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Name:
Father's Name
Date of Birth
Present Place of Posting

Form No.1
Statement of immovable property(eg) Lands,House,Shop,other Buildings etc.For the Year-----------
Sr.
No
Description
of Property
Precise Location
Name,District,Taluk
Village in which the
property is situated
and also its
distinctive number
Area of
land( in
case of
land and
buildings)
Nature
of land/
property
Extent
of
interest
if not in
own name
state in
whose
name held
and his/her
relationship
, if any to
the Govt
Employee
Date of
acquisition
How acquired(
whether by
purchase,
mortagage, lease
inheritance gift or
otherwise and
names with details
of person/ persons
from whom acquired
address and
connection of the
Govt.
Employee if any with
the person/
persons concerned
(please see note 1
blow)
Value of the
property (see note
below)
Particulars
sanction of
prescribed
authority, if any
Total
annual
income
from the
property
Remarks
1 2 3 4 5 6 7 8 9 10 11 12 13



Note:
1. For the purpose of column 9, the term would mean a lease of immovable property from year for any for any term exceeding one year of receiving a yearly rent. Where, however, the
lease of immovable property is obtained from a person having official dealing with the Govt. employee such a lease should be shown irrespective of the term of the lease, whether it is
short term or long term and the periodicity of rent.
2. In column 10 should be shown;-
a. where the property has been acquired by purchase mortgage or lease the price of premium paid for such acquisition.
b. Where it has been acquired by lease ,the total annual rent thereof and
c. Where the acquisition is by inheritance, gift or exchange ,the approximate value of the property to be acquired
Signature