I give herein below the details of my liabilities/overdues to public financial institutions and Government dues :

(Note :- Please give separate details for each item)

Sl. No. | Description | Name and address of Bank/Financial Institution Department | Amount Outstanding as on -

1 | 2 | 3 | 4

(a)

1. (i) Loans from Bank
2. (ii) Loans from Financial Institutions.
3. (iii) Government dues (Other than income tax and wealth tax) (No. Due Certificate to be enclosed in case holding or having held any public office).

1. (b) (i) Income tax including surcharge (Also indicate the assessment year upto which income tax return filed. Give also permanent Account Number (PAN).
   • (ii) Wealth Tax (Also indicate the assessment year upto which wealth tax return filed.
   • (iii) Sale tax only in case of Proprietory business).
   • (iv) Property Tax.