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    Declaration of Assets and Liabilities: AS ON DATE/MONTH/YEAR........................

    Uploaded by

    ServeX pluS
    This document is a declaration of assets and liabilities form for an employee to disclose their assets, liabilities, and personal details. It requires the employee to provide details of [1] movable assets including cash, bank deposits, investments, vehicles, and jewelry owned by themselves, their spouse, and dependents; [2] immovable assets including agricultural land, non-agricultural land, buildings, houses owned by themselves, their spouse, and dependents; and [3] liabilities including loans, taxes owed, and other government dues. The employee must then provide their personal details like PAN number, date of birth, and designation before signing to declare that all information provided is true and accurate to the best

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    Declaration of Assets and Liabilities: AS ON DATE/MONTH/YEAR........................

    Uploaded by

    ServeX pluS
    51 views3 pages
    This document is a declaration of assets and liabilities form for an employee to disclose their assets, liabilities, and personal details. It requires the employee to provide details of [1] movable assets including cash, bank deposits, investments, vehicles, and jewelry owned by themselves, their spouse, and dependents; [2] immovable assets including agricultural land, non-agricultural land, buildings, houses owned by themselves, their spouse, and dependents; and [3] liabilities including loans, taxes owed, and other government dues. The employee must then provide their personal details like PAN number, date of birth, and designation before signing to declare that all information provided is true and accurate to the best

    Original Title

    Property Return Form

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    This document is a declaration of assets and liabilities form for an employee to disclose their assets, liabilities, and personal details. It requires the employee to provide details of [1] movable assets including cash, bank deposits, investments, vehicles, and jewelry owned by themselves, their spouse, and dependents; [2] immovable assets including agricultural land, non-agricultural land, buildings, houses owned by themselves, their spouse, and dependents; and [3] liabilities including loans, taxes owed, and other government dues. The employee must then provide their personal details like PAN number, date of birth, and designation before signing to declare that all information provided is true and accurate to the best

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    51 views3 pages

    Declaration of Assets and Liabilities: AS ON DATE/MONTH/YEAR........................

    Uploaded by

    ServeX pluS
    This document is a declaration of assets and liabilities form for an employee to disclose their assets, liabilities, and personal details. It requires the employee to provide details of [1] movable assets including cash, bank deposits, investments, vehicles, and jewelry owned by themselves, their spouse, and dependents; [2] immovable assets including agricultural land, non-agricultural land, buildings, houses owned by themselves, their spouse, and dependents; and [3] liabilities including loans, taxes owed, and other government dues. The employee must then provide their personal details like PAN number, date of birth, and designation before signing to declare that all information provided is true and accurate to the best

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    of 3

    Declaration of Assets and Liabilities

    AS ON DATE/MONTH/YEAR.........................

    I,……………………………………………………., son/daughter/wife of …...………………………………,

    aged……………years, belonging to ……………………………………....................office/cadre/

    service and presently working as(Designation)................................. give herein below

    the details of the assets (immovable, movable, bank balance, etc.) of myself, my

    spouse, our children and dependants[#}:

    A. Details of movable assets


    (Assets in joint name indicating the extent of joint ownership will also have to be given)

    Sl. Description Self Spouse Dependant-1 Dependant-2 Dependant-3


    No. Name(S) Name Name Etc. Name
    (i) Cash

    (ii) Deposits in
    Banks, Financial
    Institutions And
    Non-Banking
    Financial
    Companies

    (iii) Bonds,
    Debentures and
    Shares in
    companies

    (iv) Other financial


    institutions,
    NSS, Postal
    Savings, LIC
    Policies, etc

    (v) Motor Vehicles


    (details of
    make, etc.)

    (vi) Jewellery (give


    details of
    weight and
    value)

    (vii) Other assets,


    such as values
    of claims /
    interests

    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 (include children, parents, unmarried & dependent sister/ minor brothers
    (handicapped) solely dependent on 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 Dependant-1 Dependant-2 Dependant-3
    No. Name(S) Name Name Etc. Name
    (i) Agricultural Land
    - Location(s)
    - Survey number(s)
    - Extent (Total
    measurement)
    -Current market value
    (ii) Non-Agricultural Land
    - Location(s)
    - Survey number(s)
    - Extent (Total
    measurement)
    -Current market value
    (iii) Buildings (Commercial
    and residential)
    Location(s)
    - Survey /door
    number(s)
    - Extent (Total
    measurement)
    - Current market
    value
    (iv) Houses / Apartments,
    etc.
    - Location(s)
    - Survey /door
    number(s)
    - Extent (Total
    measurement)
    - Current market
    value
    (v) Others (such as
    interest in property)

    (2) I give herein below the details of my liabilities / overdues to public financial
    institutions and government, dues to others:-
    [Note : Please give separate details for each item)

    Sr. Description Name & address of Bank / Amount outstanding as


    No. Financial Institutions(s) / on …………………..
    Department (s)
    (a) (i) Loans from Banks
    (ii) Loans from financial
    institutions
    (iii) Government Dues:
    (a) dues to departments
    dealing with government
    accommodation
    (b) dues to departments
    dealing with supply of
    water
    (c) dues to departments
    dealing with supply of
    electricity
    (d) dues to departments
    dealing with telephones
    (e) dues to departments
    dealing with government
    transport (including
    aircraft and helicopters)
    (f) Other dues, if any

    (b) (i) Income Tax including


    surcharge [Also indicate
    the assessment year upto
    which Income Tax Return
    filed. Give also Permanent
    Account Number (PAN)]
    Attach copy of ITR filed for
    the last 3 years
    (ii) Wealth Tax [Also
    indicate & attache copies
    of the assessment year
    upto which Wealth Tax
    return filed.]
    (iii) Sales Tax [Only in
    case of proprietary
    business]
    (iv) Property Tax –
    a. Remitted
    b. In arrears, if any
    C. Personal Detail

    EPF/ESI/PAN No. :-

    Gender :- (M/F)

    Date of Birth :-
    (DD/MM/YYYY)
    Place of birth :- ______________________________________

    Class/Group :- :-

    Cadre :-

    Home District :-

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

    Name of Employee:_____________________

    Place:______________ Designation:__________________________

    Date:_______________ Department:__________________________

    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.

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