FORM NO.

1
STATEMENT SHOWING DETAILS OF IMMOVABLE PROPERTY ON FIRST APPOINTMENT AND ALSO ON 1ST JANUARY OF EACH CALENDAR YEAR -2010
(eg. Lands, Houses, Shops, other Building, etc.)

NAME : Ravi Kumar EMPLOYEE NO. : 101 DESIGNATION : Sr. Manager

DEPARTMENT : Mechanical ORGANISATION : Manganese Ore (India) Limited, Nagpur

DATE OF JOINING : 24th July 1990 BASIC PAY : Rs. 25,400 /- RESIDENTIAL ADDRESS : M-20, Priya Apartment, Saraswati Nagar,
Nagpur (M.S.)

Sr. Details/description If not in own name, state in whose How and when Value of the Total annual Remarks
No. of property and its location (see notes name held and his/ her acquired (see notes 2 property income from
1&5 below) House/ Building/Land No. relationship if any to the employee & 6 below) (see note 3 below) the property
1 2 3 4 5 6 7
1. Plot (i) Purchased from
(i) Area : 1500 Sq.ft. Own name Shri Ashok Rs. 4,50,000.00 NIL
(ii) Location : Ram nagar, Nagpur Kumar
(ii) Dt.:22/05/1995
2. Flat
(i) Constructed area: 800 Sq. ft. Smt. Savita Devi – Wife (i) Gifted from Rs. 15,60,000.00 Rs. 4,000.00
(ii) Location: Dixit nagar, Nagpur uncle Shri by rent per
Rajendra Kumar
month
(ii) Dt. 11/03/2001

3. Land Own name (i) by Inheritance Rs. 18,70,000.00 Rs. 5,000.00

(i) Agriculture/Urban - Agriculture (ii) Dt. 18/06/2003
per month
(ii) Total area of land - 3 acres
in Hect./Acre
(iii) Khasra/ Patta no.- 1023
(iv) Location- Village- Munjara
Tah.- Balaghat
Distt.- Balaghat(MP)
Note: 1. If the property is not wholly owned the extent of share may also be indicated.
Note: 2. For the purpose of Col.4 the term ‘lease’ would mean a lease of immovable property from year to year or for any term exceeding the year or reserve yearly rent. When, however, the lease of immovable
property is obtained from a person having official dealings with the employee, such a lease should in this column irrespective of the term of the lease whether it is short term or long term and the periodicity
of the payment of the rent.
Note: 3. In Col 5 should be shown: a) Where the property has been acquired by purchase, mortgage or lease, the price of premium paid for such acquisition.
b) Where it has been acquired by lease the total annual rent thereof also and
c) Where the acquisition is by inheritance, gift or exchange, the approximate value of the property so acquired.
Note: 4. The annual return in respect of immovable property may also be submitted in this form as on 1st January.
Note: 5. Name of District, Division, Taluka & Village in which the property is situated and also its distinctive number etc. will be given in Col.2.
Note: 6. whether by purchase, mortgage, lease, inheritance, gift or otherwise & name with details of person/persons from whom acquired. Address & connection, if any with the person/persons concerned are also to
be given in Column.

Place: Balaghat Date: 22/07/2010 Signature:

 FORM NO. 3
STATEMENT OF ASSETS AND LIABILITIES
DETAILED STATEMENT IN RESPECT OF SHARES /DEBENTURES PURCHASED UNDER PROMOTERS/EMPLOYEES QUOTA AS ON 1ST JANUARY
OF EACH CALENDAR YEAR IN OFFICERS OWN NAME AND ALSO THOSE HELD IN THE NAMES OF SPOUSE AND DEPENDENTS/CHILDREN.

NAME : Ravi Kumar EMPLOYEE NO. : 101

DESIGNATION : Sr. Manager DEPARTMENT : Mechanical ORGANISATION : Manganese Ore (India) Limited, Nagpur

DATE OF JOINING : 24th July 1990 BASIC PAY : Rs. 25,400 /- P.F. INDEX NO. : R-301

Category Sr. Name of the Company No. of Face Cost of Whether promoters How acquired Position held at the time of acquisition
No. shares Value acquisition Employees quota and if the company had any borrowing
or other facilities at that time.
1 2 3 4 5 6 7 8
A. Self 1. Bank of India 100 Rs. 35.00 Rs. 3500.00 Promoters By purchasing Individual

B. Spouse 1. NTPC Ltd.

and In name of
Dependent 1. Smt. Savita Devi-wife 250 Rs. 125.00 Rs. 31,250.00 Promoters Gifted by -
Children Father in law -
Shri Ram singh

2. Shri Kedarnath- son 100 Rs. 125.00 Rs. 12,500.00 Promoters By purchasing

1) Any additions/deletions to this statement as on 1st January-2010 and the profit/ loss incurred by me are given below.

I hereby declare that the particulars given above are true.

Place: Balaghat Date: 22/07/2010 Signature:

 ANNEXURE
(To be submitted along with the Assets & Liabilities Statement as on 1st January of every year)
Form for giving information where total transactions in shares, securities, debentures and investment in mutual fund schemes etc. exceed Rs. 25,000/- during
the calendar year as on 1st January 2010.
1. Name and designation : Ravi Kumar, Sr. Manager (Mech.)
2. Employee No. : 101
3 i) Scale of pay and present pay : Rs. 20,600.00-46,500.00 & B.P.- Rs. 25,400.00
ii) P.F. Index No. : R-301
4. Details of each transaction made in shares, : Details mentioned in Form-3
Securities, debentures, mutual funds scheme
etc. during the calendar year.
5. Particulars of the party/firm with whom : --- do----
transaction is made
a) Is party related to you? : No
b) Did you have dealings with the party : No
in your official capacity at any time or
is the applicant likely to have any
dealings with you in the near future?
6. Source or sources from which financed?
a) Personal savings : Yes
b) Other sources giving details : 1. Loan from Provident Fund & Credit society
7. Any other relevant fact which you may like to : Nil
mention.

Declaration:

I hereby declare that the particulars given above are true.

Place: Balaghat Date: 22/07/2010 Signature: