FORM-4

STATEMENT OF ANNUAL RETURN OF IMMOVABLE PROPERTY

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

For the year Ending: 2022 As on: 31.12.2022

(1)Name of officer (in full) and services to which the officer belongs: FIROZ SHAIKH(Group B)[Telecom Service]

(2)Personnel Number : 01001501

(2)Present post: JUNIOR TELECOM OFFICER /SAINTHIA(Suri TD) Present pay[Basic + DA]: [Rs.20630.00 + Rs.40394.00]

Name of District, Name & details of Propery Present Value If not Own Name, How acquired-(Whether Annual Income Remarks
Sub-Division, Taluk _____________________________ state by purchase,lease, from property
and village in which Housing & Other| Land in whose name held Mortgage, gift or
property is situated building | and Otherwise),with date
| his/her relationship of acquisition and
| to the employee name with details of
| persons from whom
| acquired
1 2 3 4 5 6 7 8
NIL 0.00 NIL ( NIL ) 0.00 NIL

Date: 04.02.2023

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)Includes short terms lease also.

Note: The declaration form is required to be filled in and submitted by every employees of BSNL s 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.