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Annexure-I

STATEME T O! IMMO"A#$E P%OPE%TIES POSSESSE&, A'()I%E& A & &ISPOSE& O! #* S%I+SMT+,)M SI"A P%ASA& MATAM, Assistant Technical Officer &O#-./-01-234/ O% A * OT5E% PE%SO O 5IS #E5A$! O% #* A * MEM#E% O! 5IS !AMI$* &)%I G *EA% E &I G &E'EM#E% .02 6Su7-%ule689 of %ule 03 of A.P.'.S. 6'onduct9 %ules 234:9

S o 1

ame of Pro;ert<

Situation of Pro;ert< 6Sur+M;l. o.9 =ith extent9

5eld in =hose ame

&ate > Mode of Ac?uisition or &is;osal

ame and Address of ;erson from =hom ac?uired + to =hom dis;osed of9

Price Paid + O7tained

Source of Pa<ment

@hether information given or sanction o7tain =ith ref. o > &ate

Annual Income from the Pro;ert<

Apportioning criteria

Signature of the Govt.Servant Siva Prasad Matam, Assistant Technical Officer

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Annexure-II STATEME T O! MO"A#$E P%OPE%TIES POSSESSE&, A'()I%E& A & &ISPOSE& O! #* S%I+SMT+,)M SI"A P%ASA& MATAM, Assistant Technical Officer &O#-./-01-234/ O% A * OT5E% PE%SO O 5IS #E5A$! O% #* A * MEM#E% O! 5IS !AMI$* &)%I G *EA% E &I G &E'EM#E% .02

6Su7-%ule689 of %ule 03 of A.P.'.S. 6'onduct9 %ules 234:9

S o

ame of Pro;ert<+Pro;ert< &escri;tion

5eld in =hose ame

&ate > Mode of Ac?uisition or &is;osal

ame and Address of ;erson from =hom ac?uired + to =hom dis;osed of9

@hether transaction done =ithin the limits of Aurisdiction

Price Paid + O7tained

Source of Pa<ment

Signature of the Govt.Servant Siva Prasad Matam, Assistant Technical Officer

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Annexure-III Intimation of !oreign 'urrenc< + Goods received 7< the Govt. Em;lo<ee S%I+SMT+,)M SI"A P%ASA& MATAM, Assistant Technical Officer &O#-./-01 -234/ O% A * OT5E% PE%SO O 5IS #E5A$! O% #* A * MEM#E% O! 5IS !AMI$* &)%I G *EA% E &I G &E'EM#E% .021 )nder %ule 4-A of AP 'ivil Services 6'onduct9 %ules, 234:

ature of the !oreign &ate of 'urrenc<+Go receiving ods +acce;tin received+Acc g of e;ted !oreign 'urrenc< +Goods

Sources from =hich received+acce;te d

%eason+Pur;ose for =hich the foreign currenc< goods =ere received+acce;te d9

@hether the foreign currenc<+ goods received+a cce;ted The relation shi; of the =ere sendor to the reci;ient intimated and name, occu;ation to the > full address of the concerne sender. d authoritie s and customs or to the a;;ro;riat e authorit<.

@hether the foreign currenc<+ goods received+a cce;ted =ere declared to Income Tax &e;artme nt.If so,details to 7e furnished

Mode > Method of recei;t+ac ce;tances of the !oreign 'urrenc<+ goods 7< the Govt.Em;l o<ee+his de;enden ts

@hether the Govt.em;l o<ee is having an< official dealings from =hom the foreign currenc<+ goods =ere received+a cce;ted.

&etails of an< ex;enditure incurred 7< the Govt. Em;lo<ee+recei; t+acce;tance of the !oreign 'urrenc<+goods.

Signature of the Govt.Servant Siva Prasad Matam, Assistant Technical Officer