Declaration of Assets and Liabilities: Year........................

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Declaration of Assets and Liabilities

Year.........................
I,., son/daughter/wife of ...,
aged..

years,

belonging

to

.....................

service and presently working as .................................


give herein below the details of the assets (immovable, movable, bank balance, etc.) of
myself, my spouse and dependants*:
A.

Details of movable assets


(Assets in joint name indicating the extent of joint ownership will also have to be

given)
Sr.
No.

Description

(i)

Cash

(ii)

Deposits in
Banks, Financial
Institutions And
Non-Banking
Financial
Companies

(iii)

Bonds,
Debentures and
Shares in
companies

(iv)

Other financial
institutions,
NSS, Postal
Savings, LIC
Policies, etc

(v)

Motor Vehicles
(details of
make, etc.)

(vi)

Jewellery (give
details of
weight and
value)

(vii)

Other assets,
such as values
of claims /
interests

Self

Spouse
Name(S)

Dependant-1
Name

Dependant-2
Name

Dependant-3
Etc. Name

Note: Value of Bonds / shares / Debentures as per the latest market value in Stock
Exchange in respect of listed companies and as per books in the case of non listed
companies should be given.
* Dependant here means a person substantially dependent on the income of the
employee.

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