Declaration of Assets and Liabilities

Year- 2023-2024
I, ASHUTOSH KUMAR son/daughter/wife of RAMPREET KUSHWAHA aged 28
Years, belonging to BIHAR GOVERNMENT service and presently working as
SCHOOL TEACHER U.H.S AKHTA, SUPPI, SITAMARHI give herein below the
details of the assets (immovable, movable, bank balance, etc.) of myself, my spouse and
dependants*:
A. Details of movable assets
(Assets in joint name indicating the extent of joint ownership will also have to be given)

Sr. Description Self Spouse RAMPREET Dependant - Dependant -3

No. Name(s) KUSHWAHA 2 Name Etc. Name

(i) Cash 10000/- N/A 10000/- N/A N/A

Deposits in Bank,
Financial
Institutions And
(ii) 36000/- NIL 150000/- N/A N/A
Non-Banking
Financial
Companies
Bonds, Debentures
(iii) and shares in NIL NIL NIL N/A N/A
companies
Other financial
institutions, NSS,
(iv) NIL NIL NIL N/A N/A
Postal Savings, LIC
Policies, etc.
Motor Vehicles
(v) (Details of make, NIL NIL NIL N/A N/A
etc.)

Jewellery (give
GOLD
(vi) details of weight NIL NIL N/A N/A
40 gm
and value)
TV,FRIDGE,
INVERTER
Other assets, such
(vii AND
as values of claims/ NIL NIL N/A N/A
) BATTERY ,
interests
WASHING
MACHINE
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.
 * Dependant here means a person substantially dependent on the income of the employee.

B. Details of immovable assets

[Note: Properties in joint ownership indicating the extent of joint ownership will also have to be
indicated]

Sr. Description Self Spouse RAMPREET Dependant -2 Dependant -3

No. Name(s) KUSHWAHA Name Name

(i) Agricultural land

- Location(s)
- Survey number(s)
NIL N/A 10 decimal N/A N/A
- Extent (Total
measurement)
- Current market value
(ii) Non-Agricultural Land
- Location(s)
- Survey number(s)
NIL N/A 80 decimal N/A N/A
-Extent (Total
measurement)
-Current market value
(iii) Buildings (Commercial
and residential)
- Location(s)
- Survey/door number(s) NIL N/A NIL N/A N/A
- Extent (total
measurement)
- Current market value
(iv) Houses/Apartments etc.
- Location(s)
- Survey/door number(s)
NIL N/A NIL N/A N/A
- Extent (Total
Measurement)
- Current market value
(v) Others (such as interest in
NIL N/A NIL N/A N/A
property)

(2) I give herein below the details of my liabilities/ over-dues to public financial institutions and
Government dues:-
[Note: Please give separate details for each item.]
Sr. Description Name & address of Bank/ Amount outstanding as on date
No. Financial institutions(s)/ ……………….
Department(s)
(a) (i) Loans from Banks NIL N/A
(ii) Loans from financial
institutions NIL N/A
(iii) Government Dues:
(a) Dues to departments
NIL N/A
dealing with government
accommodation.
(b) dues to departments NIL N/A
 dealing with supply of water
(c) Dues to departments
dealing with supply of NIL N/A
electricity.
(d) Dues to departments
NIL N/A
dealing with telephones.
(e) Dues to departments
dealing with government
NIL N/A
transport (including aircraft
and helicopters).
(f) Other dues, if any. NIL N/A
(b) (i) Income Tax Including
surcharge [Also indicate the
assessment year up to which
Income Tax Return filed. NIL N/A
Give also Permanent
Account Number (PAN)]
(ii) Wealth Tax [Also
indicate the assessment year
NIL N/A
upto which Wealth Tax
return filed.]
(iii) Sales Tax [Only in case
NIL N/A
of proprietary business]
(iv) Property Tax NIL N/A

C. Personal Detail

GPF/CPF/PRAN No :- 110168390406

Gender :- MALE

Date of Birth :- 2 5 1 1 1 9 9 5 (DD/MM/YYYY)

Class/Group :- C (A/B/C)

Cadre :- DISTRICT CADRE

(Full Name e.g. B.A.S. Bihar Administrative Service, B.S.S.- Bihar Secretariat Service etc.)

Home District :- SITAMARHI

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

Signature: ........................................................................

Name of Employee: ASHUTOSH KUMAR

Place: SITAMRHI Designation: SCHOOL TEACHER

Date : ………………….. Department: EDUCATION

Note Please sign. each page of the declaration. Asset declaration form must be in A4 size
white paper with computer typed (single side) in prescribed format.