8/13/2019 Asset Statement form
2/3
2
AImmovable Property
(1) L ANDS
Serial No.
1
Preciselocation
2
Area
3
Natureof land
4
Extentof
interest5
Value
6
In whose name (wife,child, dependant, otherrelation or benamdar
)
the asset is7
Date andmanner of
Acquisition8
Remarks
9
(2) H OUSES
Serial No.
1
Preciselocation
2
Extent ofinterest
3
Value4
In whose name (wife, child,dependant, other relation or
benamdar ) the asset is5
Date andmanner of
Acquisition6
Remarks7
(3) I MMOVABLE P ROPERTIES O F O THER DESCRIPTION (Including
mortgages and such other rights)
Serial No.
1
Preciselocation
2
Extent ofinterest
3
Value4
In whose name (wife, child,dependant, other relation or
benamdar ) the asset is5
Date andmanner of
Acquisition6
Remarks7
Signature of Declarant
8/13/2019 Asset Statement form
3/3
3
BMovable Property
(1) C ASH , B ANK B ALANCE, C REDIT , I NSURANCE P OLICIES , S
HARES , D EBENTURES , E TC .
Serial No.1
Description ofItems2
Value3
In whose name (wife,
child, dependant, otherrelation or benamdar ) theasset is
4
In the case of , loan thename of the person
from whom the loanwas taken and therelationship of the
loanee with that person4A
Date andmanner of
Acquisition5
Remarks6
(2) O THER M OVABLES
(Including jewellery and other valuables, motor vehicles,
refrigerators and' other articles or materials of Rs. 500 andover
for each item)
Serial No.
1
Description of Items2
Value3
In whose name (wife, child,dependant, other relation or
benamdar ) the asset is
4
Date andmanner of
Acquisition
5
Remarks6
I hereby declare that the Declaration m ado above is complete,
true and correct to the best of my knowledge and belief.
Date Signature of Declarant..
