ANNEXURE ‘B’

FOR EXECUTIVES OF E – 7 & BELOW

(INCLUDING NON-EXECUTIVES)

FORM NO. 1
STATEMENT SHOWING DETAILS OF IMMOVABLE PROPERTY ON FIRST
APPOINTMENT AND ALSO ON 1ST JANUARY OF EACH CALENDAR YEAR 2019
(e.g. Lands, House, Shops, other Buildings etc.,)

NAME : A TOSHIBA PRAVEEN KUMAR

DESIGNATION : AM (ELEX)
ORGANISATION : Airports Authority of India
PLACE OF POSTING : ACS BELLARY
DATE OF JOINING : 11-02-2013
BASIC PAY : 56,840 PF ID No : 311089AK25057

SL. Details / Description If not in own How and Value of Total Remarks
No of property and its name, state when the annual
location (See notes 1 & in whose acquired ( Property ( Income
5 below) House / name held See Notes 2 see note 3 from the
Building /Shops/ and his / her & 6 below) below) property
Land relationship,
if any to the
employee
1 2 3 4 5 6 7
1. FLAT C-63, SREE 50% SHARE PURCHASE Rs.55,00,000 LOSS ON
BALAJI LAKSHMI WITH SISTER HOME
NIVASAM, LOAN
VISAKHAPATNAM

Note:‐ It is mandatory to fill in all the columns in the above mentioned forms. Forms containing the remarks "AS PER
RECORDS" or "AS PER PREVIOUS YEAR" will not be accepted.
N.B.: ADDITIONAL SHEETS MAY BE ATTACHED WHERE NECESSARY.

PLACE: BELLARY SIGNATURE___________________

DATE:
FORM – 01

Note : 1 If the property is not wholly owned the extent of share may also be indicated.

Note : 2 For the purpose of Col. 4 the term ‘ lease ‘ would mean a lease of immovable
property from year to year or for any term exceeding one year of reserve yearly
rent. When, however, the lease of immovable property is obtained from a person
having official dealings with the employee, such as lease should in this column
irrespective of the term of the lease whether it is short term or long term, and the
periodicity of the payment of rent.

Note : 3 In Col. 5 should be shown :

(a) Where the property has been acquired by purchase, mortgage or lease, the price
or premium paid for such acquisition.

(b) Where it has been acquired by lease the total annual rent thereof also and

(c) Where the acquisition is by inheritance, gift or exchange the approximate value
of the property so acquired.

Note : 4 The annual return in respect of immovable property may also be submitted in this
form as on 1st January.

Note : 5 Name of District, Division, Taluka & Village in which the property is situated and
also its distinctive number etc. will be given in Col. 2.

Note : 6 Whether by purchase, mortgage, lease, inheritance, gift or otherwise & name with
details of person/persons from whom acquired. Address & connection, if any with
the person/persons concerned are also to be given in Column.

Signature(with date) :
(without date, this form will not be accepted)
 ANNEXURE ‘B’

FOR EXECUTIVES OF E-7 & BELOW

(INCLUDING NON-EXECUTIVES)

FORM NO. 2

STATEMENT SHOWING DETAILS OF ASSETS (OTHER THAN IMMOVABLE

PROPERTY) & LIABILITIES ON FIRST APPOINTMENT AND ALSO SUBMISSION OF
RETURN ON 1ST JANUARY OF EACH CALENDAR YEAR 2019.

NAME : A TOSHIBA PRAVEEN KUMAR

DESIGNATION : AM (ELEX)
ORGANISATION : AIRPORTS AUTHORITY OF INDIA
DATE OF JOINING : 11-02-2013
BASIC SALARY : Rs. 56,840
PF ID NO : 311089AK25057
ASSETS LIABILITIES
Liabilities to the
A. Liquid Assets & Investments (including deposits & LIC Policies) 1 Bank / Financial
Institution
Held in the Annual
Amount / How Remarks
HDFC HOME LOAN
Description name of & income
original price acquired OF Rs.45 Lakhs
relationship derived
1 2 3 4 5

PPF Rs.3,38,631 SELF SAVINGS NIL NIL

Liabilities to
2
friends & relatives

B. Movable Properties : Like Gold, Vehicle, TV Etc.

Other liabilities, if
NIL NIL NIL NIL NIL NIL 3
any

Date : Signature :

Note:It is mandatory to fill all the columns in the above mentioned forms.
Forms containing the remarks”As per records or”As per Previous year” will not be accepted.
N.B. Additional sheets may be attached where necessary.

PLACE: BELLARY SIGNATURE___________________

DATE:
FORM – 02

Note : 1 In the case of share, securities, debentures etc., face value and approximate market
value as on the date of statement may be mentioned.

Note : 2 In the case of Life Insurance Policies the date of maturity may also be stated.

Note : 3 Under B information may be given regarding items like

(a) gold / gold ornaments: approximate weight only be stated.
(b) Silver including ornaments etc. (approximate weight)
(c) other precious metals, items of jewellery, precious stones forming part of
jewellery etc., approximate value to be stated
(i) Car
(ii) Scooter/Motor Cycles
(iii) Refrigerator/Air Conditioners, Radio/Radiogram/Television sets and any
other articles the value of which individually is more than Rs. 15,000/-.

Note : 4 In column 4, may be indicated whether the property was acquired by purchase,
gift or otherwise.

Note : 5 Under liabilities, brief details should be given.

DATE:

PLACE : BELLARY Signature(with date) :__________________________

(without date, this form is will not be accepted)

 ANNEXURE ‘B’
FOR EXECUTIVES OF E-7 & BELOW
(INCLUDING NON-EXECUTIVES)

FORM NO. 3
STATEMENT OF ASSETS & LIABILITIES
DETAILED STATEMENT IN RESPECT OF SHARES/DEBENTURES PURCHASED UNDER
PROMOTERS/EMPLOYEES QUOTA AS ON 1ST JANUARY OF EACH CALENDER YEAR
2019 IN OFFICERS OWN NAME AND ALSO THOSE HELD IN THE NAMES OF SPOUSE
AND DEPENDENT CHILDREN.

NAME : A TOSHIBA PRAVEEN KUMAR

DESIGNATION : AM (ELEX)
ORGANISATION : Airports Authority of India, Chennai.
DATE OF JOINING : 11-02-2013
BASIC PAY : Rs. 56,840/-
PF. ID NO : 311089AK25057
S. Name of No. of Face Cost of Whether How Position held at the
No the shares Value acquisition promoters/E acquire time of acquisition
company mployees d and if the company
Quota had any borrowing
or other facilities at
that time.
1 2 3 4 5 6 7 8
A. SELF
NIL NIL NIL NIL NIL NIL NIL

B. SPOUSE AND DEPENDENT CHILDREN

NIL NIL NIL NIL NIL NIL NIL

Any additions/deletions to this statement as on 1st January 2019 and the profit/loss incurred
by me are given below.
NB: Additional sheets may be attached where necessary.

Place : BELLARY

Date : Signature____________________
FORM NO. 3

(To be submitted along with the Assets & Liabilities Statement as on 1st January of each year)

Form for giving information where total transactions in shares, securities, debentures
and investment in mutual fund schemes etc. exceed Rs. 25,000/- during the calendar year as on
1st January 2019.

1. Name and designation : A TOSHIBA PRAVEEN KUMAR,

AM(ELEX)

2. Scale of pay and present pay : E-2 SCALE, Rs.56,840/-

3. P.F. Index No. : 311089AK25057

4. Details of each transaction made in : NIL

shares, securities, debentures, mutual
funds scheme etc., during the
calendar year

5. Particulars of the party/firm with : NIL

whom transaction is made.

(a) Is party related to you? :

(b) Did you have dealings with the party in :

your official capacity at any time or is
the applicant likely to have any dealings
with you in the near future?

6. Source or sources from which financed : NIL

(a) Personal savings :

(b) Other sources giving details :

7. Any other relevant fact which you may like : NIL

to mention.

Declaration

I here by declare that the particulars given above are true.

Place : BELLARY Signature______________________

Date : Designation :

Note:It is mandatory to fill all the columns in the above mentioned forms.
Forms containing the remarks”As per records or”As per Previous year” will not be accepted.
 ANNEXURE ‘B’

FOR EXECUTIVES OF E-7 & BELOW

(INCLUDING NON-EXECUTIVES)

AIRPORTS AUTHORITY OF INDIA

Form for intimating any transaction in movable property value exceeding Rs. 20,000/- in case
of Group A & B employees and Rs. 15,000/- in case of Group C & D employees during this
year 2018 (01st January 2018 to 31st December 2018)

Employee Code /PF ID No.

: 10020050/311089AK25057
(Mandatory)
Name (In Capital Letters) : A TOSHIBA PRAVEEN KUMAR

Designation : AM (ELEX)

Organization : Airports Authority of India

Place of Posting/ Division : BELLARY

Date of Joining : 11-02-2013

Basic Pay : Rs. 56,840/-

Details of the Assets : NIL

Date of Purchase : NIL

Purchase Value : NIL

Source of funds : NIL

Declaration

I hereby declare that the particulars given above are true.

Date :

Place: BELLARY Signature________________________

 ANNEXURE ‘B’

FOR EXECUTIVES OF E-7 & BELOW

(INCLUDING NON-EXECUTIVES)

APPLICATION FOR INTIMATION OF PERSONAL DETAILS

(Please fill application in Capital Letters)

Employee Code /PF ID No.

1. : 10020050/311089AK25057
(Mandatory)
2. Name(In Capital Letters) : A TOSHIBA PRAVEEN KUMAR

3. Designation : AM (ELEX)

4. Organisation : AIRPORTS AUTHORITY OF INDIA

5. Place of Posting/Division : BELLARY

6. Mobile No. : 9945514411

7. Telephone No. : NA

8. Email address : atoshiba@aai.aero

9. Passport No. : NA

FLAT NO.1, VIDHYANAGAR, BELLARY-

10. Present Residential Address :
583104

C-63, SREE BALAJI LAKSHMI NIVASAM,

11. Permanent Address :
VISAKHAPATNAM-530007

Certificate that:

 I have filled up the nomination form in respect of CPF, Gratuity, GSLIS, BF, Pension, etc.,
In case, I wish to change the nomination, I will do so.

 In case, my residential address is changed, I will intimate the same to Estt. Section within
30 days.

Date : Signature_________________________

Place : BELLARY
 DETAILS OF PERSONAL FOREIGN VISITS W.E.F. 01-01-2018 TO 31-12-2018

Employee Code 10020050

Name of the Employee A TOSHIBA PRAVEEN KUMAR
Designation AM (ELEX)
Department CNS, AAI
Phone / Extn. No. 9945514411
Passport No. NA

If the employee has undertaken any personal foreign visit, the details thereof may be
provided in the following format.

S. No Name of the Duration of Source of Permission letter Remarks

Visited Country Stay Expenditure issued from the
office with date

NIL NIL NIL NIL NIL

For additional information, please attach sheets.

Date : Signature : _________________

For Information :

1. Please attach the photocopy of source of expenditure, passport, visa during the period of
visit and also bring the original to verify the same.

2. The form without Employee No. will not be accepted.