1 House No. ____________ Sector/Colony/Village_______________________________________ Chandigarh.
2 Name of Landlord_______________________ @ ________________________ Age____________ Yrs.
3 Occupation ___________________________________Mobile No._______________________
Particulars of Tenant / PG
1 Name ________________________________@ __________________________Age_________________Yrs.
S/o__________________________________ Permanent R/o________________________________________
PS___________________ Dist. __________________ State ___________________Mobile_________________
2 Residing: Alone / Couple / Family () as Tenant / PG () w.e.f. ___________________, Rent Deed (Yes / No).
3 Previous Address ___________________________________________________________Up to ___________
4 Occupation and Address _____________________________________________________________________
5 Detail of Passport: Passport No. _____________________Issue Date______________________________
Valid up to ______________________Issuing Authority_________________________
6 Detail of Weapon: License No. ______________________Type / Make____________________________
Bore______________________Valid up to ____________Issuing Authority___________
7 If Senior Citizen: Living Alone / Couple / Family () Registered with Sr. Citizen Association (Yes / No)
8 Attached copy of I. D. Proof: V-Card/ R-Card / Driving License / I-Card ( appropriate only)
9 Detail of Family Members of Tenant / PG
FOR OFFICE USE ONLY
Entered in PS _________________record by MHC, Vide No. ________ Dated _______________in Verification register.
