STATEMENT OF ANNUAL IMMOVABLE PROPERTY RETURN FOR THE YEAR (AS ON 01 JAN 2021)

1 Name of Officer : 6 Date of appointment :

2 MES No : 7 Date of Birth :
3 Service to which officer belong : 8 Date of Retirement :
4 Present post held : 9 Unit where employed :
5 Present Pay :

Srl Name of District Sub Name and details of Cost of Present If not in own name, state How acquired (whether by Annual Remarks (E-
No Div, Taluk and Village or property House and construction / value in whose name held and purchase, mortgage, lease, income in-C’s Br
city in which property other building Land Acquirement his/her relationship, if inheritance, gift or otherwise) from the letter
situated (full location & (and year when any to the Govt Servant. and name with details of property reference
postal address purchased) person/persons from whom vide which
including of acquired (address and property is
land in case of connection of the Govt noted
house Servant, if any, with the
person/persons concerned).

1 2 3 4 5 6 7 8 9

-NIL-

Signature : ___________________
Name : DINESH SHARMA
MES No : MES-608687
COUNTERSIGNED Rank & Appt : JE (CIV)