Part II
IMMOVABLE PROPERTIES
Permanent Employee Number (PEN): Name of employee: Return for the year:
| Serial No | Nature of the land | Value of Land in Rs. | Whether with Building (Yes/No) | Value of building in Rs. | New building(s) put up during the year(Including extension / renovation etc ) on properties owned during previous year | Value of such building(s) in Rs. | Survey and sub division No. | Extent in Acre / Cents | State | District | Taluk | Pakuthi / Village | When acquired (Date) | How acquired ? Purchase/Gift/ Succession/patta/ Others (Furnish details) | By whom acquired | With what means (Mode of payments /receipt) Cash/ Cheque/ Draft or other (furnish details) | From whom acquired | To whom disposed | Nature of interest (Part/Full) | Share of interest | In whose name registered | Price paid/ received | Remarks |
| 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 |
| | | | | | | | | | | | | | | | | | | | | | | | |
I hereby declare that I am not possessed of or interested in any landed property other than what is stated above either in my name or benami.
I am aware that furnishing false information will be liable to disciplinary action against me.
Station: Signature:
Date: Designation:
Note: - (1) A line may be used for each transaction.
(2)The properties already acquired before the year in question may be shown first (In red ink preferably) in one line and new acquisition or disposals by a second line underneath and result shown in the third line. The third line will be the first line in the return for the following year.