Declaration

Name
Designation
Department
PF id
Samadhan id
Current Address:

Whether owned any accommodation in Mumbai and adjacent area in the name of self or
spouse or dependent children: Yes/ No

If yes, kindly provide following details for all the properties:

Details of property 1
Address:
Carpet area/ built up etc. (sq.ft.), along with copy of sale deed/possession letter or any other
such document mentioning the said details:
Date of possession:
Name of owner:
Relationship with employee:
Note: In case of multiple properties mention details of all such properties

I declare that aforementioned details are true to the best of my knowledge and I shall be
liable for any penal action if any discrepancies is found in this connection.

Signature of employee:
Name of employee:
Date:

विभाग के सत्यापन अविकारी के हस्ताक्षर /

Signature of Attesting officer of Department
नाम / Name:
पदनाम / Designation:
वदनाां क/ Date: