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k Note: (vii) Jewellery
(give Bonds,(ii) (ii) (i) No. Sr. given) myself,
A
e.mpanies (vi) (v)Motor
Vehicles financial
Other
(iv) give service aged...
ndant
Value claims
interests of
values
assets,
such
/Other
as value) details
weight
and of (details
make, institutions,
Savings,
etc.) ofPolicies,
etc Postal Shares in
Debentures
LICNSS, Companies CompaniesInstitutions
Financial
and Non-Banking And
Banks,
Deposits in Cash herein
(ASSets my and I,..
Description Details
in
should spouse presently
below
respect of Financial
here Bonds in
joint of
be and the
a movable
meansgiven. of
/ name
dependants*: detailsworking Declaration
Iisted
shares
Self belonging
years, to
assets
indicating of
companies
ntially
person as
/ the
Debentures
Name(S)
Spouse
assets of
the
and Assets
extent (immovable,
son/daughter/wife of
asS as
per Dependant-1 of
per Name
and
ndenton joint
the
books
latest ownership movable, Liabilities
in
the
market Dependant-2
Name Year..ennen
the case bank
wil
ncome value
of also balance,
i Dependant-3
Name
Etc.
have
os
to etc.)
,
be of
(a) institutions (2) (v) (iv) (iii) (ii) (i) No. Sr. also B.
No. Sr.
have
Others
property) (such
interest as
invalue - Survey
number(s) -/door Current
market
measurement)
Apartments,
- Houses Extent
(Total
| number(s) market
- measurement)
- Location(s)
residential) value (Total
- and-Current
Buildings Extent market
measurement)
Location(s) Extent
(Total
Location(s)
number(s)
- value Survey -
Agricultural
- - Land
(iii) ()
(ii) Description [Note Current
I measurement) Location(s)
market Extent
(Total -etc. value Survey Non-Agricultural
number(s)
Survey Land
- --Current
(NOte:Details
electricity dealing
dealing (cwater
accommodation (bGovernment
dealing
) government with (a)Dues:
) institutions give to
dues dues dues LoansLoans and Description be
:
Please herein /door
(Commercial Properties
indicated] of
with to with to to government
from from Immovable
departments
supplydepartments
supplydepartments give below
financialBanks in
of of separate joint
dues: the
Self assets
details ownership
details
Name(S)
Spouse
Institutions(s)
FinancialName/
of
Department(s)
for my
& indicating
address each
liabilities
Dependant-1
item) Name
of
the
Bank
/
overdues extent
/
Dependant-2 of
outstanding
Amountas Name
On
.. financial
publicto joint
ownership
Dependant-3
Name
Etc.
wil
Cadre Birth Gender
Date of
GPF/CPF/PRAN No. C. (b)
Place:.. District
Home Class/Group
Note: knowledge
belief.
and
Date:.
proprietary
business] asSsessment
filed.]
(iii) year
Taxindicate which
surcharge
indicate
th[Also government
transport
e helicopters)
aircraft
()anddealing
(i) (including
T Personal
Detail
Property
(iv)Tax caseofreturn (ii) filed.
upto theAccount
Number
(PAN)l telephones
with dealing
(e) with (d)
hereby Sales Wealth assessmentIncome Other dues dues
Give
Income
ibed
rmat.inPlease dues, to to
must which
Tax Wealth Tax also Tax departments
departments
declare
Tax
be [Only Permanent
[Also including
year if
each
sign any
in Return
A4 that Name
(Full
e.g. in upto
B.S.S.-
size
the
pagethe of Bihar
white (M/F)
above
Secretariat
Administrative
B.A.S.-Bihar (A/B/C)
Employee:
Name of
Department:...
paper Designation:. Signature
details
eclaration.
with Service
omputer are
etc.)
true
claration
form
Asset
to Service,
typed
the