For the Period of July 01, 2014 -------- June 30, 2015

Name: __________________________________ Father / Husband Name: _______________________________

CNIC: __________________________________ Date of Birth (as per CNIC): ___________________________
Cell #: __________________________________

Personal Name

Other Name

PTCL: __________________________________

Personal Name

Other Name

Prepaid

Postpaid

Home Address: ______________________________________________________________________________

___________________________________________________________________________________________
No. of Family Members: _____________ Major: ______________ Minor: _______________________________
Annual Estimated Expense (2014 - 2015):
1. Electricity:

_____________________

2. Tel (PTCL): _____________________

3. Mobile Ph:

_____________________

4. Children Fee: _____________________

5. Rent (if any): _____________________
6. Conveyance: _____________________
7. Foreign Visit (if any) : ______________
8. Gas:_____________________________
9. Water:___________________________
Total: ___________________________
Annual Income (2014 - 2015):
1. Salary: _________________________
2. Rent: _________________________
3. Agriculture: _____________________
4. Profit on Deposit: ________________
5. Business Income: ________________
6. Any Other Income: _______________
Donation / Zakat (paid to a registered charity like Shaukat Khanum hospital): ___________________
Detail of Properties (All):
First:

(a) Land Area: ______________ (b) Covered Area: __________________ (c) Purchase
Price:______________
(d) Address: __________________________________________________ (e) Year of Purchase: ___________
Second:

(b) Land Area: ______________ (b) Covered Area: __________________ (c) Purchase
Price:______________

(d) Address: __________________________________________________ (e) Year of Purchase: ___________

Detail of Vehicles (All):
First:

Registration #: ______ Model: ___ Make: ______ Power: ____ Purchase Date: ______ Purchase Price: ______
Second:

Registration #: ______ Model: ___ Make: ______ Power: ____ Purchase Date: ______ Purchase Price: ______
Detail of Agriculture Land (All):
(a) Address: _________________ (b) Area: __________ (c) Purchase Price: _______ Date of Purchase: ______
Detail of Jewelry:
(a) Weight: _________________________ (b) Purchase Price: ______________ Date of
Purchase: _________
Investment:
(a) Shares: _________________________ Purchase Price:_______________ Date of Purchase:
____________
(b) Life Insurance Company: __________ Policy Number: _______________ Premium Amount:
___________
(c) Deposit / Certificate: ______________ Start Date: ___________________ Date of Purchase:
___________
(d) Any Other Investment: _____________ Start Date: __________________ Date of Purchase:
___________
Bank Account Details (All Banks):
First:

Bank Account #: ___________________________________ Bank Name: _____________________________

Date of Opening of Account (D/M/Y): _________ Branch Name: ___________________ City: ____________
Account Title: ___________________________________________ Type of Account:

Current

Saving

Balance as on 30/06/14: _____________________ Balance as on 30/06/15: ____________________________

Second:

Bank Account #: ___________________________________ Bank Name: _____________________________

Date of Opening of Account (D/M/Y): _________ Branch Name: ___________________ City: ____________
Account Title: ___________________________________________ Type of Account:

Current

Saving

Balance as on 30/06/14: _____________________ Balance as on 30/06/15: ____________________________

Any Loan Given or Taken (through bank transfer):
__________________________________________________________________________________________

Any Assets in the Name of Spouse (if purchased from your income):
__________________________________________________________________________________________
Documents Required:

CNIC

Salary Certificate

Copy of Last Wealth Statement if Filed

Tax Certificate from Mobile Company

If Require any Assistance, Please Contact: Hammad Khalid Ch. 0321 1101666