ANNEXURE -I

STATEMENT OF ALL THE IMMOVABLE PROPERTIES POSSESSED, ACQUIRED AND DISPOSED OF BY THE GOVERNMENT SERVANT / SPOUSE OR
OTHER PERSON ON HIS BEHALF OR BY ANY MEMBER OF HIS FAMILY FOR THE YEAR ENDING DECEMBER 2013

(Sub-Rule (7) of Rule 09 of A.P.C.S. (Conduct) Rules 1964)

Situation of
property Held in Date & Mode of price
source of
Sl.No Nameof property (Sur/Mpl.No whose acquisition or paid /
payment
.) with name disposal obtained
extent

1 House
2 Flat
3 Shop
4 House Plot

5 Agricultural Land (Dry or Wet)

6 Any other immovable property

Note : Details of acquisition of properties standing in the name of Hindu un-divided family or partnership in which the officer holds a
claim or share should be seperately shown in the statement.
ID No.
Name:
DOB
Designation
Zone :
ENT SERVANT / SPOUSE OR ANY
ECEMBER 2013

Whether
information
Annual
given or
Income
sanction
from the
obtain with
property.
ref. No. &
Date

Signature of the
Govt.Servant
p in which the officer holds a
 ANNEXURE - II
STATEMENT OF MOVABLE PROPERTY POSSESSED, ACQUIRED AND DISPOSED OF BY SRI OR ANY OTHER PERSON ON HIS BEHALF OR BY ANY MEMBER
OF HIS FAMILY DURING THE YEAR ENDING

(Sub-Rule (7) of Rule 09 of A.P.C.S. (Conduct) Rules 1964)

Name and
Address of Whether
Date & Mode
Held in person from transaction done Price paid /
Sl.No. Nameof property of acquisition
whose name whom acquired / within the limits of obtained
disposal
to whom jurisdiction
disposed off

Movable (whose value exceeds

1
Rs.1,00,000/-

Vehicle: Motor
2 Car, Motor Cycle / Scooter any
other vehicle

Electrical Goods: Air

3 Conditioner, VCR/T.V.,
Refrigirator any other goods.

Jewellery :
4
Ornaments, Vessels etc.,
Investment & Cash:
5 Bank Deposits, Debentures /
Shares, Bank balance etc.,

6 Furniture
7 Live stocks
8 Any other goods
Signature of the Govt.Servant
Note : Details of acquisition of properties standing in the name of Hindu un-divided family or partnership in which the officer
holds a claim or share should be seperately shown in the statement.
ID No.
Name:
Date of Birth:
Designation :
Zone :
RSON ON HIS BEHALF OR BY ANY MEMBER

Source of payment

e of the Govt.Servant
artnership in which the officer
 ANNEXURE-III
Intimation of Foreign Currency / Goods received by Govt. Employee Sri
Under Rule 6-A of AP Civil
Services (Conduct) Rules, 1964.

1 Name of the Govt. Servant

2 Designation & Official Address

3 Department to which he belongs

Date of receiving / accepting of Foreign
4 Currency / Goods
Nature of the Foreign Currency / Goods
5 received / Accepted

6 Sources from which received / accepted

Reason / Purpose for which the foreign

currency goods were received / accepted
7
The relation ship of the sender to the recipient
and name, occupation & full address of the
8 sender.
Whether the foreign currency / goods
received / accepted were intimated to the
concerned authorities and customs or to the
9 appropriate authority.

Whether the foreign currency / goods

received / accepted were declared to Income
Tax Department. If so, details to be furnished
10
Mode & Method of receipt / acceptances of the
Foreign Currency / goods by the Govt.
11 Employee/his dependents.
Whether the Govt. employee is having any
official dealings from whom the foreign
12 currency / goods were received / accepted.
Details of any expenditure incurred by the
Govt. Employee/ receipt / acceptance of the
13 Foreign Currency / goods.

Station : Signature of the Govt. Employee

Date:

ID No.
Name:
DOB
Designation
Zone :
 ee Sri
Under Rule 6-A of AP Civil
4.

ture of the Govt. Employee