STATEMENT OF MOVABLE PROPERTY RETURN AS ON 31-12-2020

1.NAME OF
OFFICER/STAFF :
(IN FULL & CAPITAL ETTERS)

2.DESIGNATION : 3. DOB

4.DEPARTMENT/OFFICE : 5.
EMPLOYEE CODE NO :

6.PRESENT PAY : Rs. 7. EXECUTIVE/SUPERVISOR/WORKMAN : EXECUTIVE

Sl. Description of Item Price or value at the time of
No. acquisition and/or the total
payments made up to the date of
return as the case may be in case
of articles purchased on hire or
instalment basis.
If not in own name & How acquired with Remarks
address of the person in approximate date
whose name and his/her of acquisition.
relationship with the Govt.
Servant.

Date :- Signature _____________________________

 STATEMENT OF IMMOVABLE PROPERTY RETURN AS ON 31-12-2020

1.NAME OF
OFFICER/STAFF :
(IN FULL & CAPITAL ETTERS)

2.DESIGNATION : _______________________ 3. DOB

OFBIRTH

4.DEPARTMENT/OFFICE : 5. EMPLOYEE CODE NO :

6.PRESENT PAY : Rs. ________________________ 7. EXECUTIVE/SUPERVISOR/WORKMAN : ________________________

Name of Name & Cost of *Present Value If not in own How acquired- whether Annual Remarks
District, Sub- Details of construction/ name in whose by purchase, lease**, income
Division, Taluk Property, acquirement name held and mortgage, inheritance from the
and Village in Housing, Lands including land in his/her gift or otherwise, with property
which Property and other case of house and relationship to date of acquisition &
is situated buildings year when the Govt. name with details of
purchased Servant persons from whom
acquired
1 2 3 4 5 6 7 8

Date :-
Signature _____________________________