Form-4

STATEMENT OF ANNUAL RETURN OF IMMOVABLE PROPERTY

(Under Rule 21 of BSNL, Conduct, Discipline and Appeal Rules, 2006)

For the year Ending : 2016 As On : 31.12.2016

(1) Name of Officer (in full) and services to which the officer belongs : RAMESH C(Group C)[Telecom Service]

(2) Personnel Number : 99504618

(3) Present Post : TM EXTL1 CFA KUSHAIGDA HTD(Hyderabad TD) Pay(Basic + DA) : (Rs.20390.00 + Rs.24529.00)

Name & Details Of If not own name, How acquired

Property state in whose (Whether by
Name Of District, name held and purchase,lease,
Sub-Division his/her mortgage, gift or
Talukand Village relationship to the Otherwise), with date Annual
in which Housing & Present Employee of acquisition Income From Remarks
property is Other Land Value and namewith details Property
situated Building of personsfrom whom
required

1 2 3 4 5 6 7 8
PLOT 9
SOUTHSIDE
SURVEY NO
355,365,366,3
68,380,384&37
8
ADMEASURIN
DEPARTMENT
G AREA Purchase / 19.05.2016 /
NAGARAM 2275000.00 ( SELF ) 0.00 PURCHASEAPPR
120.3SQ 17.06.2016
OVAL
YARDS OR
100.57 SQ
METERS
NAGARAM
VILLAGE
KEESARA
MANDAL
Date of Submitting : 29-04-2017

SIGNATURE
(1) Inapplicable Clause to be struck out.
(2) In case where it is not possible to access the value accurately, the approximate value in relation to present conditions may be indicated.
(3) Include short term lease also.

Note : The declaration form is required to be filled in and submitted by every employee of BSNL on the 1st January every year giving
particulars of all immovable property owned, acquired or inherited by him on lease or mortgage either in his name or in name of any member
or in the name of any other person.