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Form-4

STATEMENT OF ANNUAL RETURN OF IMMOVABLE PROPERTY


(Under Rule 21 of BSNL, Conduct, Discipline and Appeal Rules, 2006)

For the year Ending : 2015

As On : 31.12.2015

(1) Name of Officer (in full) and services to which the officer belongs : MADAN SINGH(Group B)[Telecom Service]
2) Present Post : DIVISIONAL ENGINEER PHONES KARNAL(Karnal TD)
Name & Details Of
Property

Pay(Basic + DA) : (Rs.45910.00 + Rs.51603.00)

If not own name,


state in whose
name held and
his/her
relationship to the
Employee

How acquired
(Whether by
purchase,lease,
mortgage, gift or
Otherwise), with date
of acquisition
and namewith details
of personsfrom whom
required

Name Of District,
Sub-Division
Talukand Village
in which
property is
situated

Housing &
Other
Building

Land

Present
Value

179 SECTOR 14 PII


UE

10MARLA

5500000.00

Self

Annual
Income From
Property

Remarks

Purchase / 23.10.2002 /

0.00

Date of Submitting : 21-03-2016

SIGNATURE

(1) Inapplicable Clause to be struck out.


(2) In case where it is not possible to access the value accurately, the approximate value in relation to present conditions may be indicated.
(3) Include short term lease also.
Note : The declaration form is required to be filled in and submitted by every employee of BSNL on the 1st January every year giving
particulars of all immovable property owned, acquired or inherited by him on lease or mortgage either in his name or in name of any member
or in the name of any other person.

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