Download Form of Assets and Liabilities

RETURN OF ASSETS AND LIABILITIES OF FIRST APPOINTMENT/AS ON THE ________________________________________________ 1. Name of the University Servant in full (In block letters) _________________________________________________________________ 2. Service to which he/she belongs:- _________________________________________________________________ 3. Total length of service:- _________________________________________________________________ 4. i) In Non GAZETTED rank:-_________________________________________________________________ ii) In GAZETTED rank:- _________________________________________________________________ 5. Present post and place of posting:- _________________________________________________________________ 6. Total annual income from all sources during the Calendar year immediately proceeding the 1st days of January, 200 _________________________________________________________________ DECLARATION:- I hereby declare that the particulars from FORM I to V are complete, true and correct on the first appointment, to the best of my knowledge and belief, in respect of information due to be furnished by me under the provisions of Sub-Rule (i) of Rule 18 of the Central Civil Service (Conduct) Rule, 1964. Date:- ___________________ Signature: ______________________ Note: 1. This return shall contain particulars of all assets and liabilities of the University servant either in his own name or in the name of any other person. 2. If a University servant is a member of Hindu undivided Family with comparcemary rights in the properties of the family either as a "Karta" or as a member, he should indicate in the return in item No. I the value of such share in such property and where it is not possible to indicate the exact value of such share its appropriate value suitable explanatory notes may be added wherever necessary. FORM NO: I STATEMENT OF THE IMMOVABLE PROPERTY ON FIRST APPOINTMENT/AS ON THE FIRST DAY OF JOINING. (i.e. LANDS, HOUSE, SHOPS, OTHER BUILDING ETC.) Sr. No Description property Precise location (Name of District, Division, Tuluk and Village in which the property is situated and also its distinctive number etc. Area of land (in case of land & Building) Nature of land (in case of landed property) Extent of interest If not own name state in whose name held & his/her relationship if any, with the University Servant Date of Acquisition How acquired (whether by purchase, mortgage, lease inheritance gift or otherwise) & name with details of person(s) from whom acquired (address and connection of the University Servant if any, with the person/persons concerned please see note 1 below) Value of property (See note 2 below) Particulars of sanctions of prescribed authority, if any Total annual income from the propert y 1 2 3 4 5 6 7 8 9 10 11 12 Date:- ___________________ Signature: ______________________ Note:-1. For purpose of column 9 of the term (Lease would on a lease of immovable property from year to year or for any term exceeding one year or reserving a yearly rent. Where, however, the lease of immovable property is obtained from a person having official dealings with the University servant, such a lease should be shown in this in respect of the term of the lease whether it is short term or long term and periodically of the payment of the rent. 2. In Col. No. 10 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 there of also. STATEMENT OF LIQUID ASSESTS ON FIRST APPOINTMENT/AS ON THE FIRST DAY OF JOINING. i.) Cash and Bank Balance exceeding 3 months emoluments. ii.) Deposits, loans advances and investments. (Such as shares, securities and debentures etc.) Sr. No. Description Name and addresses of company, Bank etc. Amount If not in own name and address of persons in whose name held and his/her relationship with the University Servant Annual Income derived Remarks 1 2 3 4 5 6 7 Date:- ___________________ Signature: ______________________ Note:-1. In column 7, particulars regarding sanctions obtained or report made in respect of the various transactions may be given. 2. The tem "emoluments' means the pay and allowances received by the University servant. Sr. No. Description of item Price of value at the time of acquisition and /or the total payment made upto the date of return, as the case may be, in the case of articles purchased on hire a purchase of installment basis. If not in own name, name and address of the persons in whose name and his/her relationship with University employee How acquired with approximate date of acquisition Remarks 1 2 3 4 5 6 Date:- ___________________ Signature: ______________________ Note:-1. In this form/information may be given regarding items like (a) jewelry owned by him (total value) (b) Silver and other precious metals and precious stones owned by him not forming part of jewelry (total value), (c) (i) Motor Cars (ii) Scooters/Motor Cycles (iii) Refrigerators/Air-Conditions (iv) Radios/Radiograms/Television sets and any other articles, the value of which individually exceeds Rs. 1000/- (d) Value of items of movable property individually worth less than Rs. 1000/- other than articles of daily use such as clothes, utencils, books, crockery etc. added together as lump sum. 2. In column 5 may be indicated whether the property was acquired by purchase, inheritance gift or otherwise. 3. In column 6 particulars regarding sanctions obtained or report made in respect of various transactions may be given. FORM NO - IV STATEMENT OF PROVIDENT FUND AND LIFE INSURANCE POLICY ON FIRST APPOINTMENT/AS ON THE FIRST DAY OF JOINING. Sr. Insurance Name & Sum Amount PROVIDENT FUND No. policy No. and date of policy insurance Company Insured/ date of maturity of Annual premium Type of provident funds/ GPF/CPF Account No. Closing balance as last reported by the Audit /A. O along with date of such balance Contribution made subsequently Total Remarks (If there is dispute regarding closing balance the figure according to the university employee should be mentioned in this column 1 2 3 4 5 6 7 8 9 10 Date: __________________________________ Signature:__________________________________ FORM NO - V STATEMENT OF DEBTS AND OTHER LIABILITIES ON FIRST APPOINTMENT/AS ON THE FIRST DAY OF JOINING. Sr. No. Amount Name and address of creditor Date of incurring liability Detail of transaction Remarks 1 2 3 4 5 6 Date:- ___________________ Signature: ______________________ Note:-1. Individual items of loans not exceeding three months emoluments of Rs. 1000/- whichever is less need be included. 2. In column 6, information regarding permission, if any, obtained from or report made to the competent authority may also be given. 3. The term "emoluments" means pay and allowances received by the university employee. 4. The statement should also include various loans and advances available to University employees like advance for purchase of conveyances, house-building advance etc. (other than advances of pay and traveling allowance) advances from the G. P. Fund and loans on Life Insurance policies and fixed deposit.