2015-16 Year. BRISKETU BHARTI LATE RAMJEET MANDAL L ., son/daughter/wife of " aged........94 . years, belonging to ...STATE.GOVERNMENT. service and presently working as .. ASST. TEACHER, M/S MAYAGANY, NAGAR NIGAM BHAGALPUR give herein below the details of the assets (immovable, movable, bank balance, etc.) of myself, my spouse and dependants*: A. Details of movable assets (Assets in joint name indicating the extent of joint ownership will also have to be given) ‘Spouse | Dependant-i | Dependant-2 | Dependant-3 si | kati one Name(S) ‘Name Name Ete. Name. wa. BINDUNI_| MURLIDHAR KUMARI_| MURARI @ [cash 10,000/- | ~ 2000/- Giy_| Deposits in SBI BANK UCO BANK Banks, 34,621.95/- Financial “ S000/- Institutions And | yco BANK Non-Banking 10,000/- Financial Companies Gi) | Bonds, Debentures and Shares in companies wy | Other financial institutions, NNSS, Postal Savings, IC Policies, etc (v) | Motor Vehicles (details of make, etc.) (Wi) | Jewellery (aive details of weight and value) GOLD 22gm 60,500/- (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. B. Details of Immovable assets [Note: Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] sr Description mi ‘Spouse | Dependant-l | Depandant-Z | Dependant's No. Name(S) |” Name Name | Ete. Name () | Agricultural Land ~ Location(s) - Survey number(s) - - Extent (Total measurement) Current market value ()_[ Non-Agricultural Land - Location(s) - Survey number(s) - Extent (Total measurement) -Current market value (ii) Buildings (Commercial and residential) Location(s) - Survey /door number(s) = Extent (Total measurement) > Current market value Ty | Houses 7 Apartments, etc. - Location(s) - Survey /door number(s) - Extent (Total measurement) Current market value [(y J others Guches |__|. |... |... | interest in property) —~ (2) I give herein below the details of my liabilities / overdues to public financial institutions and government dues:~ [Note : Please give separate details for each item) Sr._] Description Wame & address of Bank 7 No. Institutions(s) / (a) |i) Loans from Banks (ii) Loans from financial institutions (iil) 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 electric(d) dues to departments dealing with telephones (e) dues to departments dealing with government transport (including aircraft and helicopters) (f) Other dues, if any Ty Tncome Tax including | ASSESSMENT YEAR 2015-16 surcharge [Also indicate | INCOME TAX HAS BEEN the assessment year upto | SUBMITED IN DUE COURSE which Income Tax Return 2,614/- filed. Give also Permanent Account Number (PAN)] | (ii) Wealth Tax [Also indicate the assessment year upto which Wealth Tax return file [Giysales Tax Tonlyin JY SY case of proprietary business] (iy) Property Tax . Personal Detail GPF/CPF/PRAN No, BGP/EDN - 19879 Gender m_| (M/F) Date of Birth - (OD/MM/WYY) ofr fof{s{ijo] efi Class/Group - c wre Cadre * TEACHER (Full Name e.g. BAS.-Bihar Administrative Service, B.S.S.- Bhar Secretariat Service ete.) Home District - EHAGAUPUR, I hereby declare that the above deti knowledge and belief. are true to the best of my Signature.. Name of Employee: BRISHKETU BHARTI ‘TEACHER Designation: EDUCATION DEPARTMENT Department: ssa va 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. Allipesof printing jb [Maths ton for 1! 2a oar @ 8271339944"