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~i::-~~;:".,:-~~:J!BJ~.'~;R~TURN FORIYIS FqR CLASS·' & II ~MPLOYEES .' .' . /".',', :;,:

FORM-A

1 a

b2

3

4

5 - t:;O10 z: 00

6

I hereby declare that the return enclosed.namey.jorm 1 ta farm 5 are complete.true & correct as an31-03-2012 to the best of my knowledge & belief,in respect of information due to be furnished by

me under the provisions of sub-rule of Rule 18 of the Punjab Govt. Employees (Conduct) rules 1966.

7 Strike off which ever /Jot applicableIThis return shall contain particulars of all assets & liabilities of gavt. employee either on his/her flame or inthe flame of ony other person.If a govt. employee is a member of HUF with co-forecentry rights in the property of family either as KARTAor as a member.he/she should indicate in the return in Form 1 the value of his/her share in such

iiproprty, where it is not possible to indicate the exact value of such share, the approximate valuewitbexponotory note shauld be added wherever necessary.

!hetve ~ o-,o e;;'4U.,·: H &>V. t, ."...r p -n:>r7 ~ lA_C<.- 4~-1~-J-u_(-, 'te..f.fVV 5

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STATEMENT OF IMMOVABLE PROPERTY (E.G. LAND,HOUSE,SHOPS,OTHER BUILDINGS ETC.)

Descriptioci<: n ofvi property

3

FORM 1 YEAR I 20 I\-L() , 2..

c•...ClJo,o•...Cl.

Eo.::;ClJ

Eo\J

.S"0;)ccoo~

1 2 13

PreciseLoca tion (NOfTI

e ofDistt., division,

village inwhich

property issituated & itsdistinctive no.

etc.}

4 5 6

Plotii ~ H.o L/J{

Cov,sft,.ch;

70/2, R.0.4hq£.oJ""' •••••••• f:fa/J

Sj.,ivCljl NPJ<'N A.4 .P IAA.

... F/00-/II

•.......f-1 e../y~ Lo (MA ft.c 1M Rs "~8 .1-1]:) Fe 4-:;-

(Hl>l.UI''''5--) ~

12

iv

v

NOTE» IN COLUMN 9, 'LEASE' MEANS AN IMMOVABLE PROPERTY TAKEN FOR A TERM OF MORE THAN ONE YEAR OR RESERVING AT YEARLY RENT,

THIS LEASE SHOULD BE SHOWN IN THIS COLUMN IRRESPECT OF ITS TERM & PERIODICITY OF RENT PAYMENT.

NOTE» IN COLUMN io.« PROPERTY ACQUIRED BY PURCHASE,MORTGAGE Of LEASE, THE PRICE OR PREMIUM PAID fOR SUCH ACQUISITION,lf BY

LEASE THEN FILL TOTAL ANNUAL RENT BUT IF IT IS BY INHERITANCE/GIFT/EXCHANGE THEN APPROX. VALUE Of~( OPE~TY. nI Signatures -~ 'I ~ - t-1--t

~pA~

FORM 2STATEMENT OF LIQUID ASSETS 1 YEAR 1.20I\-WI1---

1 ICash & bank balance exceeding 3 months emoluments (Pay & allowances} received.2 IDeposits.loan advance & investments such as shares,securities,debentures,mutual funds ete.

If not in own name,Name& address of person in Annual

S.No. DescriptionName & address of Amount

whose name held & his/her income RemarksCompony,Bank ete. (Rs.)

relation with Govt. derivedemployee

>i>:> I ~/ S~v/~I!><1Ii. .t <fA..-y +/<.. NI L -1 -2 S'I?> / .J fJ?l;V 'Jz.J::;$~ c/,JItYY -- NL L-3 (S//CAp.....,.. )

4 \

5 \6 -,7 ~8 -,9 -,10 -,11 1\

12 '\ ,

13 -,14 -,15 -.16 -.17 -,18

-,1920 A

\J "'" nI- t t..::t-v _a..~ -- ASignatures

N~ :J>~C JI,

I

.FORM 3

STATEMENT OF MOVABLE PROPERTY YEAR I 2--O} I ~2-0 I :2---Price/Value at the time of If not in own

acquisition &/or total payment name.Name &

S. No. Descriptionmade upto date of acquisition,as address of person in

How acquiredApprox. date

Remarksthe case may be.in case of articles whose name held & of acquisition

purchased all hire-purchase of his/her relation

instotmemts.bosis with Govt.

1 C~ l"l cJuNh.' Ritz C:, L sv{.- Lo~ J~ -2 (roW\ l...olo

3 HDFC4 B evv\ k::.5 ...6 \7 \8 \9 -.10 -,11 1\ - -12 -,13 -,14 -,15 -,16 -,17 -,18 -,19

20

a:GIVE INFORMATION OF GOLD,SILVER,PRECIOUS STONES,MOTOR• CAR,BIKES,REFRIGERATOR, T. V.,A.C,CLOTHES,UTENS1LS,BOOKS,CROCKERY ETC ~

- . ~ . /") o A

Signatures I 1~ ~ L-~N, \.J yBo \A.{'-"

.l•.

FORM 4STATEMENT OF DEBITS/LIABILITIES I YEAR 2.0 II 11..---

S.No. Amount Name & address of creditor Name of incurring liability Details of transaction Remarksa b c d fe1 ~O~.7~o I PtvPAJ.,,~ J. ~ N}J.b~ ~...Lt- KDI=C EC.5 Ylo.A~f

~.2 /051JvL r u», T)'JvJ)~ I ........_I II ~ r-:tiU ,., ~ IAA

.M •••••...•l-kl:. t:-, EC.5 V.l!

3 f!c.t~

I j/ r L- '-;''''1 ,- r/--= .•....I~A IA.

4 \5 \6 -,7 -,8 -.9 -,10 -,11 -,12 -,13 \14 \15 \16 \17 \18 \19 -,20 -.21 -,22 -,23 \2425

STA TEMENT SHOULD ALSO INCLUDE VARIOUS LOANS & ADVANCES AVAILABLE TO GOVT. EMPLOYEE E.G., LOAN FOR CONVEYANCE,HBA He. (OTHER THAN ADVANCES OF PAY & T.A.),ADVANCE FROM GPF &

LOAN AGAINST LlC POLICIES & F.DS. {\ 1\

~ {I JJ -Signatures I '"':'-------I--" , r>. ,i/1

".J ,\J .y~ v

FORMSSTATEMENT OF LIFE INSURANCE POLICIES I YEAR 1~11-11--

Sum Type of fund e.g. Closing balance asName of

assured &Amount of

GPF/PPF a/c no. &last report by

S. No. Policy no.& date insurance annual audit/accounts Remarksdate of contribution made

officer with datecompanymaturity

premiumsubsequently

of such balance1 Q7(' '-172?o 9 II c. ?~ 2.0 13'<l, ')..} -2 Per.; 1- -3 ~u..\M

4 \5 -,6 -.7 -,8 I"'"9 <,10 -,11 -.12 <,13 -.14 I~15 -.16 <,17 -.18 '"

19 -,20 -.21 <,22 <,232425 r-; A'U-. (, ~

Signatures I --------- ,0,-'1\.-' I.. Il\J}VV

'N'N'r"1