1.

rv~~(lj 2.

3.

4.

5.

6.

.

\mi. Ti. 1Form No.1

~~~~ @)~ Ifv\ J.sr J~,w20\1

llW1 ~ q'( ~ ~ ~ Cf!f qft 1 ~ ~ 3J'<Ri! ~ VT fcrcffuT I(~ : ~. 3!1G'ft1'. ¥R 3R:r 'If<R ~)

statement showing details of immovable property on first appointment and also on 1sl January of each calendar· year(e.q. Lands. House. Shop. other Bui/dings etc.)

''IT'lName

tr<'RT'1Designation

Co. ~ _

_PHHL

1)e~\;\- ~!2(J\,-t ' ~laA :ty/D9]:loID

~Organisation

~ <1ft fcIfuDate of JOining

"l:"fctRBasic Salary

~Location

w.~. ~ om ~ q;r fcrcffuT ~ ~ ''IT'l q'( "It! t 1Pft3IRifiEI ~CIi1~' <-MtU'fl ¥l reurunS.No. 161l'RT (~ ~ ~ -.nc Ti. 1 ot~"lT'l~~ ~qft~ (~~~ ~3!m Remarks

~ 5 ~ l1<IiT'1/'If<R/~ ~.) ~~CIi1~ (~~~ -.nc Ti. 3~) Total annualDetails/Description of ~~~~I "lR Ti. 2 ~ Value of the income fromproperty and its location. If not in own name. 6~) property the property(see notes 1&5 below state in whose name How and (see note 3house/Building/Land No.) held and hislher when below)

relationship. if any to acquiredthe employee (See notes

2&6 below)

l· "i Q,t,t! e. OM- ~ lA> iI\t ~ CMMJ.. e~ I~ Lq}el NIL.. ~tMjA,(XtV>. ~1M- ef!"~ fAt~"'t~P~,B PCL~·~ . hWA,

~ /j, ;Z'11 uo · c1:>1.so ~ 'yel, ~S' '1. ee'eJ,T-e.~~~;

N~~ o{H~~UJ~'1l(h.~ ~~

fQ~Iala, . ..

--

~ 7

~ 1. ~ ~ 'I,uf '{i)q -fl ~ <rfJl lR ~ t aT WR <t>'t 1{f?IT em ~ I

Note 1. If the property is not wholly owned the extent of share may also be indicated .

.rrc 2. ~ 4 ~ ~ ~ ~ c4TvT ~ <fiT 3l2f~ 3P2fin "(fCf> qcf ~ ~ ~ ~ ~ ~ ~~ <fiT ~ ~ ~ m-m I ~, <lft ~ ~ qft c4TvT ~ ~ ~ q;-nf ~.~ ~ "C.llfcffi ~ ~ <1ft \if!tft t m ~ c4TvT cffl T$ <rr ~ 3P2fin ~ m ~ ~ <fiT~ =e=r ~ 3l2f ~ cfflt ~ -;:ffif 6Fn 31'R 3l2f 31'R ~ -ij;- 'IfNA <1ft ~ ~ cfflt m 'ltft 6Fn '1

Note 2. For the purpose of Col. 4 the term lease would mean a lease of immovable property fromyear to year or for any term exceeding one year of reserve yearly rent. When, however,the lease of immovable property is obtained from a person having official dealings withthe employee, such a lease should in this column irrespective of the term of the leasewhether it is short term or long term, and the periodicity of the payment of rent.

-;:flc 3. ~ 5 ~ f.'ll'1~ftm GW<rr VfRf ~ :

Note 3. In col.5 should shown.

(q;) \iI"if ~ 1fllT, ~ 3P2fin -Rtvr 1R ~ 'It m, ~ 3lVRem 1f'ffiR fcm;rr 7l<IT ~ 31~

~(A) Where, the property has been acquired by purchase, mortgage or lease, the price or

premium paid for such acquisition.(<<) vrID ~ ~ 1R fB<rr 7l<ITt CJif ~ ~ ~ 1ft I(8) Where it has been acquired by lease the total annual rent there of also and(11) vrID ~"<fiT 3T\if.; \1i'1'(I~CfiI'<, ~ 3P2fin ~ ~ 31FvRr qft 'It m <nIT 31FvRr ~ <fiT

~~I(C) Where the acquisition is by inheritance, gift or exchange the approximate value of the

property.so acquired, __

-.nc 4. 1 ~ ~ ~ ~Cf)T ~f<mur 1ft*mVfRf ~ INote 4. The annual return in respect of immovable property may also be submitted in this form

as on 151 January .

.rrc 5. ~ R;ffi ~, ~, ~ ~ TfTq ~ ~ t \fflC1iT fcrcRur Cflm" ~ tp-rCfi msm ~ 2~<ftvwfi~ I ,

Note 5. Name of District, Division Taluka & Village in which the property is situated and also itsdistinctive number etc. will be given in Col.No. 2.

.rrc 6. 1fllT, ~, -Rtvr, ~, ~ 3P2fin ~ IfCfiR em fcrcRur 31'R "C.llfcffi / ~ <fiT "91l1 ~~ -zT 31FvRr qft 'It t I ~ ~ ~ ~ "C.llfcffi / ~ <fiT lfflT 31'R \Fffi ~ <fiT 1ft ~

~\JfRT~ I

Note 6. Whether by purchase, mortgage, lease, inheritance, gift or otherwise & name with detailsof person/persons from whom acquired Address & connection, if any with theperson/persons concerned are also to be given in Column.

__ I Signature ~ _ ~ / Date: IS- ~~ _

'Y)1»

c)

"')

(e)

~,t.2Form No.2

'l!1Ill1~ ~ qRfl"lff1<i1 ~ ~ (3l"OI"<'! ~ q;l ~) (lW ll($n ~ <I'!!qft 1 ~ (f)J rt-Crl 'ij; 1hi11J en! fllcH11J I

Statement showing details of assets (other than immovable property) & Liabilities on first appointment and alsosubmission of return on 1'1 January of each calendar year.

1. L± LDl(aetci) A, \(, GX'l')1kQi

ca..{'t------tu~W~L~ _

I)ef'~- 16~2Aro:t, ~ 2~If)q/:u>'o2,2. 9 trO , (}-()

New D~<LIN

'WIName

2. Y<RTl1Designation

3. ~Organisation

4. ~qft~Date 01 Joining

5. '!C1<l<ABasic Salary

6. o P3~Location

I >

C7\)

?1ia~Assets Liabilities

(<p)~ qRw{fR\ q f.rcm (\ifJfT ~ ~ ~ ~ ~)(A) Liquid Assets & Investments (including deposits & LIe Policies)~ Xlfu~~ ~ 'fTl11:R 6' ~ ~'tlX'6 ~ ~ 31'T<f 1.1fq;/~~Description Amount! ~ How acquired Annual Cfi't~1

Original Held in the name income 1. Liabilities to thePrice of & relationship derived Bank/Financial

1 2 3 4 5 institution

L.\C. pO~f~ - .2 rHJ-(){}f), 1ft ~1- U') fl vgSdlU

>"\0" G:'l)' A3 12:1-\ -- -~g,~, ?-O!? ~i-~ --(bJ f~613·ru

L.l c, fo~' L'j .2.e--o-v tro . £Il , - ,

VM.(iM.!i~ 2. f?rif ~ R~*m-rcf,t ~ I

~2' ~, 2...oU> 2. Liabilities to< friends & relatives

('~) £.ffi

(B) Movable Properties1 2 3 4 5

9·65 ~\L~ ~t .il~/V\._ '2> ',,-0-0 , O"D ~..e'"

c.a.,v N\ l.... 3. 3R:r~~ w 0-'1

:::tPiJM-{JtNvLL rJ IL- ~~I

g.w-u~ Z 0 &-e--O ' 0-0 3. Other liabilities, if'I NIL- any

Ac. 'f 02., 3D~O-Ot 00

~e~9J~ ~~ffl' «o ~1- 1/,rJ tt....

~~oLcL ~: ~~

50~O 00· cro~

rVlL--, Date ' Signature

(J( ~ WUL,-\Lr II 15 Idd.-l.- 1\

~ ~ Ul'R ~ :- 'Gl'ii <mft 3~ m ~ tffl ~ IN.B. Additional sheets may be attached where necessary.

"11c 1.~,~, ~ ~ em fcrcRur ~ q;'t ~ ~ alR ~ il'l'VfR ~ ulTCiNote 1. In the case of share, securities, debentures etc. face value and approximate

market value as on the date of statement may be mentioned.

-.nc 2. ~ ;ftirr 4Ifti;fft41 ~ 3Rflffi ~ 'It't eft \ilFft ~ INote 2. In the case of Life Insurance Policies the date of maturity may also be stated.

-;ffi: 3. ~ ~ 3RfTh; (<p) ~ / m;f ~ ~ ~ ~ ~ ~ ~ -wm if ~ ~ ~ ~~ \3'1<l'iT~ q\iR, (~) mcft ~ "'11A ~ ~ <rvR (7]') 3RT ~ ~, ~, ~~;:;fl ~'&;~1') i ~ em ~ ~~"GJRT~ J (i) C5R (ii) ~/~~ (iii) ~&>ciNc"! / 'flR <$~~I;H / mm / ~~ql'.ll,",/ 2:fcl~\ij'1~ m.rr 3RT 'ifitfCffiJ ~ ~ ~ ~15 6V'f'R ~ ~ i em ~ ~ fG'm VfAT ~ I

Note 3. Under B information may be given regarding items like (a) gold/gold ornamentsapproximate weight only be stated. (b) Silver including ornaments etc.(approximate weight) (c) Other precious metals, items of jewellery, preciousstones forming part of jewellery etc. Approximate value to be stated (i) car (ii)Scooter/Motor Cycles (iii) Refrigerator/Air Conditioners, Radio/Radiogram/Television sets and any other articles the value of which individually is more thanRs. 15,000/-.

-;ffi: 4. ~ 4 1') <ffi ~ fc);m \;fAT ~ ~ Cfm ~ <m 3l'\iR W1:T,~ ~ ~ \fiiiR~ fcl>m 1T<IT :!IT q)f ~ FcP<rr VfAT ~ I

Note 4. In column 4, may be indicated whether the property was acquired by purchase,gift, or otherwise.

-;ffi: 6. ~3IT 'ij; ~ ~ fif<RuT ~ VJRf ~ INote 6. Under liabilities, brief details should be given.

~ / Signature ~- .~ / Date; 15 ,4£4=-...1..) ...l..1 _

2.

3.

4.

5.,~

6.

7.

If<l?I fi. 3Form No.3

~ ~ mf 'lit 1 ~ <tit ~ / q;>f-~ $' <m-CI $' JRl1fG m.mfhii <1;~ "WI tR <!~-HllRl / q~t\ 3l'I, 311f~n i/W"

-ij;"'!TlItR~lfC:!~/~~ <m~1Tf IDetailed statement in respect of shares debentures purchased under promoters/employees quota as on 1,,' Januaryof each calendar year in officers own name and also those held the names of spouse and dependent children.

A .'L. eaN\~I-- __1. It to\ ("R~)

c~ft~.----------------"ifIl

Name

tfG-WIDesignation

~Organisation

_~\{HL

DefL\. IGluJ'kt1Dd= ~lM, J.\.t~IV

12.9tn>,Oe

mcf~~~~ct\~_Date of Joining the PSU

'F' ~'lBasic Salary

~~~mYfrP.F. Index No.

<Il<Rlocation

Sf).~. ~<P1"lJl'l ~1R1qft 3ifi\m ~qft 1;!T>rTc</<I>'i<lIl~<lI' -ij; ~~ 31vf'., -ij;Wfll m1t<f 'fq

S.No. Name of the <Wm ~ ~ <f>1Z -q ~~ 3ft\' 'iffil ~ <t>"l i3~Company No. of Face Cost of Whether promoters! How 'flTll' q;'I-J '3!tUT m 3Fl1'

shares value acquisition employees quota acquired ~m!~ IPosition held at thetime of acquision andif the company hadany borrowing orother facilities at thattime.

1 2 3 4 5 6 7 8

~

---,

~

VV

fi \ L-..>

.-/

m I Self ...,...<""'- _

qfct I tWfT ('fl!lT 3ll~ ~ . ~--L-'c.lI-I,....jJ'\ b~. _Spouse and dependent c~ -

8. 1 'GR"cR1 <m ~ ~ t1'r+T I mf.1' # ~ I ~ cpr <2lt'fr ~ tAny additions/deletions to this statement as on 15t Januaryprofit/loss incurred by me are given below,

and the

~ I Place: ~'1uGo<l.)~c;..~a _

fcW:\' I Date : t S ~.A.- \ \-

~ / Signature : _-=-...:;.;::.l...i:.:.... ••••••...:::~I--__

~ I Designation : _~~~+-_~ _

r 7

(~~ 1 VA<Rl q;1 qRflAlfftliY ~ ~;ID ~ Wl' ~ ~! I)

(To be submitted alongwith the assets & Liabilities Statement as on t" January of every year)

~ ~ ~ G'TTI'11 ~ "ifi1 ~ 25.000/- ~ ~ ~ ;); mm. ~~. ~ q~J ~3l(q q.-~.~tR~~¥fWr-~qft~~~ IForm for giving information where total transactions in shares, securities, debentures and investment inmutual fund schemes etc. exceed Rs. 25.000/- during the calendar year on 1$' January -;-;,-- __

POlY' H\J-,¥-

4. rm!f/q;lf, ~ Wl' Wr-~ flI;m lTm i IParticulars of the partylfirm with whomtransaction is made.(q,) ~ ~ 3l]"qqft fffiRR t I

(Al Is party related to you? ~("~)~ antR artR ~ tfG tR m~~ ~

. ~ Wl' Wr-~ flI;m ~ ~ ~ >l ~ <!iT "2:"'Z -=- _3fl1:ffi ~ W!-~ ~ ~~t I(8l Did you have dealings with the party inyour official capacity at any time or is theapplicant likely to have any dealings withyou in the near future?

1. ~~~Name & Designation

2. (q;)~qlllT~~(Al Scale of pay and present pay(tg) ~ P-Ifu ~ ~(Bl P.F. Index No.

3. ~ ~ <l; G'TTI'1 ~~, ~,~,.~3l(q ~, ~ tR f.mTm ~ ~-~ <!iT6!tRl I

Details of each transaction made in shares.Securities. debentures. mutual funds schemeetc. during the calendar year.

5. ~ <liT <'SIffiSource or sources from which financed?(<I» ~ <fiffl(Al Personal savings(~) aRI .mm <liT 6!tRl ~

(8) Other sources giving details.

6. <!iTt 387 ~ R;ffi 3lTQ ;t;rr ~ ~ I

Any other relevant fact, which you maylike to mention.

~ I Declaration :

.Lt(i\l(Qp~· ~C

2>h 9 LfQ. r»

N 1L- •

"II ~ $fun lIffi!T I <Im'ft ~ f,$ ~ GRT ~ lTm·~ iIi'm mft ~I hereby declare that the particulars given above are true.

~ / Place: -.&.B_J,.,.,..""'$k _~ / Date: _, S- &q1 t \ L

~IIR / Signature : rap~Cqft=~· -~ I Designation: