APPENDIX-1 fRule3(1) Return of Assets and Liabilities on First Appointment or as on the 1 August, 2014/31" March 20....* (Under Sec.44 of the Lokpal and Lokayuktas Act, 2013) 1. Name of the Public servant in full {in block letters) 2. (a) Present public position held (Designation, name and address of organization) (b) Service to which belongs {if applicable) Declaration: I hereby declare that the return enclosed namely, Forms | to IV are complete, true and correct to the best of my knowledge and belief, in respect of information due to be furnished by me under the provisions of section 44 of the Lokpal and Lokayuktas Act, 2013. Date ... Signature in case of first appointment please indicate date of appointment. Note 1: This return shall contain particulars of all assets and liabilities of the public servant either in his/her ‘own name or in the name of any other person. The return should include details in respect of assets/liabilties of spouse and dependent children as provided in Section 44(2) of the Lokpal and Lokayuktas Act, 2013, (Section 44(2}: A public servant shall, within a period of thirty days from the date on which he makes and subscribes an oath or affirmation to enter upon his office, furnish to the competent authority the information relating to {a) The assets of which he, his spouse and his dependent children are, jointly or severally, owners or beneficiaries; (b) His liabilities and that of his spouse and his dependent children.) Note 2: If a public servant is a member of Hindu Undivided Family with co-parcenary rights in the properties of the family either as a ‘Karta’ or as a member, he should indicate in the return in Form Noll the value of his share in such property and where It Is not possible to indicate the exact value of such share, its approximate value, Suitable explanatory notes may be added wherever necessary. Note 3: “dependent children” means sons and daughters who have no separate means of earning and are wholly dependent on the public servant for their livelihood. (Explanation below Section 44(3) of Lokpal and Lokayuktas Act, 2013APPENDIX. Rule 3(1 FORM No.l Details of Public Servant, his/her spouse and dependent children Public Position held, Whether return being if any filed by him/her, separately 1 [self 2 [Spouse 3 |Dependent-1 4 |Dependent-2 S* [Dependent-3 + Add more rows, if necessary. Date SignatureFORM No.l Statement of movable property on first appointment or as on 1.8.2014/31st March 20. (Use separate sheets for self, spouse and each dependent child ) Name of public servant/spouse/dependent child Sno [ Description Remar Fany {)* [Cashin Bank Balance (iy [insurance (Premia paid) Fixed/Recurring Deposit(e) [shares/Bonds [Matual Fundis) Pension Scheme/Provident Fund Other investments, any Personal loans/ advance given to any person or entity including Firm, Company, Trust, ete land other receivables from debtors and the amount (exceeding two months basic pay or| [Rupees One lakh as the case may be) Motor Vehicles (Details of Make/registration number / year of purchase and amount paid) liewellery [Give details of approximate weight (plus or minus 10 gms in respect of gold and precious stones, plus or minus 100 gms in respect of slver)] [core iver [Precious metals and precious stones [Composite tems (indicate approximate value)*** [Any other assets (Give detials of movable assets not covered i (i) to (v) above] fa) Furniture [(b) Fotures (ey Antiques (d) Paintings [e) Electronic equipments (Others [indicate the details of an asset, only if the total current value of any particular asset in any, particular category (e.g. furniture, fixtures, electronic equipments, etc.) exceeding two Jmonths basic pay or Rs 1.00 lakhs, as the case may be] Date Signature . “= Details of deposits in the foreign Bank(s) to be given separately, "+ Investments above Rs. 2 lakhs to be reported individually. 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