ANNEXURE - 2

STATEMENT OF MEANS

1. N a me

1 . 1 Name of Father/ Husband

1 . 2 PAN of Income Tax, if any

(attach a copy of PAN Card)
2. Address with Telephone/mobile No.
a) Residential

b) Business/Office

3. Age
4. Guarantee offered in the account of

5. Occupation
6. Total Annual income for the last two Year ended Year ended
years (copy of IT Returns/orders 31.3……… 31.3…………
to be enclosed in case of Income
Tax Payers.)

7. Whether connected with any other firm (If so, name of the firm and the position therein
to be furnished)
Name of the firm/Company P a r tners/Dir ectors

8. a. Details of Assets owned : (Amt.in Rs)

S l . Full P u rc ha se P r e s e mt Details of Details of title Whether
N o . description of P ri ce Market annual deeds of the free fro m
propert y Pri ce p ro p e rt y f re e f ro m
giving location inco me encum
from pro- bra nce.
and full address perty in
question
b. Details of Investments, if any :
Sl. No. of Shares/ Name of the Company Face Value Present Market
No. Units/Bonds etc. (Rs.) value (Rs.)

c. Investment by way of capital in associates firm / company :

Sl. Name of firm/company Amount of Net Capital/Invested
No. As on date (after setting of Losses, if any)

d. Loans/Deposits with third par ties/firms :

Sl. Name of firm/company Amount of deposit/
No. Loan given as on Date (Rs.)

e. Deposit with Banks :

Sl. Name of Bank Nature of A/c B a la n c e
No. S.B./F.D./R.D./C.A. As on date (Rs.)

f. Insurance Policies on own life held :

Sl. Policy Amount Surrender Date of Date of Whether Annual
No. No. Insured C o m me n c e - Maturity e n c u m- P r emium
(Rs.) Value/Paid ment bered Pay abl e
up Value (Rs.)
 g. Details of other personal assets such as jewellery, car etc.

Sl. Details of Items Purchase Price (Rs.) Present Market Value

No.

Total of 8 (a) to 8(g) above: Rs. …………………………… Lac.

9. Details of borrowings :
Sl. Amount of From whom borrowed Security of fere d When payable.
No. Borrowing (Rs.)

1 0 . Net Means (8 - 9) : Rs. …………………………………… Lac.

1 1 . Details of Personal Guarantees given, if any :

Sl. Amount of Guarantee In whose favour Purpose of Guarantee
No. Given

I hereby declare that the information given hereinabove are true and correct.

Date : ………………………………………
( Signature )

The correctness of the facts contained in the statement has been verified by the undersigned
to the extent possible from the documents/papers furnished by the borrower and also by
making enquiries from the market.

Name of the Official : Signature :

Designation : Date :