Bengal DCL Housing Development Company Ltd.
A Joint Enterprise of West Bengal Housing Board and DC Properties Ltd.
Registered Office : 24 Park Street, Kolkata 700016
City Office: Sree Manjari, 4
thFloor,
8/1A Sir William Jones Sarani (Middleton Row) Kolkata 700016
Phone : (91) 33 40003333, 40003343, 40003307, 40003309
Fax: (91) 33 40003300
e-mail: sampoorna@bengaldcl.com
Visit us at www.bengaldcl.com
APPLICATION FORM
Serial NumberPlease fill in relevant portions of the APPLICATION FORM for Individual/ Joint or Other Entity. Strike out portions that are not applicable and deposit the APPLICATION FORM in full. Please deposit/mail the Application Form along with signed General Terms and Conditions
at/toBengal DCL Housing Development Company Ltds city office
Sampoorna
Tritiya
INDIVIDUAL / JOINT APPLICATION FORM
Sole / First Applicant Joint Applicant
Please fill in block letters
1. Full Name Mr./Ms. ___________________________ Mr. / Ms. _______________________________ 2. Relation to the First Applicant (Only for Joint Applicant) ___________________
3. Father / Husbands Name / Father / Husbands Name /
Natural guardian (in case of minor) ________________ Natural guardian (in case of minor) _______________ 4. Date of birth ____________________________ ____________________________
D D M M Y Y D D M M Y Y
5. Occupation Doctor Lawyer Doctor Lawyer Engineer Engineer IT Professional Accountant IT Professional Accountant
Business - Nature of business _____________________ Business Nature of business _______________
H Housewife Student
Any Other Specify _________________________
6. Gross Annual Income Below 10,00,000.00 -Between 10,00,001.00 15,00,000.00 Above 15,00,000.00
Housewife Student
Any Other Specify ________________________
6. Gross Annual Income Below 10,00,000.00 Between 10,00,001.00 15,00,000.00
Above 15,00,000.00
7. Status Resident Indian Non Resident Indian Resident Indian Non Resident Indian
8. PAN NO. _________________________ ________________________________
9. Permanent address ______________________________________________________________________________ (for Sole / First Applicant) City ______________________ State _________________ Country _______________ PIN/ZIP _______________________ Phone Home __________________ Phone Work ________________________ Mobile ______________________________ Fax ____________________________ Email ______________________
10. Correspondence address ________________________________________________________________________ (for Sole / First Applicant) City ______________________ State _________________ Country _______________ PIN/ZIP _______________________ Phone Home __________________ Phone Work ________________________ Mobile ______________________________ Fax ____________________________ Email ______________________
Affix Photograph
Affix Photograph
Sampoorna
Tritiya
ADDITIONAL INFORMATION (NON-RESIDENT APPLICANTS ONLY)
Sole/First Applicant Joint Applicant
1. Nationality __________________________________________ _______________________________ 2. Native place in India ___________________________________ _______________________________ 3. Passport Indian Foreign Indian Foreign
4. No. , Place & Date of issue ___________ _____________ ______________ ________________ 5. Whether any property Yes No
held in India ?
Yes No
If yes, please specify _______________________________________________________________________ 6. Contact person in India :
Full Name ________________________________________________________________________________ Correspondence address ______________________________________________________________
City _______________________ State ______________________________ Pin _________________ Phone _______________ Mobile ________________ Fax _______________ Email ________________
7. i. (a) NRE Account No. ________________ ______________________ (b) Name of bank and branch ________________ ______________________ ii. (a) FCNR Account No. ________________ ______________________ (b) Name of bank and branch ________________ ______________________ iii. (a) NRO Account No. ________________ ______________________ (b) Name of bank and branch ________________ ______________________
OTHER ENTITY APPLICATION FORM
Please fill in block letters
1. Name of the organization ________________________________________________________________________ 2. Status Proprietorship Firm Partnership Company
AOP/BOI Others ____________________________
3. Registered / Head Office address _____________________________________________________________________________ City _______________________ State ______________________________ Pin / Zip _______________
Phone _______________ Mobile ________________ Fax _______________ Email ________________
4. Name of authorized signatory with designation __________________________________________________________ _______________________________________________________________________________________________ 5. PAN No. __________________________________________________________________________________
Sampoorna
Tritiya
APARTMENT SELECTED Apartment No. Tower No. 1 2 3 4 5 (Tick one)Please mention the category you are applying for
Duplex 3 Bed Room
(Please tick only one)
Parking Preferences (Ref Clause No. 7 of the GTC)
Type 1st Choice 2nd Choice 3rd Choice 4th Choice
Covered
Open
Stack Tier I
Stack Tier II
How did you come to know of the project? (May tick more than one option, if applicable) Through news paper advertisement (Specify which one) _______________
From my relative/friend/colleague _______________ From Realtors _____________
Others (Please specify) __________________________
PAYMENT DETAILS
Payment Plan Down Installment
Application Money Rs. ________________ (Rupees ___________________________________ only) Pay order / DD No. ________________________________________ dated ____________________ Drawn on ___________________________________________________________________________ In favour of Bengal DCL Sampoorna.
Sampoorna
Tritiya
DECLARATION
1. I/We hereby solemnly declare that all the foregoing facts are true to the best of my/our knowledge and nothing relevant has been concealed or suppressed. I/We also undertake to inform Bengal DCL Housing Development Company Limited of any future changes, related to the information and details shown in this Application Form. 2. I/We declare that I/We have read and understood the terms and conditions of sale and other information / Payment conditions stated in the General Terms & Conditions including Area Schedules. I/We do hereby solemnly accept and agree to abide by them, and as also others as may be prescribed by Bengal DCL Housing Development Company Limited in future. I/We further agree to sign and execute the necessary documents as and when desired by Bengal DCL Housing Development Company Limited.
3. I/We being Non Resident Indians Foreign Citizen of Indian Origin do solemnly declare that I/We want the apartment (applied for), for residential purposes only. (strike out, if not applicable)
4. I/We hereby accord my/our irrevocable consent to become member of the Apartment Owners Association and execute necessary documents as and when called upon.
Signature of Sole/First Applicant Signature of Joint Applicant
Place : Place : Date : Date : APPLICANTS COPY D D M M Y Y Y Y PAY-IN-SLIP BENGAL DCL HOUSING DEVELOPMENT COMPANY LIMITED SAMPOORNA- TRITIYA Application No.
Received from Mr./Ms. (in block letters) .. For Sampoorna - Tritiya Apartment No. Tower . vide Pay Order / Draft No. . Rs. .. (Rupees only) dated . drawn on Bank Branch. Deposited by
Sampoorna
Tritiya
BDCL COPY D D M M Y Y Y Y PAY-IN-SLIP BENGAL DCL HOUSING DEVELOPMENT COMPANY LIMITED SAMPOORNA - TRITIYA Application No.Received from Mr./Ms. (in block letters) .. For Sampoorna - Tritiya Apartment No. Tower vide Pay Order / Draft No. .. Rs. (Rupees ..only) dated . drawn on Bank Branch. Deposited by