Cycle Adv Form

APPLICATION FOR ADVANCE FOR PURCHASE OF A BICYCLE 1 2

Name of applicant (in block letters) Present designation

3

Substantive pay

4

Date of Birth

5

Date of entry in the department

6

Amount of advance applied for

7

No of installments in which the advance should be recovered Whether permanent /QP/temp or ED If temporary/QP or ED, whether willing to produce a security bond executed by a permanent departmental official in the department Whether applying for the first time. If not, year of previous advance. Nature of duties performed by the official

8 9

1 0 1 1

Place : Date: Signature of applicant

I.

Declaration

I am willing to sell my cycle to Shri / Smt……………………………………………… ……………………………………………………………………………………………. for Rs…………….

Signature & Name & address of the person selling the bicycle

II Declaration I hereby declare that I will not sell or mortgage my cycle purchased out of the advance granted to me and that I will keep the cycle in good running condition. Station Date

Signature Name & designation

III Declaration I hereby declare that the advance will be utilized for the purchase of the bicycle which will be helpful in the discharge of my duties. Station Date

Signature Name & designation