APPENDIX - II

[(Rule 3 (I)]
Form No.1
Details of Public servant, hisher s!ouse an" "e!en"ent chil"ren
Sl.
No.
Name Public position
held, if any
Whether
returns being
filed by him /
her, separately
1 Self
2 Spouse
3 ependent 1
! ependent 2
" ependent 3
# ependent !
ate$ Signature$%%%%%%%..
F&'( N&. )))
Statement of immo*able property on first appointment or as on the 31st (arch, 2+....
,e.g. -ands, .ouse, Shops, &ther /uildings, etc.0
1.eld by Public Ser*ant, his/her spouse and dependent children2
Sl.
No.
escription of property
,-and/ .ouse/ Flat/
Shop / )ndustrial etc.0
Precise
location
,Name of
istrict,
i*ision,
3alu4 and
5illage in
6hich the
property is
situated and
also its
distincti*e
number etc,0
7rea of land
,in case of
land and
buildings0
Nature of land
in case of
landed
property
89tent of
interest
)f not in name
of public
ser*ant, state
in 6hose
name held
and his/her
relationship if
any to the
public ser*ant
ate of
ac:uisition
.o6 ac:uired
,Whether by
purchases,
mortgage, lease,
inheritance, gift or
other6ise0 and
name 6ith details
of person /
persons from
6hom ac:uired
,address and
connection of the
;o*ernment
ser*ant, if any0
6ith the person /
persons
concerned0
,Please see Note
1 belo60 and cost
of ac:uisition.
Present *alue
of the
property ,if
e9act *alue
not 4no6n,
appro9 *alue
may be
indicated.
3otal annual
income from
the property
remar4s
1 2 3 ! " # < = > 1+ 11 12
ate$ Signature$
Note$ ,10 For purpose of column ,>0 the term ?lease@ 6ould mean a lease of immo*able property from year or for any term e9ceeding one year or reser*ing a yearly
rent. Where, ho6e*er, the lease of immo*able property is obtained from a person ha*ing official dealings 6ith the ;o*ernment ser*ant, such a lease should be
sho6n in this Aolumn irrespecti*e of the term of the lease, 6hether it is short term or long term and the periodicity of the payment of rent.
Form No.))
Statement of mo*able property on first appointment or as on the 31
st
(arch 2+%%.
etails of the mo*able assets of self, spouse and dependent children
Sl.N
o.
escription 7mount in 'upees
Self Spouse ependent
1
ependent
2
ependent
3
,i0 Aash in hand
,ii0 etails of deposit in /an4
account ,F's, 3erm
eposits and all other types
of deposits including sa*ing
accounts0. eposits 6ith
financial institutution, NonB
/an4ing financial
Aompanies and AoB
operati*e societies and the
amount in each such deposit
Name of
/an4 /
Financial
institutions C
Nature of
eposit
,iii0 etails of in*estment in
/onds, debentures / share
and units in companies /
mutual funds and others.
Name of
company
,i*0 etails of in*estment in
NSS, Postal Sa*ings,
)nsurance policies and
in*estments in any Financial
instrument in Post &ffice or
)nsurance Aompany
Name of
)n*estment
,*0 etails of deposits in
Pro*ident Fund / Ne6
Pension Scheme
Name of
)n*estment
*i Personal loans /ad*ance
gi*en to any person or entity
including firm, company,
trust etc. and other
recei*ables from debtors
and the amount ,e9ceeding
,a0 t6o months basic pay
6here applicable
,b0 'upees one la4h in other
cases0
Name of the
debtor
5ii (otor *ehicle
/7ircrafts/Dachats/Ships
,details of (a4e, registration
number etc. year of
purchase and amount
Nature of
*ehicle
registration
No. C year of
purchase
*iii Ee6ellery, bullion and
*aluable thing,s0
,gi*e details of 6eight0
;old
Ee6ellery
Sil*er
Pre*ious
stones/
precious
metals
/ullion ;old
Sil*er
Precious
stones /
precious
metals
)9 7ny other assets
ate$ Signature$
Note# $# 7ssets in Foint name indicating the e9tent of Foint o6nership 6ill also ha*e to be gi*en
Note $2$ )n case of deposits/in*estments, the details including 7mount, date of deposit the scheme,
Name of the /an4/)nstitution and /ranch are to be gi*en.
Note# 3$ 5alue of /onds/share debentures as per current mar4et *alue in stoc4 e9change in respect of
listed companies and boo4 *alues in case of unlisted firms
Note !$ etails including amount is to be gi*en separately in respect of each in*estment
Note %# Gnder ,ic0 details of mo*able assets not co*ered in ,i0 to ,*iii0 abo*e *aluing indi*idually o*er t6o
months basic pay 6here applicable or 's. 1 la4h may be indicated.
Form No. )5
Statement of derails and other -iabilities on First appointment or as on 31
st

(arch 2+%%%.