Delhi
Date ________________
Issue date of Warrant ___________________________

Commanding Officer

REQUEST FOR WARRANT FOR SELF & FAMILY OF SAILORS
Name/Rank/No.______________________________ Dept______________Inliving/MLR______
Div. Officer___________________________Dept. Officer ___________________________
Request regarding issue of Warrant for the family as follows: S.No.

Name

Age

Relationship

Dependent Pass No.
(Mandatory)

1.
2.
3.
4.
5.
6.
Warrant Required : under 184(i)/184(ii)/184(iii) TR (upto 1450 Kms)
From : _________________________ To ___________________________
(a)
My home station is ________________ and nearest Rly Stn is _____________ home
station as recorded in service documents is ____________________.
(b)
I am/ my family is/are proceeding on ___________ days of AL/PAL/PBAL/BAL of 20____
w.e.f. _____________ vide INS India Gx No._______________ dated __________ (copy
enclosed). 1st/2nd/3rd Sleeper/AC Rajdhani/Maill/Express.
OR
(c)

My family alone is proceeding on leave.

(d)

Under 184(iii) TR distance from New Delhi to ______________ is _____________ Kms.

(e)
My Father/Mother/Brother(s)/Unmarried Sister(s) is/are wholly dependent on me and
residing with me at duty station and their income is not more than Rs. 1500.00 per month.
(f)

The above particulars are true to the best of my knowledge.

(g)

LTC/Warrant under Rule 184(ii) TR was availed by me for self & family during ________

(h)

LTC/Warrant under Rule 184(iii) TR was availed by me for self & family during _______

(j)

The above particulars are correct and recorded in service documents.

(k)
I am ready to face any disciplinary action if any information furnished by me in this form
is/are found false.
Date : __________________
Signature of the Sailor

_____________________

The Service Documents of the sailor has been verified by me and the family members
mentioned above are correct. Dependents are residing with the sailor at the duty station.
Date : __________________
(Divisional Officer Signature)
Rank, Name &No. ______________

_____________________

II

Stamp
(Signature of Passage Section)

INSTRUCTION FOR PASSAGE SECTION
(i)
Passage Section in-Charge to see dependent pass before signature. (PASSAGE
SECTION SIGNATURE WILL BE DONE BY POWTR OF SAILOR’S SECTION)
(ii)

Separate warrant not to be issued for self and family.

(iii)

Original movement order to be attached along with form.

(iv)
Warrant is parts will not be issued for family members. (i.e. warrant for family will be
issued only once a year)
III
REMARKS BY SD SECTION
Certified that the dependent family members (Father/Mother/Brother(s)/Sister(s) and children for
whom warrant is required has/have been declared by the sailor in his Service Documents.
His/Her date of birth (Age) as per SD’s is/are given below: Relationship

Date of Birth (Age)

Brother

________________

Unmarried Sister

________________

Railway Station as per Service Documents: ________________________

(Signature o SD Section)

Stamp
_________
APS/-____

WARRANT ISSUED TO FAMILY OF SAILORS
UNDER TR 70, 72, 73, 74 AND 200
Name_______________________ Rank___________________ P.No. _____________
Dept _________________ Div. Officer _______________________________
(a)
ON PERMANENT TRANSFER (A) (II) – When borne in AME and in occupation of
Govt. quarter or was in receipt of CILQ there of at the married scale was necessitated by
transfer of head of family from INS India (New Delhi) to INS __________________ at
___________________ w.e.f. ___________________ vide INS India GX No.
____________________ dated ________________________.
(b)
JOINING HEAD OF FAMILY FOR FIRST TIME AFTER MARRIAGE TR72.
The sailor whose family has not been issued with Railway warrant for first time was
married on____________________ and is borne in AME at his station with effect from
___________________ or in receipt of CILQ.
(c)
CONVEYANCE TO FAMILY WHEN SEPARATED FROM HEAD OF FAMILY TR
73.
The move of the family when borne on authorized Married establishment and was
residing in Govt. Quarter of was in receipt of CILQ of the married scale in necessitated by
transfer of head of family to afloat service from INS India to __________________ vide
GX No. ________________________.
OR
Transfer of the head of family from afloat service/service overseas./field
service/non family station to _______________________(family station) and allotment of
marriage accommodation on _____________________ from ________________ date
________________________.
OR
Allotment of Marriage Accommodation at _______________________ (Station) on
____________________ dated ____________________ or in being paid period of Govt.
Quarter last occupied and that the onward journey had been at Govt. experience.

(d)
ON VACATION OF GOVT. ACCOMMODATION TR 74.
The move of the
family who was in AME was necessitation by the vacation under orders of married
accommodation in the station and that a period of __________________ (station number
of months) has elapsed from the date of re-joined the head of the family.

-2(e)
ON RELEASE OF THE HEAD OF THE FAMILY UNDER TR200 When borne in
AME and in occupation of Govt. Quarter or in receipt of CILQ. Family moving from old
duty station to home station of selected place of residence.
(f)

The married accommodation was vacated on _______________________13/74.

Signature of Divisional Officer
(with office stamp)

Signature of Accommodation Officer
(with office stamp)

(Verification from the Accommodation officer whether the sailor is borne in AME or not)
Details of family members entitled for three warrants.
Wife ___________________ Mother ________________ Father _________________
Children between 05 to 12 years __________ Children above 12 yrs of age _________
Brother________________ DOB _______________ Age ___________ (below 18 yrs)
Sister _____________ DOB ___________ Age _______ (unmarried or in divorce case)
Home Station ________________ Nearest Railway Station ____________________
I certify that mother/father/brother/sister are wholly dependent and residing with me
his/her monthly income does not exceed Rs. 1500.00 per month from any sources and
above particulars are recorded in Service Documents.

(SD Section Signature)

(Sailor’s Signature)

Date :

Date :

Issued warrant N. (IAFT) __________________ dated ____________ for the family of
the sailor from _______________ to ________________ in 1 st A/C, 2nd A/C, 3rd A/C for
_________________ full and ________________ half with ______________________
Quintal baggage _________________________.

Date :

(Signature of Issuing Officer)

GENERAL REQUEST FORM
Name _____________________ Rank ________________ No. __________________
Division ___________

Div/Dept Officer ____________________________

Request to see DO/RO/EXO through proper channel regarding ______________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Div/Dept Officer’s Remark

Sailor’s Sign ___________

Date
--------------------------------------------------------------------------------------------------------------------GENERAL REQUEST FORM
Name _____________________ Rank ________________ No. __________________
Division ___________

Div/Dept Officer ____________________________

Request to see DO/RO/EXO through proper channel regarding ______________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Div/Dept Officer’s Remark
Date

Sailor’s Sign ___________

ACCOMMODATION OFFICE
CPO’S ROSTER
FROM – 21/01/04 TO 24/11/
LDG’S ROSTER
FROM – 12/01/04 TO 05/09/06
LDG’S ROSTER
FROM – 13/09/06 TO 05/07/10

LDG’S ROSTER
FROM – 14/07/10
CPO’S ROSTER
FROM – 30/11/10

PO’S ROSTER
FROM – 23/05/08

VENDOR’S REGISTER
SUBSCRIPTION BOOK
WEF: - 01/01/2008

Appendix ‘E’
(Refer Para 5 (b))
CERTIFICATE FOR CLAIMING FAMILY ACCOMMODATION ALLOWANCE
1.
I _________________________________________ (Name, Rank & No) hereby
certify that : (a)
I am not borne in Authorised Married Establishment.
(b)
I have not been provided with Govt. Married Accommodation .
(c)
I am not entitled for CILQ/HRA.
(d)
My family (*wife/children father/mother/dependent brother/sister) is/are
residing at ______________________________________________________
______________________________________________________________
(e)
I have reported to ______________________ (unit) at ____________
(Station) on ___________ (date) and am entitled to draw Family Accommodation
Allowance with effect from ___________ at ‘Z’ class city/town rate (i.e. 10% of
Pay in Pay Band, Grade Pay and MSP).
* Delete whichever not applicable
Station ____________________
Unit

_________________

Date _________________

__________________________
(Signature of sailor)
Name _______________________________
Rank______________ P.No. ______________
II

Certified that the above named sailor is not borne in AME and has not been
allotted any type of Govt. Married Accommodation.
Date ____________________

(Signature of Station Cdr/Accommodation Officer )
III

Permitted to claim Family Accommodation Allowance (FAA) with effect from
_______________.
Date ____________________

(Signature of Executive Officer)
IV

Genform No. _____________ dated ___________ for claiming Family Accommodation
Allowance (FAA) issued and dispatched to Naval Pay Office, Mumbai for crediting the
same through IPA.

Date ____________________

(Signature of RO)

VR O. _____________
DATE______________
MAINTENANCE / BDF / VENDORS / GUEST ROOM/ TRANSIT
Received a sum of Rs. ________________ (Rupees ______________________
_______________________) From ________________________ towards Maintenance /
BDF / Vendor / Guest Room/ Transit Charges from Receipt No. _______ to _______.

(Santosh Kumar)
Commander
Officer-in-charge
Date :

/

/2013

Fund :
---------------------------------------------------------------------------------------------------------------------

VR O. _____________
DATE______________
MAINTENANCE / BDF / VENDORS / GUEST ROOM TRANSIT
_______________________) From ________________________ towards Maintenance /
BDF / Vendor / Guest Room/Transit Charges from Receipt No. _______ to _______.

(Santosh Kumar)
Commander
Officer-in-charge
Date :
Fund :

/

/2013

APPLICATION FOR GUEST ROOM BOOKING
Dear Sir,
Kindly book the Guest Room of SS Complex for me as per details below. I am aware of
rules, regulations and charges.
Name, Rank & Number ……………………………………………………………………
Unit/Dte and Tel No. ………………………………………………………………………
Name and address and Tele No. of the Guest ………………………………………….
…………………………………………………………………………………………………
…………………………………………………………………………………………………
Relation & Purpose of Visit …………………………………………………………………
Nationality ……………………………………………………………………………………..
Date and Duration of Booking ……………………………………………………………….
Receipt No.
Date :

Amount Rs.
2011

Dated
Div Officer Signature ……………
With Stamp

(Santosh Kumar)
Commander
Accommodation Officer
RULES
GUEST ROOM – SS COMPLEX
1.
Room No. 4/2 will be used as the Guest Room for the benefit of the in living sailors
staying in SS Complex.
2.

The guest room will function under the control of officer-in-charge NSB.

3.

The room is available for sailors staying in SS Complex for his male guests only.

4.

Sailors booking the Guest room is responsible for the conduct of his guest.

5.
Guest room may be booked for not more than 02 days at a time. Booking charges
will be Rs. 25/- per day, Civilian Bearer Rs. 10/- per day.
6.
A sum of Rs. 250/-(Refundable) towards security deposit will require to be
deposited at the time of booking.
7.
Check in timings are 0900 hrs Food will be provided by Galley as per the menu of
the day at the prevailing rates (Presently Rs, 54/- day).
8.

Cooking of is strictly not permitted inside the room.

9.

All damages to the property will be charged.

10.

Guests are responsible for safety of their belongings / cash / valuables.

11.

Guest Room should be booked minimum three working days in advance.

Date

2011


ALLOTMENT OF FAMILY ACCOMMODATION
(INVENTORY)
NAME. --------------------------------------- RANK. ------------------------- NO. ----------------------Meter reading No -------------You have been allotted qtr. No. -------------------ON ----------------- you are to take over the
quarter from the representative of accommodation office by ------------The furniture supplied in quarter is as given below: S No.

Description

Quantity

1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

Charpoy Wooden/ GI Pipe
MNF Sets
Chair dining Caning/ wooden bottom
Chair easy
Table dressing gents
Table 3/2 wooden without drawer
Table 3/2 with drawer
Receptacle with/without bucket
Fan with Regulator
Kitchen Steel Rack
Steel Sink
Bed Side Table/ Teapoy
Meat & Milk sheaf with marble
Wooden sheaf 2/23
Sheaf with glass slider 4/9

Four
Four
Four
One
One
One
One
One
----One
One
One
One
One
One

DEFICIENCIES

CERTIFICATE
Certified that I. -----------------------RANK. -------------------------- No. ---------------------------Taken over above accommodation along with furniture/ Deficiencies.

(Handed over by)

(Taken over by)

ORDER AUTHORISE TO MAKE PRIVATE ARRANGEMENT
FOR THE PURPOSE OF MLR/INLIVING CILQ
NAME................................................ RANK....................................... NO . .......................
AGE.................................................. DATE OF BIRTH.......................................................
Certified that the above mentioned sailor is MLR / inliving and he is staying with his family
at the following address: .............................................................
.............................................................
.............................................................
Sailor’s Signature ____________
DO’s Signature _________________
With stamp

II
CERTIFIED THAT: (a)
The sailor is authorised to make private arrangement for the
accommodation w.e.f..........................................................................
(b)
He is within the AME w.e.f.......................................................
(c)
He has not been provided with Govt. married accommodation.

(
)
Commander
For Commanding Officer

(GS Kalkat)
Commander
Executive Officer
for Commanding Officer

His name has been placed on the roster w.e.f. ...................................
With back seniority w.e.f. ....................................................................
403/1/3
INS India
Dalhousie Road
New Delhi-110011
Date...............
Distribution
Original
Duplicate
Triplicate
Quadruplicate

:
:
:
:

CDA (N) Mumbai (TRLA Section)
Accommodation Office of the station
Sailor’s Copy
Office Copy

APPLICATION FOR PLACING THE NAME IN
MARRIED ACCOMMODATION ROSTER
After Marriage / Joining New Duty Station / On Promotion
(Strike off which ever is not applicable)
Name __________________________Rank ______________ No. _______________
Office Address ___________________________________________________________
_____________________________________ Date of Reporting _________________
Reporting Gx. No. ___________ dated _______________ date of promotion to
Present rank _______________________ Gx. No. ____________ dated ___________
Date of birth __________________ Date of Marriage ___________________________
No. of Children ______________________ Name of last duty station/Ship __________
Date of Name Struck OFF from last duty station __________________.
If retaining accommodation at last duty station _____________ Yes/No.
(a) On ground of children education up to ____________
(b) Any other ground (state) up to ___________________
Back Seniority: As ____________ for _____________ months (original seniority certificate attached).
As ____________ for _____________ months
As ____________ for _____________ months

Div Officer’s Remarks
Date: _____________

Date: ___________

Bank’s Counterfull (To be forwarded to the CDA)
(To be filled in by MRO issuing authority)
_______________________________________________________________________________________Dt:
__________2010
Received a sum of Rs.
0

0

0

0

0

0

Total (Rs in words) __________________
Crores

From

Lakhs

Thousands

M/S

Hundreds

Tens

Numbers

(name of the individual/unit/office)

By cash/ cheques No ______________ date ____________ Bank________________ for credit to PCDA/CDA Western
Command Chandigarh on account of Rent & Allied Charges as defence receipt.

CDA Western Command
Chandigarh
Budget Head-1/105/1
Code Head-1/105/2
Individual)
Code No-4013000001

(Signature of

BSR Code

DD

MM

YY

Serial No

Bank Seal
_______________________________________________________________________________________________
_____________
Depositors Counter foil-1 (To be retained by the Depositors)
(To be filled up by Treasury/RBI/Bank)
Treasury/RBI/Bank ..............................................
Received a sum of Rs....................................(Rs ....................................................................................................only)
From.................................... (individual/Unit/Office) on account of.....................................
..............................................for credit to PCDA/CDA..........................as defence receipts.

BSR Code

DD

MM

YY

Serial No

Bank Seal

Depositors Counter foil –2 (To be forwarded to PCDA/CDA)
(To be filled by Treasury/RBI/Bank)
Treasury/RBI/Bank..............................................
Received a sum of Rs.................................... (Rs ................................................................................................ only)
From.................................... (individual/Unit/Office) on account of.....................................
..............................................for credit to PCDA/CDA..........................as defence receipts.

BSR Code

DD

MM

YY

Serial No

Bank Seal

Tele 23011069
INS India
Dalhousie Road
New Delhi – 110011
808/PRC

Jul 10

The Principal/Director
National Industrial Training Centre
STATUS AND EMPLOYMENT OF
CONSERVANCY OF MALIS
DATE

CONSERVANCY

MALIS

BORNE STRENGTH PRESENT
LEAVE/ABSENT
-

BORNE STRENGTH PRESENT
LEAVE/ABSENT
-

SER
NO

AREA

(a)

SS COMPLEX &
SURROUNDING
AREA

MAIN ENTRANCE
GARDEN &
NAUSHALA LAWN

(b)

NAUSHALA &
SURROUNDING

NAUSHALA
SURROUNDINGS

(c)

NWWA COMPLEX
& TARSH

NWWA COMPLEX &
SWIMMING POOL

(d)

SWIMMING POOL
& SURROUNDING
AREA
ACC. OFFICE
MAIN ENTRANCE
GUARD ROOM &
CANTEEN EXTN
BUILDING &
ROADS &
COMMON AREAS

COP/CPS

GARBAGE
CLEARANCE

CHIDRENS PARK
NEAR DE-BLOCK
AND REAR GATE

(e)

(f)

(g)

MCPO I/C

NO OF
PERSONEL
DETAILED

REMARKS

AREA

NO OF
PERSONEL
DETAILED

TRIMMING AND TREE
CUTTING

AREA
SURROUNDING
FOOT BALL GROUND

AO

INS India
Dalhousie Road
New Delhi – 110 011
103/2

Date ___________
ALLOTMENT OF ACCOMMODATION

Meter reading with allotment ---------------------------------------------------------------------Name______________________Rank____________________No._______________
1.
You have been allotted Qtr No.___________________in _________________
for ________________ years and you are to take over quarter form accommodation
office INS India by ____________________
2.
You will be personally responsible for taking over the furniture and fitting etc from
CPWD/MES. You are to return this form along with sanction from CPWD/MES to
accommodation office within 24 hrs, failing which rent on market rate will be charged from
you.
3.
The person authorized to live in your quarter are member of your family i.e. wife
and children.
4.
Sharing: You are to strictly adhered to NO 126/83. In case unauthorized sharing is
detected you will be deprived of quarter. No sharing is to be entertained by you in the
absence of your family being away from the station.
5.
Out of Turn: - All Out of turn allotee are not permitted to share their
accommodation except with those persons/ sailors specified by the accommodation
office.
6.
In case if it is found that your family has not occupied the qtr within one month from
taking over or is away from quarter for more than two months except when you are on
leave will be ordered to vacate the quarter.
7.
You are to take/furnish the particulars of your family in the enclosure and hand
over the same to the accommodation officer immediately after take over.
8.
Your premises is liable to be inspect by a person deputed by the accommodation
officer/Commanding officer as such time is deemed necessary.
9.
You are requested to pay the subscription in accommodation office NSBI/II/III
before 10th of every month, failing which a fine will be charged from you as per existing
rules.
10.

You will be required to make good damages at the time of handing over.

11.
You are responsible for keeping the surrounding of the building allotted to you in
neat and clean shape. For this you will be required to participate in the Shramdan as and
when organized.

-212.
You are not to leave your boxes/stores in the common areas like stair cases,
lobbies and in the surrounding.
13.
Your family members are not to climb in the terrace of the buildings at any time as
all terrace top are out of bonds.
14.
You are not to extend any fitting out side the balcony, which gives shabby
appearance to the building.
15.
You are to ensure that your families do not spread clothes for drying in park and
along the roads.
16.
Your family members should be in possession of family passes issued by DNPM
(DA), failing which the entry inside the NSB I, II and III will be prohibited.
17.
You will be charged for violating any of the above orders and may be ordered to
vacate the accommodation immediately.

(Santosh Kumar)
Commander
II
I have read and understood above instructions and shall comply with them.

Name _____________________
Rank ________________
No. __________________
Date _________________

WEEK

EXO’S REMARKS/
SIGNATURE

CO’S REMARKS/
SIGNATURE

Tele: 26881925

INS India
Dalhousie Road

103/1

2013

NAME ___________________ RANK _________________ NO. _______________
QTR NO. _________________ sailors married accommodation NSB I/II and NSB III.
Meter reading while handing over accommodation------------------------------------------------NOTICE FOR VACATION OF GOVT. MARRIED ACCOMN
1.
You have been in occupation of Govt. married accommodation Qtr No.
____________________ since ____________________ and you are required to vacate
the said qtr and hand over to the accommodation office INS India by
_________________________ on following reason:(a)

On completion of three/two years of occupation.

(b)

On proceeding permanent transfer/course of 26 weeks or more.

(c)

On release from service.

(d)

On disciplinary ground.

2.
If you fail to vacate the quarter by the date mentioned in para one above you will
be charged for the period as over staying without further notice at the assessed or market
rate which ever is higher for the rent and allied charges in addition if to any with existing
regulation.
3.
Any damage to be made good before handing over the Govt. married
accommodation.

(Santosh Kumar)
Commander

GENERAL REQUEST FORM – SAILORS
Name: ______________________ Rank: _____________ No: __________________
Dept: ____________

Divisional Officer: ______________________

Dept Officer: _____________________
Request to see Divisional Officer/Departmental Officer/Executive
Officer/Commanding Officer through proper channel regarding __________________

Sailor’s Signature __________
Divisional Officer:
Dept Officer:

GENERAL REQUEST FORM – SAILORS
Name: ______________________ Rank: _____________ No: __________________
Dept: ____________ Divisional Officer: ______________________
Dept Officer: _____________________
Request to see Divisional Officer/Departmental Officer/Executive
Officer/Commanding Officer through proper channel regarding __________________

Sailor’s Signature __________
Divisional Officer:
Dept Officer:

NOTICE
NAME _________________ RANK ________ NO _______ QTR NO ____
You have to report in accommodation office at ___________On_________
In connection with.

(Santosh Kumar)
Commander

NOTICE
NAME _________________ RANK ________ NO _______ QTR NO ____
You have to report in accommodation office at ___________On_________
In connection with.

(Santosh Kumar)
Commander

GUEST PASS FORM
(30 days)
(Name) _____________________ (Rank) ___________(No)___________________
may please be permitted to keep following guest in quarter no. _________________at
NSB I/II/III for a period ______________________days/months w.e.f _____________
Particulars of guest are as follows:S.No.
(i)
(ii)
(iii)
(iv)
(v)
(vi)

Name

Age

Relation

Home Address

Reason __________________________________________________________
Number of family members of allottee ________Adults_______Childrens_______
Number of family members of sharer_________Adults_______Childrens_______

Divisional Officer’s Signature
With stamp

Sailors Signature_____________

With ships stamp

Date________________

APPROVED/NOT APPROVED

(Santosh Kumar)
Commander
SHARING FORM
Name _____________________ Rank ________________ No ________________
Unit __________________ Date ____________________ Valid up to _____________

SHARING OF GOVT MARRIED ACCOMMODATION
(a)

1.
It is requested that I may be permitted to share quarter no ___________
of _______________ for period of _______________ months w.e.f._________
2.
I am on married accommodation roster for _____________ - (rank).
I am willing to pay the subscription towards the SMQ maint. Fund at the
exiting rate.

Div Officer’s Signature
With ships, stamp

(b)

Sailor Signature.
(Sharer)

1.
I am willing to accommodate _______________________ in my quarter
No ___________________ - for a period of _____________ months
2.
The member of my family are adults _____________ children _________
3.
Certified that no other family is sharing in my quarter.

With ships stamp

Allotee;s Signature
Name: ________________
Rank & No- _____________

(c)

Approved for ______________ months W.e.f ________________________

(d)

FINES
(a)
1to 10 days (b)
11 to 30 days -

no fine
Rs 25 by allottee & sharer each

Disciplinary action will be taken
(e)

Received Rs ______________ vide receipt No----------- dated _______________
(Santosh Kumar)
Commander

SPECIAL LIBERTY

Name …………………………….. Rank ………………… P No ………………………..

Dept …………………………….Div Officer ……………………………………………….
The above mentioned sailor may be permitted to proceed ashore to……………...
……………………………………………… from………………………on……………………
Div. Officer’s Remarks……………………………
Dept. Officer’s Remarks………………………….

DUTY ASHORE

Name …………………………….. Rank ………………… P No ………………………..
Dept …………………………….Div Officer ……………………………………………….
The above mentioned sailor may be permitted to proceed ashore to……………...
……………………………………………… from………………………on……………………
Div. Officer’s Remarks……………………………
Dept. Officer’s Remarks………………………….

APPLICATION FOR RETENTION OF ACCOMMODATION
ON CHILDREN EDUCATION/RETIREMENT
NAME------------ RANK--------------- NO---------------- DEP---------------------QTR. NO----------------- PLACE------------DATE OF ALLOTMENT----------DATE OF TRANSFER--------------------------NEW UNIT (ON TRANSFER OF

RETIREMENT ----------------------------REASON FOR RETENTION ------------------------------------------------___________________________________________________________
PERIOD OF RETENTION ---------------------------------------------------PARTICULARS OF CHILDREN STUDYING:NAME OF CHILDREN-----------------------------------------------------------------------------------------------------------------------------------TERMINATION OF CURRENT ACADEMIC SESSION -------------------------CERTIFIED THAT I WILL VACATE THE ACCOMMODATION
IMMEDIATELY ON COMPLETION OF THE CURRENT ACADEMIC
SESSIONAL / APPROVED PERIOD OF RETENTION I.E ---------------------DIVISION OF OFFICER’S REMARK
SIGNATURE WITH SHIPS STAMP

SAILOR SIGNATURE
II

APPROVED / NOT APPROVED
NOTE:APPLICATION FOR ACADEMIC GROUNDS IS TO BE
SUPPORTED WITH CERTIFICATION (SCHOOL’S PRINCIPAL)
SIGNATURE

LEAVE REQUEST – SINGLE WINDOWS SYSTEM
NOTE:- ALL ENTRIES TO BE FILLED IN CAPITAL LETTERS, PARA I TO III TO BE
FILLED BY INDIVIDUAL SAILORS AND TO BE DROPPED IN LEAVE REQUEST BOX,
AFTER DULY CLEARED FROM LEAVE COUNTER (INS INDIA) UNFILLED/
IMPROPERLY FILLED LEAVE REQUEST WILL NOT BE ACCEPTED
PART-I
NAME--------------------------------- RANK----------------PART II. Q------------No------------------DEPARTMENT----------------------------TEL NO--------------------- RATION-----------------------DIV OFFICER----------------------------------- DEPT. OFFICER--------------------------------------REQUEST THROUGH PROPER CHANNEL FOR---------------DAYS----------LEAVE
OF--------INCLUDING------DAYS (TT) WP/WOP W.E.F-------------------------------------------(WITH PERMISSION TO ENCASH----------DAYS LEAVE ALONG WITH LTC FOR THE
YEAR--------) WITH PERMISSION TO PREFIX ON----------AND SUFFIX ON----------BEING--------------- CV REQUIRED/NOT REQUIRED
PART II
LEAVE ADDRESS________________RAILWAY STATION_____________________
C/O--------------------------------------RELATION-------------H.NO/NAME------------------------VILLAGE/TOWN------------------------------POST OFFICE-------------------------------------------TEL. OFFICE-----------------------POLICE STATION--------------------------------------------------DIST-------------------------------STATE-------------------------PIN--------------------------------------TELEPHONE (WITH STD CODE) ------------------MOBILE NO----------------------------------NEAREST MILITARY HOSPITAL------------------------------DIST-----------------------------KMS
NEAREST CIVIL HOSPITAL------------------------------------DIST-----------------------------KMS
DSSA BOARD------------------------------------------------------DIST------------------------------KMS
1.
CERTIFIED THAT THE ABOVE PARTICULARS ARE CORRECT
2.
IT IS FURTHER CERTIFIED THAT I HAVE ENCASHED----------DAYS LEAVE IN
MY SERVICECAREER.
SAILOR’S SIGNATURE_____________
PART III
SD SECTION REMARKS-----------------------------SIGNATURE-----------------------------------MI ROOM REMARKS------------------------------SIGNATURE---------------------------------------DIV OFFICER REMARKS------------------------SIGNATURE---------------------------------------PART IV
CDR’S OFFICER REMARKS-------------------SIGNATURE----------------------------------------PART V
GRANTED-------------------DAYS-----------------------LEAVE
OF
20-------------INCLUDING------------------DAYS TT WP/WOP, W.E.F-------------------VIDE MY GX
NO---------------------DATED-------------WITH
PERMISSION
TO
PREFIX
ON------------------------------AND SUFFIX-----------------------

D SECTION---------------------------CDR OFFICE----------------------------------------------------

APPLICATION FORM FOR ISSUE OF TEMPORARY PASS
FOR INS INDIA/SS COMPLEX, NAU SENA BAGH & KH
1.

Full Name of the employee

………………………………………………………

2.

Employed as and Department

………………………………………………………

3.

Place of Employment

………………………………………………………

4.

Father’s Name

………………………………………………………

5.

Date of Birth

………………………………………………………

6.

Height

………………………………………………………

7.

Colour of Hair

………………………………………………………

8.

Colour of Eyes

………………………………………………………

9.

Complexion

………………………………………………………

10.

Visible Identification Mark

………………………………………………………

11.

Local Address

………………………………………………………
………………………………………………………
………………………………………………………

12.

Pmt. Address

………………………………………………………
………………………………………………………
………………………………………………………

Place:

(Signature of the Individual)

Date:
(Left Thumb Print)……………………
Department Letter No.
And date…………………
II
COUNTERSIGNED
(HOD WITH OFFICE STAMP)
(Certified that the above particulars are correct)

APPLICATION FOR SAILOR’S ACCOMMODATION BOOKING
Dear Sir,
Kindly book the transit accommodation of NSB______ for me as per the
details below. I am aware of rules, regulation and charges.
1.

Rank, Name & Number::_________________________________

2.

Unit/Dte: -_______________________

3.

Name and Address of the Guest:-____________________________

Phone No________________
4.

Reason for visit__________________________________________

5.

Relation and Purpose of Visit:_______________________________

6.

Nationality:-___________________

7.

Date and duration of Booking_______________To_______________

Date-

Receipt No.

With stamp

Amount Rs.
Dated
II
Recommended/Not Recommended
Officer-in-Charge
Transit Accommodation
III
Approved

Note : - If booking cancelled booking charge will not be
refunded.

NOTICE
SAILORS NOT SHIFTING AS PER
ORDER WILL MARCH OFF TO EXO
BY ORDER

NOTICE
SAILORS NOT SHIFTING AS PER
ORDER WILL MARCH OFF TO EXO

BY ORDER

RULES ON TAKING OVER A QUARTER
2.
CPWD/MES. You are to return this form along with sanction from CPWD/MES to accommodation
office within 24 hrs, failing which rent on market rate will be charged from you.
3.
The person authorized to live in your quarter are member of your family i.e. wife and
children.
4.
detected you will be deprived of quarter. No sharing is to be entertained by you in the absence of
your family being away from the station.
5.
Out of Turn: - All Out of turn allotee are not permitted to share their accommodation
except with those persons/ sailors specified by the accommodation office.
6.
In case if it is found that your family has not occupied the qtr within one month from taking
over or is away from quarter for more than two months except when you are on leave will be
ordered to vacate the quarter.
7.
You are to take/furnish the particulars of your family in the enclosure and hand over the
same to the accommodation officer immediately after take over.
8.
9.
You are requested to pay the subscription in accommodation office NSBI/II/III before 10 th
of every month, failing which a fine will be charged from you as per existing rules.
10.


11.
You are responsible for keeping the surrounding of the building allotted to you in neat and
clean shape. For this you will be required to participate in the Shramdan as and when organized.
12.
You are not to leave your boxes/stores in the common areas like stair cases, lobbies and
in the surrounding.
13.
Your family members are not to climb in the terrace of the buildings at any time as all
terrace top are out of bonds.
14.
You are not to extend any fitting out side the balcony, which gives shabby appearance to
the building.
15.
You are to ensure that your families do not spread clothes for drying in park and along the
roads.
16.
Your family members should be in possession of family passes issued by DNPM (DA),
failing which the entry inside the NSB I, II and III will be prohibited.
17.
You will be charged for violating any of the above orders and may be ordered to vacate
the accommodation immediately.

INS India
Dalhousie Road
103/2

Date ___________
ALLOTMENT OF ACCOMMODATION

Meter reading with allotment ---------------------------------------------------------------------Name
KS Rajput
Rank
HAV
No. 15569239-H
1.
for

You have been allotted Qtr No.___________________in
NSB II
02 years
and you are to take over quarter form accommodation office INS India by
DOA – 19 JUL 2012
DOV – 18 JUL 2014

2.
CPWD/MES. You are to return this form along with sanction from CPWD/MES to accommodation
office within 24 hrs, failing which rent on market rate will be charged from you.
3.
The person authorized to live in your quarter are member of your family i.e. wife and
children.
4.
detected you will be deprived of quarter. No sharing is to be entertained by you in the absence of
your family being away from the station.
5.
Out of Turn: - All Out of turn allotee are not permitted to share their accommodation
except with those persons/ sailors specified by the accommodation office.
6.
In case if it is found that your family has not occupied the qtr within one month from taking
over or is away from quarter for more than two months except when you are on leave will be
ordered to vacate the quarter.

7.
You are to take/furnish the particulars of your family in the enclosure and hand over the
same to the accommodation officer immediately after take over.
8.
9.
You are requested to pay the subscription in accommodation office NSBI/II/III before 10 th
of every month, failing which a fine will be charged from you as per existing rules.
10.


11.
You are responsible for keeping the surrounding of the building allotted to you in neat and
clean shape. For this you will be required to participate in the Shramdan as and when organized.

-212.
You are not to leave your boxes/stores in the common areas like stair cases, lobbies and
in the surrounding.
13.
Your family members are not to climb in the terrace of the buildings at any time as all
terrace top are out of bonds.
14.
You are not to extend any fitting out side the balcony, which gives shabby appearance to
the building.
15.
You are to ensure that your families do not spread clothes for drying in park and along the
roads.
16.
Your family members should be in possession of family passes issued by DNPM (DA),
failing which the entry inside the NSB I, II and III will be prohibited.
17.
You will be charged for violating any of the above orders and may be ordered to vacate
the accommodation immediately.

(Santosh Kumar)
Commander
II

I have read and understood above instructions and shall comply with them.

Name _____________________
Rank ________________
No. __________________
Date _________________

RECEIPT
Received a sum of Rs. 20,000/- (Rupees Twenty Thousand
only) towards advance payment of tentage in Diwali Mela on 11
Nov 12.

Sandeep

VR NO. _____________
DATE______________
_______________________) From ________________________ towards Maintenance / BDF /
Vendor / Guest Room/ Transit Charges from Receipt No. _______ to _______.

Received by ______________
Name ___________________
Rank ___________________
P.No. ___________________
(Santosh Kumar)
Commander
Officer-in-charge Fund
Date :

/

/2013

--------------------------------------------------------------------------------------------------------------------VR NO. _____________
DATE______________
_______________________) From ________________________ towards Maintenance / BDF /
Vendor / Guest Room/ Transit Charges from Receipt No. _______ to _______.

Received by ______________
Name ___________________
Rank ___________________
P.No. ___________________
(Santosh Kumar)
Commander
Officer-in-charge Fund
Date :

/

/2013

DEPENDENT CERTIFICATE

This is to certify that under mentioned family members are dependent on me:(a)

Mrs. Saroj Yadav

Wife

(b)

Subham Yadav

Son

(c)

Nisha Yadav

Daughter

(d)

Sugriv Singh

Father

(e)

Gindo Devi

Mother

(SS Yadav)
CPO
114173-K

Divisional Officer

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