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Declaration of Assets and LiabilitiesYEAR :- 2015-16

I MD ABU QAIS AZAM, Son of Late SHAMSUZZAMAN, aged 53 Years, belonging to Bihar State Food andCivil Supplies Corporation Limited Service and presently working as Assistant Manager, Bihar State Food andCivil Supplies Corporation Limited, Nawada give here in below the details of the Assets (Immoveble Movable,Band Balance etc ) of myself my spouse and dependants.,

S. Description Self Spouse(s) Dependent- Dependent-2 Dependent-Name (s) 1 Name Name 3 Name

No. .. . .

1 2 3 4 5 6 71 Cash Rs.3000.00 7200.00 Nil Nil Nil

2 Deposits in Banks, Financial PNB,NAWADA Nil Nil Nil Nil630333/- BOI

Institutions and Non Banking13613/-NALANDA

CO. BANK 170756/

financial Companies3 Bonds, Debentures and Shares in Nil Nil Nil Nil Nil

Companies4 Other Financial Instruments Nil Nil Nil Nil Nil

NSC Nil Nil Nil Nil NilK.V.P.Postal Savings Nil Nil Nil Nil Nil

LIC Policies etc. LIC 22630/- Nil Nil Nil Nil

YEARLY

5 Motor Vehicles (details of make, PRIYA SCOOTER Nil Nil Nil Niletc.) FourWheelar BR-21S-0089

6 Jewellery (give details of weight Gold - 15 gms Gold - 185 Nil Nil Niland Value) gms

silver 210

GMS7 Other Assets, Such as Values of Nil Nil Nil Nil Nil

Claims/Interests

Note: Value of Bonds/ Shares/ Debentures es per the latest Market Value in Stock Exchange in respect of listedcompanies and as per Books in the case of non listed Companies should be given.

* Dependent here means a person substantially dependents on the Income of the Employee

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rB DETAILS OF IMMOVABLE ASSETS

{ Note: Properties in Joint Ownership indicating the extent of Joint Ownership will also have to be indicated}

S. Description Self Spouse(s) Dependent- Dependent-2 Dependent-Name (s) 1 Name Name 3 Name

No.1 2 3 4 5 6 7

1 Aariculture Land Nil Nil Nil NilPATERNALNOT

Location (s) DIVIDEDI

-

Survey Number (s)

Extent (Total Measuremet)

Current Market Value2 Non Aariculture Land Nil Nil Nil Nil

Location (s)PATERNALNOT

DIVIDEDSurvey Number (s)

Extent (Total Measuremet)

Current Market Value3 Buildings (Commercial !'!illl Nil Nil Nil Nil Nil

Residential'\Location (s)Survey Number (s)Extent (Total Measuremet)Current Market Value

4 House/Apartments . etc. Nil Nil Nil Nil,Location (s) PATERNALNOTSurvey Number (s) DIVIDEDExtent (Total Measuremet)Current Market Value

5 Others (such as Interest in Nil Nil Nil Nil NilProperty)

2 I give here in below the details of my liabilities/ overdues to public financial institutions and government dues:

Note: Please give separate details of each item)

So Description Name & Address of Amount Outstanding asNo. Bank! Financial on .............1 2 4 6

a. i. Loan from Banks Nil Nil

ii. Loans from Financial Institutions Nil Nil,

iii. Government Dues:a. dues to Departments dealing with Government Nil Nil

accommodationb. dues to Departments dealing with Supply of Water Nil Nil

c. dues to Departments dealing with Supply of Flecticity Nil Nil

n. n\le~to oepartments oealing with Telephones Nil Nil

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;I

e. dues to Departments dealing with Gevernment Nil Nil

Transport ( including Aircrafts and Helicopters)f. Other Dues, if any Nil Nil

b.i. Income Tax including surcharge [ Also indicate the AAKPQ-3826E NilAssessments Year upto which Income Tax ReturnFiled. Give also Permanent Acount Numer ( PAN) ]

ii. Wealth Tax [ Also Indicate the Assessment Year upto Nil Nil

which Wealth Tax Return filled.]iii. Sales Tax [ Only in Case of Proprietary Business] Nil Nil

iv. Property Tax Nil Nil

C Personal DetailGPF/CPF/PRANNo.

Gender Male

Date of Birth 15-09-1962

Class / Group C

Cadre B.5.F.es

( Full Name e.g. B.A.S. - Bihar Administrative ServiceB.S.S. - Bihar Secretariat Service etc.)

Home District NALANDA

I heredy declare that the above details are true to the best of my Knowledge and belief.

Signature ~~~ ~

Name of Emlpoyee : MD ABU QAIS AZAM

Place : Nawada Designation: Assistant Manager

Date: Department: Bihar State Food andCivil Supplies Corporation Limited

Not Please sign each page of the declaration. Assest declaration form must be in A4 size white papere : with Computer typed (single Side) in prescribed format.

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