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APPLICATION FOR RESERVATION OF HOLIDAY HOME/I.B/IQ AT

(ASSAM CIRCLE)

1.	Name of officer/official (in block letters)*
2.	Email Address *
3.	Designation *
4.	Office to which attched
5.	Grade (III/IV)
6.	Date of appointment (dd/mm/yyyy)
7.	Basic pay with GP
8.	Date in which reservation is required (dd/mm/yyyy)
9.	No. of days required
10.	No. of seats required
11.	Purpose for reservation Holiday Home / I.B
12.	Whether leave sanctioned if yes copy of memo to be enclosed
13.	No. of IPO, date & value (IPO-dd/mm/yyyy-value)
13. Name and number of seats rewuired by the applicant with relationship with the applicant to be mentioned:

Sl No.	Name of the members	Relationship	Seats required
1.
2.
3.
4.
5.
6.
		Total: