(Format No 12)

DETAILS OF ASSETS AND LIABILITIES OF

Shri/Smt_____________________________
_______________________________________________________________________________________
Assets
. Immovable Properties Location Market If encumbered
Value to what extent

• Land * Buildings

Agricultural Land

* Other movables like

LIC Policies, Bank Deposits,
Gold/Silver Jewels Cash at
Bank/ Cash On Hand.
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2. Liabilities Amount

a Borrowing from
Banks,

b. Borrowing from
other sources

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* Documents confirming ownership of movable/immovable assets have to be produced.

SIGNATURE

Place:

Date :

Verified and Satisfied

For Indian Overseas Bank

Date :
Seal
Senior/Chief Manager