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DeptL 0f.'pcrsonncl (A-N)
No.RC (B)3(2)2008 'L S- 2. ~ Government of Himachal Pradesh, Resident Commissioner office, Himachal Bhawan !"-
27-Sikandra Road New Delhi-110001 Dated: 06.11.2009 To
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/~ecretary (Personnel) to the Govt. of Himachal Pradesh Shimla-171002. Sub: Regarding submission of Assets & Liability return as on 31.12.2008, as required under rule 18(1) of CCS (Conduct) Rules, 1964. Kindly refer to your office letter No. Per(A-IV)-F(11)-1/2004 dated 30 September, 2009 on the subject cited above and find enclosed herewith Return of Assets and liabilities as on 31.12.2008 in respect of the undersigned along with declaration form indicating non membership in any private company as well as about visit in foreign country for further necessary action at your end please. Encls: as above Yours faithfully, th
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(Himanshu Shekhar Chaudhary) --{--Dy.Resident Commissioner, Govt. of Himachal Pradesh.
27, Sikandra Road, Himachal Shawan, New Delhi-11 0001 Phones: Off.: 23711964, 23716124 Fax: 011-23715087
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RESIDENT COMMISSIONER GOVT. OF HIMACHAL PRADESH
I, H. S. Cbowdbary, presentJ.y 'Working w.s DY. Resident Cowwissioner, Goverr:ment of Himachal Pradesb, New De.1.bihereby deCJ..are that I tun not a MeEDerof any privw.te caapany .LiJ[e AlBw;;,y, Bindustan Lever Ltd. etc. from tbe ye-r 2003 to 2007. I lurtber dec.Lare that I h20ve never visited any foreign country so rare
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DY. Resident
caaadssioner.
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RETURN OF ASSETS AND LIABll..ITIES 1.
Name of the Government Servant in full (In block letters):-
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Service to which he/she belongs:-'ft·
3.
Total length of service as on date :(i) In Non GAZETTED rank:ii) In GAZETTED rank:-
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AS ON 31·12-20 ~
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Total annual income from all sources during the Calendar year immediately proceeding the 1st day of January, 20 ~.
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I hereby declare that the particulars from FORM I to V are complete, true and correct on 31.,03·20_, to the best of my knowledge and belief, in respect of information due to be furnished by me under the provisions of Sub-Rule (i) of Rule 18 of the Central Civil Service (Conduct) Rule, 1964.
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Note: I. This return shall conlllin particulars of all assets and liabilities of the Government servant'either in his own 2.
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name of any other person. If a Government servant is a member of Hindu undivided Famjly with coparcener rights in the properties of the' family either as a "Karta" or as a member, he should indicate in the return in item No. I the value of such share in such property and where it is not possible to indicate the exact value of such share its appropriate value suitable explanatory notes may be added wherever necessary. '
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FORM NO: I STATEMENT OF THE IMMOVABLE PROPERTY AS ON 31.12.20~ (i.e. LANDS, HOUSE, SHOPS, and OTHER BUILDING ETC.) Sr. No
Description property
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Precise location (Name of District, Division, Tehsil and Vdlage in which the property is situated and also its distinctive numberetc.
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Area of land (in case of land &BuiIding)
E~1ent of interest
Nature of land (in case of landed property)
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7
6
5
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ICnotown name state in whosename heJd & bislher reJatioDShip if any, with the Gort. Servant
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Ho'" acquired (whether by purchase, mortgage, lease inheritance gift or otherwise) & name with details of person(s) from whom acquired (address and connection of the Gort. Servant if any, with the person/persons concetned please see note 1 below) 9
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Value of property (See note 2 beJow)
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Particulars of sanctions of prescribed authority, if any
Total annual income from the property
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For purpose of column 9 of the term (Lease would on a lease of immovable property from year to year or for any term exceeding one year or reserving a yearly rent. Where.
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obtained from a person having official dealings with the Govt. servant, such a lease should be shown in this in respect of the term of the lease whether it is short teon or long term and periodically of the payment of the rent. 2.
In Col. No. 10 should be shown (a) where the ~ also.
has been lIajuired by purchase. mortgage or lease, the price or premium paid for such acquisition (b) where it has been acquiIed by lease the total annual rent there of
STATEMENT
OF LIQUID ASSESTS ON 31-12-20~
i.) Cash and Bank Balance exceeding 3 mo'hths emoluments. ii.) Deposits, loans advances and investments. (Such as shares, securities and debentures etc.) Sr. No.
1
Description
Name and addresses of company, Bank etc.
3
2
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Amount
H not in own name and address of persons in whose name held and hislher relationship with the Govt. Servant
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5
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Remarks
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Annual Income derived
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Signature:
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FORM NO-m STATEMENT OF MOVABLE PROPERTY AS ON 31-12-20~ Sr. No.
Description of item
1
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Price of value at the time of acquisition and lor the total payment made upto the date of return, as the case may be, in the case of articles purchased on hire a purchase of installment basis. 3
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If not in own name, name and address of the persons in whose name and hislher relationship with Govt. employee·
How acquired with approximate date of acquisition
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Signature:
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In this fonnlinfonDation
~Y be given regarding items Iikc (a) jewelry owned by him (total value) (b) Silver and other ~ious
Motor Cars (ii) SCOOIel'SIMotor Cycles (ill) RefrigeratoniAir-CooditiOllS 2. 3.
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