Declaration of Assets and Liabilities

Year: 2023-24

I, Priyanka Raj, son/daughter/wife of Upendra Kumar, aged 32 years, belonging to Govt.

service and presently working as School teacher, +2 High School Singhia, Kishanganj

give herein below the details of the assets (immovable, movable, bank balance, etc.) of

myself, my spouse and dependants*:

A. Details of movable assets

(Assets in joint name indicating the extent of joint ownership will also have to be
given)

Sr. Description Self Spouse Dependant-1 Dependant-2 Dependant-3

No. Name Name Name Etc. Name
Rohit Raj Ayaansh Raj
(i) Cash Rs. 4,000/- Nil Nil

(ii) Deposits in Rs. 50,000/- Rs. 3,50,000/- Nil

Banks, Financial
Institutions And
Non-Banking
Financial
Companies

(iii) Bonds, Gold Sovereign Nil Nil

Debentures and Bond- Rs.
2,20,000/-
Shares in
companies

(iv) Other financial Max Life annual LIC annual Nil

institutions, premium- Rs premium- Rs.
51126.04/- 20,888/-
NSS, Postal
Savings, LIC
Policies, etc

(v) Motor Vehicles Honda Activa Honda Amaze Nil

(details of 5G- Scooty SX MT
make, etc.)

(vi) Jewellery (give Gold- 10 gm Nil Nil

details of (Value- Rs
58,000/-)
weight and
value)

(vii) Other assets, Nil Nil Nil

such as values
of claims /
interests

Note: Value of Bonds / shares / Debentures as per the latest market value in Stock
Exchange in respect of listed companies and as per books in the case of non listed
companies should be given.
* Dependant here means a person substantially dependent on the income of the
employee.
B. Details of Immovable assets
[Note: Properties in joint ownership indicating the extent of joint ownership will
also have to be indicated]
Sr. Description Self Spouse Dependant-1 Dependant-2 Dependant-3
No. Name Name Name Etc. Name
Rohit Raj Ayaansh Raj
(i) Agricultural Land Nil Nil Nil
- Location(s)
- Survey number(s)
- Extent (Total
measurement)
-Current market value
(ii) Non-Agricultural Land Nil App. 1500 Sq. Nil
- Location(s) feet (Value-
Rs. 5,00,000/)
- Survey number(s)
- Extent (Total
measurement)
-Current market value
(iii) Buildings (Commercial Nil Nil Nil
and residential)
Location(s)
- Survey /door
number(s)
- Extent (Total
measurement)
- Current market
value
(iv) Houses / Apartments, Residenti Residential Nil
etc. al House House
- Location(s)
- Survey /door
number(s)
- Extent (Total
measurement)
- Current market
value
(v) Others (such as Nil Nil Nil
interest in property)

(2) I give herein below the details of my liabilities / overdues to public financial
institutions and government dues:-
[Note : Please give separate details for each item)

Sr. Description Name & address of Bank / Amount outstanding as

No. Financial Institutions(s) / on …………………..
Department (s)
(a) (i) Loans from Banks Nil Nil
(ii) Loans from financial Nil Nil
institutions
(iii) Government Dues: Nil Nil
(a) dues to departments
dealing with government
accommodation
(b) dues to departments Nil Nil
dealing with supply of
water
(c) dues to departments Nil Nil
dealing with supply of
electricity
 (d) dues to departments Nil Nil
dealing with telephones
(e) dues to departments Nil Nil
dealing with government
transport (including
aircraft and helicopters)
(f) Other dues, if any Nil Nil

(b) (i) Income Tax including PAN NO.- BODPR4294F Nil

surcharge [Also indicate
the assessment year upto
which Income Tax Return
filed. Give also Permanent
Account Number (PAN)]
(ii) Wealth Tax [Also Nil Nil
indicate the assessment
year upto which Wealth
Tax return filed.]
(iii) Sales Tax [Only in Nil Nil
case of proprietary
business]
(iv) Property Tax Nil Nil

C. Personal Detail

GPF/CPF/PRAN No. :-
110109682670
Gender :-
F
Date of Birth :- 1 8 0 8 1 9 9 1
(DD/MM/YYYY)

Class/Group :- C :-
Cadre :-
EDUCATION DEPARTMENT
(Full Name e.g. B.A.S.-Bihar Administrative Service,

B.S.S.- Bihar Secretariat Service etc.)

Home District :- NALANDA, BIHAR

I hereby declare that the above details are true to the best of my
knowledge and belief.

Signature ..................................................

Name of Employee: PRIYANKA RAJ

Place: KISHANGANJ Designation: ASSISTANT TEACHER

Date:....................... Department:EDUCATION DEPARTMENT

Note: Please sign each page of the declaration. Asset declaration form
must be in A4 size white paper with computer typed (single side)
in prescribed format.