DR Chaitanya Thakur

THE SCHEDULE( See Rule 18(1))Return of Assets and Liability on the first appointment as on 1st December,20. .!/.1. Nameof the Govt. Servant .Y. u ~... .2. Service in which he belongs. irnvmJ.kJ~?Jj.j#M:~3.4.5.6.Total length of service up to date ... ... ,(i) In non Gazetted rank(ii) In Gazetted rankPresent post held and place of postingTotalannual'. mcome from all sources .11)'~1/fn.urI1.'.. ... :'~..."~ a I .....Dunng the Calendar ye ar Immediately .Preceding the..-lst J. '" ..' .,.."""'" -s;:""""""\;~:::::,:g'J!j.1 rlhA. auuary20J1. r .DecIaratlOn:- . ?.f/a\ İ.J Y.,,~'C,. ''''''' , ."I hereby declare that the retu,rnn 10s ,,'e .I NO.1 to V are comped.Y'., nmIl,".'., F.oontrue and correct as on .a~l~:2-.-1.2 tQ.tb~ . best of my knowledge and be,.,.. .in respect of information due t.'.' " .fumished by me underthe ,, , provisionsof,rule( 1) of Rule 18 of the Centra! Ciyil serVicesrO')Q.dttct~R~994Date a:z/?:i! .4-.., SigrUiture..d... ".' .",'Notel:- This recl;m shall contain particulars of all assets and liabilities ofGov!. servant either in his own name or in the name of any other person.Note 2:- If a Govt. servant is a member of Hindu United Family wcopercenary rights in the properties of family either as a "Karta" or as a memblhe should indicate in the return in the Form No. I the value of his share inproperty and where it is not possible to indicate the exact value of such shat~, ,itapproximate value, suitable explanatory notes should be added \vhere\~necessary

wdi~.~.~FORMNo. IStatement of immovable property on the first appointment as on 3pt December 20... ( e,g., Lands. House, Shops, OtherBuildings etc.) ) I' .If not in ownSr. No.1 Descri- Precise location Area of Nature of Extent ofPtion (Name of Distt., Land(In case land and Land in Interest Name, state in whose:Of property Division, Taluka & Building) Case of landed N3ffiCheld andVillage in whichPropertyHis/her relationshipThe propertyIs situated & also,if any to theGovt.1 2Its distinctiv~Servant. "YJtlr)'}.jt'Y 8k. I45 6 7I0 ~'a~ &v..wd-4tkva ,f

'.FORM NO.IIStatementof Liquid assetson first appointmentas on 31st December, 20. J.~ . "1. Cash & Bank balance exceeding 3 months emoluments2. Deposits, loans, advances and investments (such as shares, securities, debentures etc.)Sr. No. Description Name and Amount Ifnot in own Annual incomeAddress of company Name, nameAnd addressDerivedOf the personIn whose nameHeld and his/her relationShip with the Govt.ServantRemarks if anyr...-----Date ~~2- .Signature...~ ".~,. ". ...» ",,,,,"'" ..,. . 0" ..-' ..., .,. .. ., ...,.. ""..". INOTE I.-In Column 7, particulars regarding sanctions obtained or \report made in respect of the various transactions may be given.NOTE2.- The term, "emoluments" means the pay and aIJowances-~M;..",rI 1\\1 tnp (~(Wf\rnment servant."-

-.,FORM NO. IIIStatement of mov~ble pfoperty on first appointmentSr. No. IDescriptionOf items( .2-...Price or value at the timeOf acquisition and/or the totalPayments made up to the dateof return, as the case may bein case of articles purchasedon hire purchase orinstalment basisbl~.I jo.Jd.as on 3151December 20..r.,..If riot in own name,Name and addressIn whose name andHis/her relationshipWith the Govt.ServantHowacquired I RemarksifWith approximateDate of acquisition..any I .'3'3. bid.. tit .--,,-NOTEI.-In this Form, information may be given regarding iterps like(a) jeweIJery owned by him (total value): (b) silver and other precious metalsand precious stones owned by him not forming part of jewellery (totalvalue); (c) (i) Motor Cars, (ii) Scooters/Motor Cycles, (iil) refrigerators/airconditioners,(iv) radios/radiograms/television sets and any other articles,the value of which individuallyexceedsRs. 1,000; (d) val,ueof iteITIs, of, movable property individually worth less than Rs. 1,000 other than articleshGaslum of daily p sum. use such as clothes, utensils, books, crockery, etc. I added together,,'"'(/, NOTE2.-ln Column 5, may be indicated whether tbe property wasL ' acquiredby purchase,inheritance,gift or otherwise.r"INOTE3.-10 C;olumn 6, particulars regarding sanction obtained or1'- report::.e in respeel of VariO,":transactions may be g~,.nb R, t:Signature ..

.FORM NO.IVStatement ofProvidentFund and LifeInsurancePolicyon FirstAppointmentas on 31st December20.J.L..Insurance PoliciesSr. No. Policy No. and Name of Sum Insured/dateDate of policy insurance Of maturity1 I \ 2f Com an 3 4L~O/f1 ./ LI L.,-152~ ?o$5y Lr L. cJ5tA.CQ 200 02-T"Y1.NJVqI\ul. L\ c. - ) S" 20 g'12S. l\ C. kla)\ h.200 2c:,24wwv-ov1L\C - I~o f 6(3 L- \ C- ~ o.k./"").00 I([ 20 2- £Amount of AnnualPremium5,,/qSILf.ICJ/{g- «)~lf,IIIIIIIIIProvident FundType of Closing balance as Contribution madeProvident Last reported by SubsequentlyFunds/GPF/CPF The Audit!AccountsAccount No. Officer along withDate of suchBalance678Hf/oYI5'~{cr /6v/(:)00 (~Total amount9~ ?6/, dORemarks (If there isDispute regardingClosing balance,The figures accordingTo Govt. servantShould also beMentioned 10fJ-IISignaturt.. t!

\.1FORM NO.VStatement of Debts and Other Liabilities onFirst Appointmentas on the 31 5t December,20... .......I Sr. 1\0.1 AmountI-- iIName and addressOf CreditorDate ofincurringLiabilitDetails of Transactions Remarks if anyI.~.s,.13~6ooQed~J~,K,C.~C'3131~. HcLri'fwIJ