TATA STEEL, JAMSHEDPUR

ESTATE DEPT.

CURRENT RETIREMENT

Sr.Mgr.(M&E) Serial No……………….. 5. Particulars of the relation in whose name allotment is sought……..
Tata Steel Date:-…………………… Name…………………………………………………………………
Jamshedpur. P.No………………..Relationship…………………………………..

Dear Sir, Department………………..Date of employment…………………..

I have to inform you that I shall be superannuated from Co’s
Service with effect from…………………………I therefore request
you for allotment of a quarter to my son/son-in-law/brother/wife/
Daughter. The relevent particulars which are given below are
Correct to the best of my knowledge and belief.
Yours faithfully,
Signature/Thumb Imppression of the
Applicant.
. . . . . .. .. .
1.Service particulars of the applicant :
Name of the applicant ………………………………………………….
(in block letters)
P. No…………………… Dept. ……………………………………...
*Date of employment……………… *Date of discharge……………….
*Reason for discharge…………... *Length of service……………….
*If service is above 40 yrs. ) 1………………………………………..
give punishment particulars )
(To be filled up by Allotment)2. ……………………………………….
Section). ) possession of the Co.’s quarter now occupied by the
)3……………………………………….
If quarter is under occupantion
of ex-employee give: Qr.No……..Type……….Road……..Area…….
2.Give particulars of holding if any )Holding No………………
in the name of the applicant or any ) disciplinary action.
family members in/or around Jamshedpur )Line No…….Area………
3.Particulars of applicant’s children :
Rate of pay……………….Points…………………………………...
Native place (full address) :
Village…………… P.No…………….P.S…………………………
6.Give particulars of quarter which is under occupation of the relation
Qr.No……………Type……..Road…………..Area………………
If son-in-law’s father was an employee of the Steel Co. give
his particulars:
Name…………………..P.No…………………Dept……………..
Place & Date of marriage(In case of son-in-law)……………….
Applicant’s daughter’s name………………………………………
7. Undertaking of relation is whose name is sought……………..
This application is made with my consent and I request you
to consider and allotment of a quarter on the ground of the
retirement of my father/father-in-law/brother/husband
Sri………………………………………………………………
I hereby declare that the statement given above are true, If
allotment is made, I shall be responsible for giving vacant
ex-employee and his family in the quarter allotted to me, if
the above statement is found incorrect at any time in future
or I fall to carry the undertaking, the quarter allotted to me on
compassionate ground any cancelled. Falure on my part to
give vacant possession of the quarter will render no liable for
If the claimed relationship is found to be false, I will be liable for
disciplinary action.

Name Age Relationship Employment Status Date………………20…. Signature of relation

1……………………………. ….. …………….. ……………………….. ……………………………………………………………………..
2. …………………………... ….. …………….. ……………………….. (To Be filled by A.P.M.(T)
3. …………………………… ….. …………….. ……………………….
4. …………………………… . …. …………….. ………………………. 1.Relationship established or not…………………………………..
5. …………………………… …… …………….. ……………………….
6. …………………………… . ….. ……………... ………………………. 2.Both living together or not……………………………………….

4. Give particulars of persons (Tisco employee only) living in the quarter

3.Report vide P.D.Memo No…………..Date………..Encl……..
of the ex-employee. ……………………………………………………………………
1.Place at H.A.C. on ……………………………………….
Name P.No. Dept. Relationship 2. Decision of Memo Allotment Committee……………………
…………………………………………………………………….
…………………………………………………………………………………. *Items marked by esterisk are to be checked by Asst.Allot.Officer

………………………………………………………………………………….
 APPLICATION FORM FOR COMPANY’S ACCOMMODATION
MEDICAL GROUND TO H.A.C./Q.A.C.

APPLICANT’S DETAILS: APPLICATION DATE:

NAME: ........................................... PATIENT’S NAME: ............................................
P.NO............................................... RELATIONSHIP: ................................................
DEPARTMENT................................. MEDICAL BOOK NO..........................................
PAY ROLL NO.: ................................
..................................................................................................................................................................

Particulars of the person suffering from a disease:

Name of the disease:

(Please tick in the box)
1. ( ) Chronic renal Failure
2. ( ) Amputation of Legs/Hands of employee (self only)
3. ( ) Employee or family members, who have been issued Medical Books as
Handicapped with current M.C. from Chief (TMH)
4. ( ) Leprosy- with obvious physical deformity (caused by Leprosy)
5. ( ) Cancer case
6. ( ) Heart Disease :
a) Operated Valve Related diseases.
b) Operated for Blockage (e.g. By-pass surgery or CABG)
c) Myocardial Infarction.
7. ( ) Mental Disorder :
a) Chronic Psychosis
b) Schizophrenia
c) Dementia – Dependent for ADL MMSE score should be 18 or less. To be assessed by
Psychiatrist
8. ( ) Paralysis (Hemiplegia, Paraplegia, Monoplegia)
9. ( ) Total Blindness of both eyes.
10. ( ) Interstitial Lung disease (ILD)

TREATING SPECIALIST DOCTOR’S COMMENTS.........................................................................................

R.M.O’s COMMENTS.................................................................................................................................

Treating Specialist Doctor R.M.O.

Signature with Date & Stamp Signature with Date & Stamp

I hereby declare that no other relations of my father/father-in-law/brother/sister has been allotted

company accommodation on his/her service points or on the ground of sickness of a relative. If the above
information is found incorrect, I shall be liable for disciplinary action as well as for vacating the quarter
allotted to me on medical grounds.

APPLICANT’S SIGNATURE
NAME.................................................
P.NO...................................................
DEPT...................................................