FORM 'A' (CONFIDENTIAL) (Ref. SRO-199 of 19th June, 1998) STATEMENT SHOWING THE DETAILS OF PROPERTY BOTH IMMOVABLE AND MOVABLE OWNED BY A PUBLIC SERVANT OR ANY MEMBER OF HIS/HER FAMILY OR THE PROPERTY IN WHICH HE/SHE OR ANY MEMBER OF HIS/HER FAMILY HAS INTEREST (AS IT STOOD ON THE LAST DAY OF THE YEAR ________________ VIZ. 31ST DECEMBER, _________________) 1. Declaration made by (full name with surname in block letters) ______________________________________________________________________________________________________________________ 2. Present Designation with full official address at which correspondence to be conducted (stating whether on deputation, if so, parent department should be quoted) ______________________________________________________________________________________________________________________ 3. Scale of pay and rate of salary on the last day of December of the preceding year ______________________________________________________________________________________________________________________ 4. Date of first appointment as Public Servant : ______________________________________________________________________________________________________________________ 5. The average strength of the family members dependant on officer during the period under report ______________________________________________________________________________________________________________________ 6. The Name, Address and Occupation of the officer's father and father-in-law (in case any property is shown in the statement as having been received from the parent or parent-in-law) ______________________________________________________________________________________________________________________ 7. Name of the officer, wherefrom statement of property submitted last year ______________________________________________________________________________________________________________________ Categories of property Description Date on which acquired Means by which acquired Mode of acquisition whether by purchase, lease, mortgage, inheritance, gift or otherwise, with date of acquisition and name with details of persons from whom acquired Reference to the authority and number and date of order under which sanction was obtained for the acquisition of the property if required under Government Servants Conduct Rules Value of the property Annual Income, if any accruing from the property In whose name property stands (self, dependant or any other person). Here give name and relationship with the Government Servant Remarks 1 2 3 4 5 6 7 8 9 10 I. II Immovable Property : 1. Building with Mohalla, name of Village, Town, Tehsil and District wherein situated. 2. Kharsa Nos. or other description of land and with area and name of Village, Town, Tehsil and District wherein situated. 3. Mortgages on Immovable property with full description as in 1 and 2 above. Property other than Immovable exceeding Rs. 20,000 under each one of the following Heads : 1. Cash balance, Saving bank Deposits, Shares, Cash Certificates, Fixed Deposits, Debentures and Security bounds. 2. Jewellery/Ornaments 3. House hold items (Electric and Electronic items) 4. Vehicles I do hereby declare that the above statement is true to the best of my knowledge and belief. I further declare that I, my wife/husband or any other member of my family as referred to in the J&K Public Men and public Servants (Declaration of Assets and other provisions) Act, 1983 neither own nor have any property other than that mentioned above. Note: -This return should be submitted complete in all respects without making any reference to previous statement or any of its item or sub-item incomplete Statements, if received from any public servants shall not be entertained. Signature of the Public Servant
