|1.||Name of the Government servant :||__________________|
|(b)||Service to which belongs:||__________________|
|(c)||Employee No./ Code No.:||__________________|
|2.||Scale of Pay and present pay:||__________________|
|3.||Purpose of application:@||__________________|
|4.||Whether property is being acquired or disposed of:||__________________|
|5.||Probable date of acquisition/disposal of property:||__________________|
|6.||(a)||Mode of acquisition β :||__________________|
|(b)||Mode of disposal β :||__________________|
|7.||Description of Property.|
|8.||In case of acquisition, source or sources from which financed/ proposed to be financed. Ω:||__________________|
|9.||In the case of disposal of property, was requisite sanction/intimation obtained/given for its acquisition (A copy of the sanction/acknowledgement should be attached):||__________________|
|10.||Details of the Parties with whom transaction is proposed to be made:|
|11.||In case of acquisition by gift, whether sanction is also required under Rule 13 of the CCS (Conduct) Rules, 1964? a||__________________|
|12.||Any other relevant fact which the applicant may like to mention||__________________|
I ……….. ……………… . ….. . …… . . hereby declare that the particulars given above are true. I request that I may be given permission to acquire/dispose of property as described above from/to the party whose name is mentioned in item 11 above.
I, … . . . …. . … . . … . . …… . ….. . ………. hereby intimate the proposed acquisition/disposal of property by me as detailed above. I declare that the particulars given above are true.
Instructions to follow while filling up the above form:
|Symbols||Sl. No./ Field no.||Instructions|
|@||3.||Purpose of application: sanction for transaction or prior intimation of transaction.|
|Mode of acquisition/ disposal: whether Purchase/ sale/ Gift/ Mortgage/ Lease or otherwise should be mentioned.|
|$||7(a)||Full details about location viz. Municipal No., Street/Village, Taluk, District and State in which the property situated.|
|ψ||7(b)||Type of Property: Housing and other buildings or Lands.|
|&||7(d)||Whether applicant’s interest in the property is in full or part, in case of partial interest, extent of such interest must be indicated.|
|*||7(e)||Ownership of the property, in case transaction is not exclusively in the name of the Government servant, particulars of ownership and share of each member may be given.|
|#||7(f)||Sale/ purchase price of the property (Market value in the case of gifts)|
|Ω||8.||In case of acquisition, Source or sources from which proposed to financed:- (a) Personal Savings or (b) other sources giving details.|
|€||10(c)||Did the applicant have any dealings with the party in his official capacity at any time, or is the applicant likely to have any dealings with him in the near future? Write the answer in YES or NO. If yes, full details should be given|
|®||10(d)||How was the transaction arranged? (Whether through any statutory body or a private agency through advertisement or through friends and relatives). Full particulars to be given.|
|a||11||Write the answer in YES or NO.|
2. In the above form, different portions may be used according to requirement.
3. Where previous sanction is asked for, the application should be submitted at least 30 days before the proposed date of the transaction.
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