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LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

TO ALL OFFICES OF CORPORATION Dated 29th April,2010 Re: LIC's Policy Holders' Housing Scheme "JEEVAN BIMA NAGAR ­ PHASE II", Chandrasekharpur, Bhubnaeswar ­ Allotment of Flats under Managing Director's (MD's) Quota for Employees 228 flats are under construction in the afore-mentioned scheme on the lease hold plot taken from Govt. of Orissa. Out of 228 nos. of flats, 30 flats are on offer under this M.D's Quota. 18 flats are 2 BHK in B5 Block, 8 flats are 3BHK in A3 Block and 4 flats are 3 BHK (Deluxe) in AH4 Block. The details locations of flats are given below: For " B" Type Flat ­ 2 BHK (Block No. ­ B5) ­ 18 Nos. Flat No. 101,102,103,104,105 & 106 at 1st floor = 6 Nos. flat Flat No. 201,202,203,204,205 & 206 at 2nd floor = 6 Nos. flat rd Flat No. 301,302,303,304,305 & 306 at 3 floor = 6 Nos. flat For "A" Type Flat - 3BHK (Block No. A3) ­ 8 Nos. Flat No. 201,202,203 & 204 at 2nd floor = 4 Nos. flat rd Flat No. 301,302,303 & 304 at 3 floor = 4 Nos. flat For "AH" Type Flat - 3BHK Deluxe (Block No. AH4) ­ 4 Nos. Flat No. 201,202 & 203 at 2nd floor = 3 Nos. flat Flat No. 301 at 3rd floor = 1 No. flat The Employee has to furnish the following information to enable the Managing Director to allot flat from his quota: Employees who had applied against the press advertisement for public and fail to get firm allotment through lottery for the above cited project (Phase-II). Employees who are closer to superannuation. Employees who do not own a house in his/her name or his/her spouse's name any where in India. Employees who do not own a house in his/her name or his/her spouse's name at Bhubaneswar. Employees who have not availed MD's Quota earlier in LIC Housing Scheme any where in India. Contd...p/2

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 2 ## Topmost priority will be given to the employee who fulfills all the five above mentioned criteria. Please note that those employees who are in service in LICI or on deputation to its subsidiaries at the time of notification for MD's Quota are eligible to apply. APPLICATION FORM & BROCHURE: Application form & brochure (detailing out of all terms & conditions of scheme in general applicable to allottee's under MD's quota wherever relevant and /or as per decision of LICI) are available:1. Our Intranet site "Jeevan Sanchar" which can be down loaded and used for applying. 2. Or can buy an application form on payment of Rs. 50.00 (Rupees fifty) only by cash/demand draft drawn in favour of LIC of India, payable at Cuttack from the Office of the Dy. Chief Engineer, Jeevan Jyoti Complex, Link Road, Cuttack ­ 753012. The registration amount of Rs.50,000.00 (Rupees fifty thousand) only is payable by a crossed demand draft or pay order in favour of "LIC of India" payable at Cuttack. The deposit will not carry any interest. Applicant down loading application form from Intranet site has to send an additional draft/pay order of Rs.50.00 (Rupees fifty) only towards the cost of the form. The completed application clearly superscribing "APPLICATION FOR ALLOTMENT UNDER MD's QUOTA" with registration amount should be submitted to the Dy. Chief Engineer at aforementioned address by 15.05.2010 The managing Director reserves the right for changing the allotment criteria without assigning any reason at his sole discretion. Dy. Chief Engineer LIC of India, O/O the Dy. Chief Engineer Jeevan Jyoti Complex, Link Road, Cuttack ­ 753012

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

"BROCHURE"

Terms and conditions for registration of flats under the MD's Quota in LIC's Policy Holders' Housing Scheme "JEEVAN BIMA NAGAR ­ PHASE II", Chandrasekharpur, Bhubnaeswar. LOCATION OF FLATS: a) b) The proposed flats on offer are being constructed at Chandrasekharpur, Bhubaneswar about 5 Km. from Railway Station. It is by the side of "NALCO" Housing Complex and in close proximity of ITHub. Post Office, Banks, Medical Facilities etc., are available in the vicinity.

FLATS ON OFFER: 228 flats are under construction in the afore-mentioned scheme on the lease hold plot taken from Govt. of Orissa. Out of 228 nos. flats, 30 flats are on offer under this M.D's Quota. 18 flats are 2 BHK in B5 Block, 8 flats are 3BHK in A3 Block and 4 flats are 3 BHK (Deluxe) in AH4 Block. The details of flats are given below: For " B" Type Flat ­ 2 BHK (Block No. ­ B5) ­ 18 Nos. Flat No. 101,102,103,104,105 & 106 at 1st floor = 6 Nos. flat Flat No. 201,202,203,204,205 & 206 at 2nd floor = 6 Nos. flat Flat No. 301,302,303,304,305 & 306 at 3rd floor = 6 Nos. flat For "A" Type Flat - 3BHK (Block No. A3) ­ 8 Nos. Flat No. 201,202,203 & 204 at 2nd floor Flat No. 301,302,303 & 304 at 3rd floor

= 4 Nos. flat = 4 Nos. flat

For "AH" Type Flat - 3BHK Deluxe (Block No. AH4) ­ 4 Nos. Flat No. 201,202 & 203 at 2nd floor = 3 Nos. flat Flat No. 301 at 3rd floor = 1 No. flat These flats are being built in Stilt + 3 Storied structure in Sixteen buildings called "B" Block (8 Buildings), "A" Block (4 Buildings) &. "AH" Block (4 Buildings). The accommodation shall comprise of a Living room, two/ three Bed Rooms, Balconies, a Kitchen and two Toilets. The floor immediately above stilt floor is called 1st floor and accordingly 2nd floor & 3rd floor are named. The tentative sketch showing layout of the entire scheme and indicating flats are in M.D's Quota are furnished in Annexure-I The Broad Specification adopted is indicated in Annexure- II. OUR GOALS: a) b) c) d) To provide quality work with constant supervision. To provide timely and cost effective service. To bring past experience to benefit current work. To provide Good Environment adopting building bye-laws. Cond...p/2

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

HIGHLIGHTS: ## 2 ##

a) Concealed internal Plumbing work. b) Individual Stilt Parking Space. c) Concealed Internal Electrical Wiring with Copper wire, Miniature Circuit Breaker, Earth Leakage Breaker with state of the art technology. d) Concealed cabling for telephone, TV and electricity lines through conduits. AREA & PRICE Approximate area as well as basic price of flats are as bellow: JEEVAN BIMA NAGAR PHASE - II Sl. No. 1. 2. 3. Approximate area in Sq.M 98.00 Sq.M 121.00 Sq.M 123.00 Sq.M Basic Price of Each flat (S) Rs.* 24.50 Lakh 27.60 Lakh 31.60 Lakh

Block B5 A3 AH4

Type of Flat 2BHK 3 BHK 3 BHK (Deluxe)

No. of Flat 18 8 4

1 Sq.Mt. = 10.76 Sq.ft. * In addition to the basic price, VAT/ Service Tax as applicable, Cost of Electric Meter provision are to be borne by the purchaser. It also does not include stamp duty for registration of flat, legal expanses etc. and variation in price as detailed later. NOTE: Area is sum of built up area of each flat and proportionate area of common facilities like stair case, passages, mumty etc.

PRICE OF FLATS: The approximate areas as well as basic price of flats are indicated in tabular form above. The basic price of the flats will be modified depending on the variation of the Wholesale Price Index during the project execution. The quantum of increase/ decrease on the basic price shall be worked out on the basic of the formula given below. W ­ Wo Vs = S X --------------Wo Where, Vs = The quantum of increase/ decrease on the basic price. S = Basic price as indicated above. Wo = The value of all India Wholesale Price Index for all commodities considered as of March 2008 (Base =100, 1993-94). W = All India Wholesale Price Index for all commodities (Base=100, 1993-94) as Published in the RBI Bulletin in the month in which the project will be completed.

Contd...p/3

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 3 ## However, quantum of increase/ decrease on the basic price (Vs) will be restricted to ( + ) 5% or ( - ) 2% (max.) of the basic price (S). The final price will be the total of the basic price (S) and the quantum of increase/decrease worked out on the above basis (Vs) and VAT/ Service Tax as applicable, if any shall be extra. The areas of flats mentioned herewith are approximate. However, the basic price given above will be treated as firm for calculation of final price as above. ELIGIBILITY: The Employee has to furnish the following information to enable the Managing Director to allot flat from his quota: Details of in-force Life Insurance Policy/ policies, issued by LIC of India on his/her own life, as on the date of application Employee who had applied against the press advertisement for public and fail to get firm allotment through lottery for the above cited project (Phase-II). Employee who are closer to superannuation. Employees who do not own a house in his/her name or his/her spouse's name any where in India. Employees who do not own a house in his/her name or his/her spouse's name at Bhubaneswar. Employee who have not availed MD's Quota earlier in LIC Housing Scheme any where in India.

The applicant should hold at least one in-force Life Insurance Policy with minimum sum assured of Rs.50,000.00 (Rupees fifty thousand) only issued LIC of India. Application can also be made in joint name of Husband & Wife or Parent & Child provided policies as above are held by both. HOW TO APPLY: Application form & brochure (detailing out of all terms & conditions of scheme in general applicable to allottee's under MD's quota wherever relevant and /or as per decision of LICI) are available:1. Our Intranet site "Jeevan Sanchar" which can be down loaded and use for applying. 2. Or buy an application form on payment of Rs. 50.00 (Rupees fifty) only by cash/demand draft drawn in favour of LIC of India, payable at Cuttack from the Office of the Dy. Chief Engineer, Jeevan Jyoti Complex, Link Road, Cuttack ­ 753012. The registration amount of Rs.50, 000.00 (Rupees fifty thousand) only is payable by a crossed demand draft or pay order in favour of "LIC of India" payable at Cuttack. The deposit will not carry any interest. Applicant down loading application form from Intranet site has to send an additional draft/pay order of Rs.50.00 (Rupees fifty) only towards the cost of the form. The completed application clearly superscribing "APPLICATION FOR ALLOTMENT UNDER MD's QUOTA" with registration amount should be submitted to the Dy. Chief Engineer at aforementioned address by 15.05.2010

Contd...p/4

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 4 ## Incomplete applications received without the prescribed registration fee and/or cost towards downloaded Application form are liable to be rejected without assigning any reasons and without entering into any further correspondence. Application/s received after expiry of last date will not be entertained and the registration fee will be refunded without any interest. No applicant will be eligible for registration of more than one flat in his/her name, in this scheme. PROCEDURE FOR REGISTRATION: i. ii. iii. A list of eligible applicants will be prepared after scrutinizing the applications. If the number of eligible applicants is more than the number of flats offered under each type, the allotment will be made by MD, at his sole discretion. The registration fee of all other applicants who could not be registered would be refunded without any interest within 60 (sixty) days from the last date of acceptance of application for registration. If the registration fee is not refunded within the stipulated period, a simple interest of 6% per annum will be paid from the date of expiry of the prescribed time to the date of payment. The registration fee of the successful applicants would be adjusted towards the cost of flat at the time of allotment. No interest will be payable on this amount. In case registered applicant withdraws before the date of allotment, 50% of the registration fee i.e. Rs.25,000.00 (Rupees twenty five thousand) only would be forfeited and the balance would be refunded without any interest.

iv. v.

COMPLETION OF FLATS: In case, if the project is delayed beyond the specified time i.e. 24 months from the date of commencement i.e. 19th September,2009, the allottees has option to withdraw from the scheme and in such case, full amount paid will be refunded without any interest. ALLOTMENT OF FLATS i. ii. Once allotment is decided upon, it cannot be transferred to or exchanged with another applicant. The allottee may avail loan facility which is available with LIC Housing finance Ltd. or such other organization as per their terms and conditions.

The managing Director reserves the right for changing the allotment criteria without assigning any reason at his sole discretion.

Contd..p/5

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 5 ## MODE OF PAYMENT: No interest shall be payable on the registration amount of Rs. 50,000.00 (Rupees fifty thousand) and amount shall be adjusted towards the price of the flat for the allottees. Please note that all payment to be made in favour of LIC of India payable at Cuttack. a) The Mode of Payment of flats shall be as follows: Allottees should pay all installment of payment within 45 days from the date of intimation. 1st installment payment has to be paid within 45 days from the date of allotment along with consent/acceptance of the terms and conditions offered by LIC of India. i. ii. iii. 1st Installment 2nd Installment 3rd Installment 4th Installment 5th Installment : 33% of Basic price (approximate) on allotment of flat. : 20 % of Basic price (approximate) after completion of Foundation and plinth : 20 % of Basic price (approximate) after completion of R.C.C frame work. : 20 % of Basic price (approximate) after completion of brick work & finishing work : Balance amount including price escalation, electrical Service connection charges and Rs.10,000.00 (Rupees ten thousand) only for maintenance for initial six months etc. at the time of taking possession. VAT/Service Tax as applicable shall be extra and it has to collected each stage/installment of payment..

vi.

v.

b)

In respect of allottees who decline the allotment or fail to respond to the allotment within the prescribed time, total registration charges of Rs.50,000.00 (Rupees fifty thousand) will be forfeited. In respect of allottees, who have accepted the allotment & paid the installment/instalments but fails to pay balance subsequent amount within time schedule as mentioned above and as per intimation by LICI, the registration charges of Rs. 50,000.00 (Rupees fifty thousand) and 25% of the total amount paid till date will be forfeited. The balance amount will be refunded without any interest. In case any payment is not paid within the stipulated period (with or without availing loan), the allotment is liable to be cancelled. However, the right to extend the period beyond the stipulated period on convincing grounds will be resting with LICI. In such cases, Simple interest @6% per annum for the extended period shall be charged additional.

c)

PLEASE NOTE THAT IN CASE OF "2 BHK FLATS" R.C.C FRAME WORK HAS BEEN COMPLETED AND IN CASE OF "3 BHK FLATS" & "3 BHK FLATS (DELUXE)" FOUNDATION & PLINTH HAVE BEEN COMPLETED. ACCORDINGLY, THE ALLOTTEES HAVE TO MAKE THE PAYMENT. Contd..p/6

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 6 ## ALLOTMENT OF FLATS: LIC of India reserves the right to extend the last date prescribed for submission of the application for registration as also the right to accept or reject any application for registration without assigning any reason thereof. The list of application eligible for allotment of flat under MD's Quota shall be final and no appeal shall lie against the same. The expenses on stamp duty and registration charges shall be borne by the allottee. Occupation of the flat shall be made only after the full price is received by LIC of India including the payment towards maintenance and after registration of the flat. The lease deed shall be as per the draft prescribed by LIC of India and shall be made available for perusal of the allottee on request. The flats are for residential purpose only. After the possession is handed over, LIC of India owes no responsibility for any damage to the property. Any additions/ alternations to the flat after taking over possession are at purchaser's risk and responsibility. The purchaser shall necessarily become a member of flat owners association i.e. "JEEVAN BIMA NAGAR (PHASE-II)" which will be registered bodies formed within the frame work of the constitutions and regulations of Co-operative Societies as applicable in the State. Common roads shown in the integrated layout shall be used by Both Phase-I & Phase-II (i.e. Occupants of 192 flats of Phase-I & Occupants of 228 flats of Phase-II) Occupants of 192 flats of Phase-I & Occupants of 228 flats of Phase-II, shall also share sewerage disposal system & water supply system. Other amenities like school, community hall & recreational space shall also be utilized by Occupants of 192 flats of Phase-I & Occupants of 228 flats of Phase-II Therefore for harmonious and smooth functioning of common services, an apex society need to be formed comprising of both Phase ­ I (192 flats) and Phase ­ II (228 flats) occupants. The responsibility for maintenance of the building including open areas, sewerage, water supply, sewerage disposal, Rain Water Harvesting, Pumps, Security and Street lighting etc. shall be of the individual purchaser or of Consortium / Association to be formed by the Allottees. An amount of Rs. 10,000/- (Rupees ten thousand) only per flat shall be deposited with LICI at the time of taking possession of the flat for attending the day to day maintenance of the Premises for the period of 6(Six) months after handing over possession or until maintenance is taken over by the Society/ Association, whichever is earlier. In case the Consortium/ Association is not formed within 6 (six) months, a further amount of Rs. 10,000.00 (Rupees ten thousand) only should be paid per flat for further period of 6 (six) months in case the day to day maintenance is to be attended by LIC of India. LICI will not take responsibility of maintenance after a period of one year, reckoned from date of intimation to the allotteess for taking possession, and the balance amount collected, if any, would be handed over to the said Society/ Association. However, if the amount spent on maintenance during the period is in excess of collected amount, the Corporation reserves the right to recover the same from allotteess/association/society as the case may be. Contd..p/7

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 7 ## No alternations in the specifications will be made at the request of the allottees, in construction regarding the nature of floor, doors, windows, their locations etc. LIC of India reserves the right to amend/ alter the provision of the Scheme before the allotment of flat after duly notifying the eligible applicants regarding such amendments/ alternations. Legal jurisdiction shall be within the limit of Cuttack city only.

Contd...p/8

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 8 ##

SPECIFICATIONS: FOR "B" TYPE AND "A" TYPE FLATS. STRUCTURE FINISH a) Internal b) External DOORS (Entrance/Main) (Internal Doors) (Toilet Doors) Hard Ware Fittings WINDOWS & VENTILATORS. FLOORING STAIRCASE DADO KITCHEN PLATFORM WATER SUPPLY a) Internal b) External Pillar Tap & Bib Tap SANITARY : : : : : : : : : : : :

ANNEXURE-II.

R.C.C. framed structure Cement based putty punning with cement primer Weather proof Acrylic (Anti-Fungal) paint over cement-sand plaster Sal wood frame with Solid core factory made flush door shutter with teak veneer finish on both faces. Sal wood frames with solid core factory made flush door shutters with Synthetic Enamel Paint. Flush door shutter with lamination on inside & Synthetic enamel paint on outside face. Heavy duty extruded stainless steel/brass materials. All fully clear glazed anodized openable & fixed aluminum windows. Rooms & Drawing Hall : Ceramic Tiles Toilet, Kitchen & Utility: Ceramic Tiles. Kota Stone with Marble Lining Bath: Ceramic Tiles (Dado upto 2100 mm ) Black Granite top with stainless steel sink with drain board & Ceramic Tiles upto 600 mm high above platform. Concealed G.I. pipes. G.I. Pipes Chromium Plated Brass. a) CI (Centrifugally spun) Soil/ waste pipe with lead joint. b) White vitreous Wash Basin, WC pan & Commode with P.V.C. low level flushing Cistern. Concealed Copper wiring, Cable T.V. Conduits& Telephone point in two rooms, AC point in one bed room. Cement based integrated waterproofing treatment for terrace/ toilets. Source: Ground water supply. RCC under ground tank and HDPE Over head Tank and Centralized RCC elevated water reservoir tank. Six Passengers capacity with provision for back up generator for one lift per block (LIC will not provide Generator). Car Parking under Stilt. Semi-modular type.

: : : : : : : :

ELECTRICAL WATER ROOFING WATER SUPPLY

LIFT PARKING ELECTRICAL SWITCH

: : :

Contd...p/9

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 9 ##

SPECIFICATIONS: FOR "AH" TYPE DELUXE FLATS. (Items not mentioned below are similar to those of "A" & "B" type flats) DOORS : Hard Ware Fittings FLOORING : : Deluxe type Heavy Duty extruded stainless steel/brass. Bed Rooms: Ceramic Tiles, Drawing Room: Vitrified tiles, Toilet, Kitchen & Utility: Ceramic Tiles. Toilet: Designer Tiles (Dado upto 2100 mm ) Granite top with stainless steel sink with drain board & Ceramic Tiles upto 600 mm high above platform. Deluxe decorative Chromium Plated Brass with Basin Mixture. Modular type.

DADO KITCHEN PLATFORM WTER SUPPLY Pillar Tap & Bib Tap ELECTRICAL SWITCH

: :

: :

Internal wiring for electrification will be provided in each flat and the allottees will have to apply to Electricity authority individually for obtaining supply of power and meter for their own flats.

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

APPLICATION FORM Application form for allotment of a flat in LIC's Policy Holder Housing Scheme "JEEVAN BIMA NAGAR ­ PHASE ­II" Chandrasekharpur, Bhubaneswar under M.D's Quota. (Incomplete form not accompanied by Registration amount is liable to be rejected) Sl. Particulars of the Applicant No. 1 a) Name (in Block Letters) & S.R. No. b) c) Father's / Husband's Name Marital Status Details

2.a) Residential Address

b)

Address for communication

c)

Telephone No., if any

Office: Residence: Mobile: E-Mail ID :

3. 4.

Date of Birth and Age Designation and address of the LIC Office where presently working

5.

Date of Joining in LIC of India Contd....p/2

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 2 ## Sl. No. 6. Particulars of the Applicant Whether the Employee own a house in his/her name or his/her spouse's name at Bhubaneswar. Whether the Employee own a house in his/her name or his/her spouse's name any where in India. Whether the Employee closing to superannuation (please furnish date of retirement) Whether you have availed M.D's Quota earlier in L.I.C housing scheme any where in India. Whether you have applied against the press advertisement for public and failed to get firm allotment through lottery for the above cited project (PHHS, Phase ­ II ) Give preference for type of Flat desired to be purchased by writing 1st /2nd/ 3rd preference in the space shown with your initial. You can give maximum three preferences. For Example: If 2 BHK is your 1st preference, 3BHK (deluxe) is your 2nd preference and 3BHK is your 3rd preference then please write "1st preference"' under 2BHK and initial the same. Write "2nd preference" under 3 BHK (deluxe) and initial the same. Write "3rd preference" under 3 BHK and initial the same. Details

7.

8.

9.

10.

11.

Type of 2 BHK Flat Preference and Initial

3 BHK

3 BHK (Deluxe)

Contd...p/3

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

### 3 ### 12. Details of in-force LIC Policy / Policies held by the applicant : Policy No. Sum Assured (Rs.) Plan and Term Date of Mode of Commen Payment cement My/ Qty / Hly / Yly Due Date of last premium paid & date of payment Name of the Branch Office Servicing the policy

Sr. No.

(Copies of latest premium paid receipt / certificate from the servicing branch / employer to the effect that the premium have been received/ deducted must be enclosed.) Particulars of Registration fee: Amount Rs. _______________ D.D. No. ___________________ Date ______________ Drawn on ______________ ____________________________________________________________________ Details of Earlier application for this Scheme & Details if any:

Application No Fortune Plus No.

: :

Contd...p/4

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

### 4 ###

Declaration

I, Mr./ Mrs. / Miss ________________________________________ son / daughter / wife of ____________________________________________________hereby declare that the above particulars are true and correct to the best of my knowledge and belief and they do not entitle me to claim any priority in allotment of flat under LIC's Policy Holder Housing Scheme "JEEVAN BIMA NAGAR ­ PHASE ­II", Chandrasekharpur, Bhubaneswar under M.D's Quota. I, hereby declare and affirm that the Particulars given in this application are true in all respects and that above referred flat, if allotted will be purchased for residential use and occupation and that the herein before made affirmation shall form the basis of consideration of allotment of a flat to me by L.I.C. of India and if any untrue averment is made be me herein, the L.I.C. is at liberty to cancel the allotment of the flat and also take such other action / actions against me as they deem fit and / or as they may be advised by their legal advisers. Further, I hereby agree that the registration amount of Rs. 50,000/- (Rupees Fifty thousand only) has been remitted by me to the L.I.C. of India in terms of relevant provision in relation there to contained in the brochure and the circular setting out the terms and conditions for sale of flats at LIC's Policy Holder Housing Scheme "JEEVAN BIMA NAGAR­ PHASE ­II", Chandrasekharpur, Bhubaneswar under M.D's Quota. I also agree that the allotment of flat is subject to the terms and conditions set out in the brochure. Date at _________________on the ____________ day of ____________ 2010.

Signature of Witness * ; Name S.R. No. Department Office Address : _________________________ : _________________________ : _________________________ : _________________________

Signature of Applicant S.R. No...................

* Witness shall be an existing Class ­ I Officer of the Corporation. Contd...p/5

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 5 ##

Application Acknowledgment Slip

Office of the Dy. Chief Engineer Jeevan Jyoti Complex, Link Road Cuttack ­ 753012 (Orissa) (To be filled in by the Applicant)

Name of applicant Date of Payment Amount Paid Demand Draft No Address for Communication

_______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

Drawn on (Bank) Branch Date

_______________________________ _______________________________ _______________________________

Date of Receipt: __________________ Signature & Stamp of LIC Official

Contd...p/6

LIFE INSURANCE CORPORATION OF INDIA OFFICE OF THE DY. CHIEF ENGINEER JEEVAN JYOTI COMPLEX, LINK ROAD, CUTTACK-12 PH. NO. 06712367179/81/82, FAX :0671-2367179

## 6 ##

Application Acknowledgment Slip

Office of the Dy. Chief Engineer Jeevan Jyoti Complex, Link Road Cuttack ­ 753012 (Orissa) (To be filled in by the Applicant)

Name of applicant Date of Payment Amount Paid Demand Draft No Address for Communication

_______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________ _______________________________

Drawn on (Bank) Branch Date

_______________________________ _______________________________ _______________________________

Date of Receipt : __________________ Signature & Stamp of LIC Official

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