DECLARATION OF ASSETS & LIABILITIES
Submitted to [Bank / Authority / Institution Name] as a statement of net worth as on [As-on Date].
I, [Full Name / Entity Name], [Designation, if applicable], residing / registered at [Full Address], holding PAN [PAN Number], do hereby declare the following statement of assets and liabilities as on [As-on Date]:
Assets: Immovable property Rs. [Immovable Value]; Bank balances and deposits Rs. [Bank Balance]; Investments and securities Rs. [Investments]; Movable assets and others Rs. [Movable Value]. Total Assets: Rs. [Total Assets]. Liabilities: Loans and borrowings Rs. [Loans]; Other payables Rs. [Other Liabilities]. Total Liabilities: Rs. [Total Liabilities]. Net Worth: Rs. [Net Worth].
I confirm that the above statement is complete, and that no material asset or liability has been concealed. The particulars stated above are true and correct to the best of my knowledge and belief.
[Signature of Declarant]
[Name]
Place: [Place] Date: [DD/MM/YYYY]