INDIAN BANK, Adarsh Nagar Branch BRANCH
DETAILS OF ASSETS AND LIABILITIES
Annexure-3
OF Mrs. REKHA MEDATWAL AS ON
Add:
CHHIPA COLONY, GAYATRI PUBLIC KE PASS, BHOMIYA JI KA THAN, MEDIYA BEAWAR AJMER RAJASTHAN
305901
Lands. IMMOVABLE PROPERTY.
Name of the village Ancestral of If encumbered Extent in acres Doc Regn No. Total value
or Taluka Self acquired To what extent Wet/Dry Date & Address Rs
Where the lands of Registrar
are situated with Office
S.No
------------NIL----------
(1) Total
Buildings
Name of the village Ancestral or If encumbered Doc Regn No. Total Value
or Town where they are Self- acquired. To what Date & Rs.
situated and the street & Extent. Address of
Municipal No: Registrar
Office
Residential House
Shops and
factories ------NIL------
Machinery/
Vehicles etc
(2) Total
Liquid Assets
Nature of If encumbered Amount Market Total Value
stock To what extent Value Rs.
Saving self 0.40
Cash & Bank Balance bank
NA NA NA NA NA
Investment in business
NA NA NA NA NA
Investment in Government
Promissory Notes, shares, NSC
Etc
Gold , Self 1.60 lacs - 1.60lacs
Other movable property like Life SILVER,
Policy etc. (Paid up value) vehicle etc
(State their nature) lic
(3) Total Rs Rs 2 .00 lacs
(1)+(2)+(3) Grand Total of Assets Rs
Liabilities
Borrowing SECURITY
Nature Value Limit Amount borrowing
Rs
From our Bank*
From other Bank* ---N.A---
From other sources*
Gross Income for the year 2020-21 : Rs.
Net Income for the year 2020-21 : Rs.
I certify that all information furnished above is true. I have no borrowing except those mentioned above. No legal action has
been taken or pending in any court against me/us/firm/company .I am not in the defaulters list of RBI/SAL of ECGC. I am not
directors on board of any Public/Private sector/Co-operative Banks. I am also not related to any official of Indian Bank.
Date:19.8.2021
Signature.
Furnish full details on the reverse side.
Investment in Business
Name of the Company/Firm Amount invested Amount withdrawn Net investment.
----------Not
Applicable--------
*Borrowings from our Bank
Name of the branch Nature of facility Limit sanctioned Security value (Rs) Balance outstanding
(Rs)
------NIL-----
*Borrowing from other Banks
Name of the Bank Name of branch Nature of facility Amount Sanctioned Balance outstanding
(Rs) (Rs) (Rs)
------------N.A-----------
*Contingent Liabilities
Name of facility Details of Liability Amount (Rs)
1.Guarantees signed
2.Taxes under dispute outstanding
3.Claim against us, not acknowledged as
debts
4.Bills discounted with Banker not yet ----------------N.A.-------------------------
due for payment
5. Letters of Credits/Guarantees issued
on my behalf.
6. Estimated amount of contracts
remaining to be executed as capital
account not provided for.
7. Others, if any.
Total Rs
Details of legal heirs:
Name Age Relationship
MUKESH KUMAR MEDATWAL 40 SPOUSE
I undertake that:
I will intimate the bank, if any of the assets mentioned in my assets and liability statement is disposed off.
I will intimate the bank, if I will assume any further liability other than the mentioned in my assets and liability
statement.
DATE: 19.08.2021 Signature
Details to be enclosed: a. IT/WT returns; b. Proof of Ownership of assets
