SBI FOUNDATION

ASSETS & LIABILTIES STATEMENT

(for Partner NGOs)

Details of Board members

Sr. Name Designation Residential Contribution Whether A&L
no. in Address to the statement as per
organization associated Lokpal Act being
organization filed by him/her
separately

Details of Movable Property as on

Cash
Insurance Premium
FDRs
Shares/Bonds
Mutual Funds
Pension scheme
Other Investment if
any
Personal loans given
to any person
Motor Vehicle Make Registration No. Year of purchase Amt. paid

Jewellery
Silver
Furniture & Fixtures
Others
Total

Statement of Immovable property on First Appointment as

Sr. Description Location Area Extent Date of How Present Income
No. of property of of acquisition acquired value from the
land interest property
LIABILITIES:

i) BORROWINGS FROM BANKS:

ii) BORROWINGS FROM MARKET:

iii) BORROWINGS FROM OTHER SOURCES:

iv) ASSUMED INDIRECT LIABILITY:

Declaration:

I hereby declare that the return enclosed are complete, true and correct to
the best of my knowledge, belief in and respect of information due to be
furnished by me. That I undertake and declare further to notify to the SBI
Foundation, any change, whether by way of increase or diminution, in the
assets/liabilities as detailed above every year.

Place: Name:
Date: Address: