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Note: Submission of annual property Statement/Returns of

Assets and Liabil ities for the year 2008(as on 1-1-09)Amendment thereto Please submit Form No- 1 and 3 only

FORM NO 1

STATEMENT SHOWING DETAILS OF IMMOVABLE PROPERTYON FIRST APPOINTMENT AND ALSO ON 1ST JANUARY OF

EACH CALANDER YEAR

(e.g. Lands, House, Shops, Other, Building etc.)

NAME :

EMPLOYMENT NO. :

DESIGNATION :

PLACE OF POSTING :

DATE OF JOINING :

BASIC PAY :

Sl.No.

Details /Descriptionof propertyand itslocation(see notes1 & 5below)House/

Building/Land No.

If not in ownname inwhosename heldand his/ herrelationship,if any, to theemployee

How &whenacquired(seeNotes 2& 6below).

Value oftheProperty(seenote 3below)

TotalannualIncomefrom theProperty

Remarks

1. 2. 3. 4. 5. 6. 7.

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Note 1 If the Property is not wholly owned the extent ofshare may also be indicated.

Note 2 For the purpose of Col. 4 the term `lease would meana lease of immovable property from year to year or for

any term exceeding one year of reserve yearly rent.When, however, the lease of immovable property isobtained from a person having official dealings withthe employee, such a lease should in this columnirrespective of the term of the lease whether it isshort term or long term and the periodicity of thepayment of rent.

Note 3 In col. 5 should be shown:

a) Where the property has been acquired bypurchase, mortgage or lease, the price or premiumpaid for such acquisition.

b) Where it has been acquired by lease the totalannual rent thereof also and.

c) Where it has been acquired is by inheritance, giftor exchange the approximate value of the propertyso acquired.

Note 4 The annual return in respect of immovable property

may also be submitted in th is form as on 1st January..Note 5 Name of District , Division, Taluka & Village in which

the property is situated and also its distinctivenumber etc. will be given in Col.2.

Note 6 Whether by purchase, mortgage, lease inheritance,gift or otherwise & name with details of person/persons from whom acquired. Address &

connection, if any, with the person/ personsconcerned are also to be given in column.

Signature________________________________

Date____________________________________

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(To be submitted alongwith the Assets & Liabili ties Statement ason 1st January of every year)

Form for giving information where total transactions in shares,securities, debentures & investment in mutual fund schemesetc. exceed Rs. 25,000.00 during the calendar year as on 1st

January______________

1. Name & Designation :

2. (i) Scale of pay & present Pay:

(ii) P.F. Index No. :

3. Details of each transaction made in shares, securit ies,

debentures, mutual funds scheme etc. during thecalendar year.

4. Particulars of the party/firm with whom transaction ismade

(a) Is party related to you?

(b) Did you have dealing with party in your officialcapacity at any time or is the applicant likely to

have any dealings with you in the near future?

5 Source of sources from which financed?

(a) Personal Savings.

(b)Other sources giving details.

6 Any other relevant fact which you may like to mention.

Declaration :

I hereby declare that the particulars given above are true.

Signature____________________