STATEMENT OF IMMOVABLE PROPERTY FOR THE YEAR 2019 / as on 1ST JANUARY 2020

1. Name of the Officer (in full): 4. Date of Birth:

2. Service to which the officer belongs: Central Govt 5. Present Pay: Rs.
3. Present post held (from when): 6. Formation where working: A&ACC, Bengaluru
Name and Details of the property How acquired, whether
If not in own
by purchase, lease
name state in
Name of District, mortgage, inheritance
whose name

REMARKS
Sub-Division, Taluk gift or otherwise with Annual
Present held and
and Village in which Housing the date of acquisition income
Value his/her
the property is & other Lands and name with details from the
[Approx- in relationship
situated. buildings of person from whom property
Rs,] to the
acquired and also
Government
indicate the source of
Servant.
finance
1 2 3 4 5 6 7 8

Place:
Date:

SIGNATURE WITH DATE