st STATEMENT OF IMMOVABLE PROPERTY RETURN FOR THE YEAR 2017 AS ON 01 January 2018

1. Name of Officer (in full) : TUBAI DUTTA

2. Service to which the Officer belongs : SSS

3. Cadre & Batch : Employee Code: 6449

4. Present Pay : 41100

SL Name of Name & Cost of Present value* If not in own name, How acquired Annual income from Remarks NO. Khasra No., Details construction/ state in whose whether by property Village/City, of Property Acquirement name held and his/ purchase, lease**, Taluk, Sub- (Description) (and year her relationship to mortgage Division, when the Govt. Servant inheritance, gift or District purchased) otherwise with in which including of date of property is land in case acquisition and situated (full of house name with details location & of postal address)

1 2 3 4 5 6 7 8 9 1 WEST BENGAL House Semi 670000.00 No Bipula Dutta Inheritance - 20000 JALPAIGURI Pukka House Mother MAL MAL Malbazar C/O Late Shibu Dutta, Adarsha Colony, Ward No: 1, PO/PS: Mal, Dist: Jalpaiguri, West Bengal 735221

2 WEST BENGAL Shop A small 330000.00 Yes Sole Inheritance - 10000 Jalpaiguri Mal shop of length Mal Malbazar 40 feet and C/O Late Shibu

SL Name of Name & Cost of Present value* If not in own name, How acquired Annual income from Remarks NO. Khasra No., Details construction/ state in whose whether by property Village/City, of Property Acquirement name held and his/ purchase, lease**, Taluk, Sub- (Description) (and year her relationship to mortgage Division, when the Govt. Servant inheritance, gift or District purchased) otherwise with in which including of date of property is land in case acquisition and situated (full of house name with details location & of postal address)

1 2 3 4 5 6 7 8 9 Dutta, Adarsha breath 9 feet Colony, Ward No: 1, PO/PS: Mal, Dist: Jalpaiguri, West Bengal 735221

6449 TUBAI DUTTA Date : 23-03-2018 Signature JUNIOR STATISTICAL OFFICER

NOTES: 1) * In case where it is not possible to assess the value accurately, the approximate value in relation to present conditions may be indicated.

2) ** Includes short term leases also.

3) The declaration form is required to be filled in and submitted by every member of Class I and Class II services under relevant provisions of Conduct Rules and the first appointment to the Service and thereafter, at the interval of every twelve months, giving particulars of all immovable property owned, acquired or inherited by him or held by him on lease or mortgage, either in his own name or in the name of any member of his family or in the name of any other person dependent on Government Servant.

4) The wording ‘No Change or No Addition or As in previous year’ may be avoided and all details filled up.

5) All Officers are requested to fill the form in duplicate.