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Профессиональный Документы
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Year.........................
I,.,son/daughter/wifeof...,
aged.. years, belonging to .....................
service
and
presently
working
as
Detailsofmovableassets
(Assets in joint name indicating the extent of joint ownership will also have to be
given)
Sr.
No.
Description
(i)
Cash
Depositsin
Banks,
Financial
InstitutionsAnd
NonBanking
Financial
Companies
Bonds,
Debenturesand
Sharesin
companies
Otherfinancial
institutions,
NSS,Postal
Savings,LIC
Policies,etc
MotorVehicles
(detailsof
make,etc.)
Jewellery(give
detailsof
weightand
value)
Otherassets,
suchasvalues
ofclaims/
interests
(ii)
(iii)
(iv)
(v)
(vi)
(vii
)
Self
Spouse
Name(S)
Dependant1
Name
Dependant2
Name
Dependant3
Etc.Name
Note: Value of Bonds / shares / Debentures as per the latest market value in Stock
Exchange in respect of listed companies and as per books in the case of non listed
companiesshouldbegiven.
(i)
(ii)
(iii)
(iv)
(v)
Description
AgriculturalLand
Location(s)
Surveynumber(s)
Extent(Total
measurement)
Currentmarketvalue
NonAgriculturalLand
Location(s)
Surveynumber(s)
Extent(Total
measurement)
Currentmarketvalue
Buildings(Commercial
andresidential)
Location(s)
Survey/door
number(s)
Extent(Total
measurement)
Currentmarket
value
Houses/Apartments,
etc.
Location(s)
Survey/door
number(s)
Extent(Total
measurement)
Currentmarket
value
Others(suchas
interestinproperty)
Self
Spouse
Name(S)
Dependant1
Name
Dependant2
Name
Dependant3
Etc.Name
(2)
I give herein below the details of my liabilities / overdues to public financial
institutionsandgovernmentdues:
[Note:Pleasegiveseparatedetailsforeachitem)
Sr.
No.
(a)
Description
(i)LoansfromBanks
(ii)Loansfromfinancial
institutions
(iii)GovernmentDues:
(a)duestodepartments
dealingwithgovernment
accommodation
(b)duestodepartments
dealingwithsupplyof
water
(c)duestodepartments
dealingwithsupplyof
electricity
Name&addressofBank/
FinancialInstitutions(s)/
Department(s)
Amountoutstanding
ason..
(b)
C.
(d)duestodepartments
dealingwithtelephones
(e)duestodepartments
dealingwithgovernment
transport(including
aircraftandhelicopters)
(f)Otherdues,ifany
(i)IncomeTaxincluding
surcharge[Alsoindicate
theassessmentyearupto
whichIncomeTaxReturn
filed.GivealsoPermanent
AccountNumber(PAN)]
(ii)WealthTax[Also
indicatetheassessment
yearuptowhichWealth
Taxreturnfiled.]
(iii)SalesTax[Onlyin
caseofproprietary
business]
(iv)PropertyTax
PersonalDetail
GPF/CPF/PRANNo. :
Gender
(M/F)
DateofBirth
Class/Group
Cadre
(FullNamee.g.B.A.S.BiharAdministrativeService,
B.S.S.BiharSecretariatServiceetc.)
HomeDistrict
I hereby declare that the above details are true to the best of my
knowledgeandbelief.
Signature..........................................
NameofEmployee:............................
Place:.......................
Designation:......................................
Date:.......................
Department:..........................................
Note:
Pleasesigneachpageofthedeclaration.Assetdeclarationform
mustbeinA4sizewhitepaperwithcomputertyped(singleside)
inprescribedformat.