Form 1 ( Page 2)

(12) In cases of acquisition, source(s) from which
financed/ proposed to be financed:
(a) Personal savings:
(b) Other sources (giving details):
(13) 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):
(14) (a) Name and address of the party with whom
transaction is proposed to be made:
(b) Is the party related to the applicant? If so,
state the relationship?
(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 in near future?
(15) In case of acquisition by gift, whether
sanction/ requisite intimation obtained/ given
for its acquisition under Rule 15 of Conduct
Rule (If so, copy of the sanction or intimation
should be attached) :
(16) Any other relevant fact which the
applicant may like to mention :
DECLARATION
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 14 above.
OR
I,……………….…………………………….., hereby intimate the proposed
acquisition /disposal of property by me as detailed above. I declare that the particulars
given above are true.
Station: Signature:
Date:
Designation:
Note: Where previous sanction is asked for, the application should be submitted
at least 30 days before the proposed date of the transaction.