Statement of Immovable Property Return for the year ending on 31.12.2014 (as on 01.01.

2015)

1. Name of officer (In Full): Jawahar Thakur 2. Batch: ICAS-1979

3. Present Post held: CGA 4. Present Pay: Rs. 80,000/-

Name of District Sub- Name & Details of Present value* If not in own name, state How acquired, whether by Annual income Remarks
Division, Taluk & Village property Housing in whose name held & purchase, lease**, from the
or City in which lands and other his/her relationship to mortgage, inheritance, gift property
property is situated(full buildings the Government Servant or otherwise with date of
location & Postal acquisition & name with
address) details of person(s) from
whom acquired
1 2 3 4 5 6 7
1.Dwarka (New Delhi) 1 three bedroom Present value not Own name HBA from Government of Rs. One lac CGA in 1997
house known. Acquired India & SBI annual rent
value Rs. 10 lacs in
1997
2.Raghunath Pur(Distt. 15 Acres land with a Not known Late parents’ name (late Ancestral (I will have no 0.75 lacs Not required
Purnia) Bihar house in the name of Upendra Thakur & Late selling right) (Approx.)
Parents (Ancestral) Kamla Devi) annual income
3.(i)Bahora*(Distt. 15 Acres of land Not known Wife’s Parental name & Ancestral and gifted 0.50 lacs Not required. As
Purnia), Bihar borther’s name (Stridhan) (Approx.) stridhan is yet to
Annual Income be transferred in
(My wife will have no the name of Mrs.
selling right) Renu Thakur

(ii) Distt.Purnia 75 years’ Old House & Wife’s name Wife’s name Rs.1 lac
18 kathas land as part approx.
of (3)(i) only

Sd/-
(Signature with name & date)
NOTES:

* In case where it is not possible to assess the value accurately, the approximate value in relation to present conditions may be indicated.
** Include short terms lease also.
The declaration form is required to be filled in and submitted by every member of Class I and Class II (Group-A and Group-B) services under rule 15(3) of the Central Civil Services
(Conduct) Rules, 1955, [now rule 18(1) of the CCS(Conduct) Rules, 1964] on the first appointment to the service and thereafter at the interval of every twelve months, giving
particulars of all immovable property owned, acquired or inherited by him or held by him on lease or mortgage, either in his own name or in the name of any members of his family
or in the3 name of any other person dependent on Government servant.
The wording ‘no change’ or ‘no addition’ or ‘as in the previous year’ should be avoided and full details provided.
The columns should be filled up neatly in capital letters.