DECLARATION OF ASSETS-Format by ashrafp

VIEWS: 6 PAGES: 5

									                                                 Declaration of Asset and Liabilities
                                                                  PROFORMA
                                                                                                                              Year:…………….

I, …………………………………………………….. , Son/wife/daughter of …………………………………… ,                                    aged ….. years , belonging to
………………….. ……………………….service , and presently working as …………………………………………………………………………………………..
give herein below the details of the assets (immovable, movable, bank balance, etc.) of myself, my spouse and dependents*:

Notes:




A. Details of movable assets as on 31.12.2010
           (Assets in joint name indicating the extent of joint ownership will also have to be given)

                                                                      Wife (Name)         Dependent –   Dependent-2 (Name)   Dependent-3 etc
 S. No.   DESCRIPTION                           SELF
                                                                                           1(Name)                              (Name)
    (I)   Cash

   (II)   Deposit In Banks,
          Financial Institutions
          & Non-Banking
          Financial Companies


          Bank accounts (give
          details)




          LIC (including all policies)


                                                                                                                                    Page 1 of 5
(III)   Mutual Funds, Bonds,
        Debentures and Shares
        in Companies.

        Mutual Funds:


        Bonds, Debentures:

        Shares:
        a)Investment in shares
            listed companies (give
            details)


        b) Any investment in non-
            listed companies

(IV)    Other             Financial
        Instruments, NSS, Postal
        Post Office - Monthly
        Income Scheme Savings.
        UC etc Post Office -
        Recurring Deposit.
 (V)
        Motor Vehicles
        (Details of make, etc.)

(VI)
        Jewellery
        (Detail of Weight & Value)
(VII)
        Other assets, such as
        values of claims/Interest (
        value   more    than    Rs.
        10,000)

                                      Page 2 of 5
    (VIII) Any      other    assets
           generating income( rent
           etc.) and Income from
           such asset


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 companies should be given.
* Dependent here means a person substantially dependent on the income of the employee.

B    Details of Immovable assets as on 31-12-2010

                                                                    Wife             Dependent – 1(Name)   Dependent – 2(Name)    Dependent – 3
     S.No. DESCRIPTION                   SELF
                                                                                                                                   etc(Names)
      (I)     Agricultural Land
              Location{s)
              Survey (Khata)
              number (s)
              Extent (Total
              measurement)
              Current market
              value
              (Circle Rate + 50%
              of Circle Rate)
      (II)    Non-Agricultural
              Land
              Location(s)
              Survey (Khata)
              number(s)
              Extent (Total
              measurement)
              Current market
              value
              (Circle Rate + 50%
              of Circle Rate FOR
              (a))
      (iii)   Buildings
              (Commercial &
              Residential)

                                                                                                                                         Page 3 of 5
                 Location:
                 Residential (a) &
                 (b)
                 Survey (Khata)
                 number(s)
                 Extent (Total
                 measurement)
                 Current market
                 value
                 (Circle Rate + 50%
                 of Circle Rate)
     (iv)        House/Apartments
                 etc.
                 Location:
                 Survey number(s)
                 Extent (Total
                 measurement)
                 Current market
                 value

     (v)         Others




I give herein below the details of my liabilities/overdues to public financial institution and government dues:
   Sl.               DESCRIPTION                             Name & Address of Bank/ Financial Institution(s)/    Amount Outstanding as on
                                                             Department(s)                                              31.12.2010
     (a) (i)         loans from Banks:

         (ii)        Loans from Financial Institutions.
         (iii)        Government dues :-
                      (a) dues to departments dealing with
                      government accommodation.
                      (b) dues to departments dealing with

                                                                                                                                        Page 4 of 5
                     supply water.
                     (c) dues to departments dealing with
                     supply of electricity.
                     (d) dues to departments dealing with
                     telephones
                     (e) dues to departments dealing with
                     govt. transport (including aircrafts and
                     helicopters)
                     (f) Others dues, if any
      (b) (i)        Income Tax including surcharge [also
                     indicate the assessment year up to
                     which income tax returned filed. Give
                     also Permanent Number (PAN)]
        (ii)         Wealth     Tax     (also  indicate   the
                     assessment year up to which wealth tax
                     returned filed).
        (iii)        Sales Tax (Only in case of proprietary
                     business)
        (iv)         Property Tax


     I hereby declare that the above details are true to the best of my knowledge and belief.



                                                                        Signature ..................................................

                                                                        Name of Employee: ....................................

Place:.......................                                           Designation:...............................................

Date:.......................                                            GPF/CPF No. :…………………………………………………

                                                                        Office :..............................................

                                                                        Department:..............................................



Note: Please sign each page of the declaration.
                                                                                                                                       Page 5 of 5

								
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