'L. Nam of the Government JYOTSNA.. flaflia!ta flt AI Servfnt in, full ' i n block. IfAT ION: REITURN.OF fli_fl..il' A CCCTC Atkin I IAQI ITICC

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1 RETURN.OF fli_fl..l' A CCCTC Atkin AQ TCC 'S ru's tfls!! t!''s fl_ AS \N 'L. Nam of the Government JYOTSNA.. flafla!ta flt A VVflL Servfnt in, full ' i n block a letter$ 2. Service to which he/she Himachal Judicial Services belongs 3. Total length of service as on 14 years month. date i} n Non GAZETTED rank } n GAZCTTCfl nn, A l'nare TED t.411fl 1r 7'i. ' flrll. 4. Present post and place of CVL JUDGE (SftDV)-CUMposting CJM SHU1LA, H.P. 5: Total annual income from all Salary as a Judicial Officer is sources during the calendar only income. Y.ar immediately proceeding the day of January. flcfl &s'srl AOTATflTU fat ON: -, hereby declare that the particulars from FORM to V are complete, true and correct as on to the best of may knowledge and belief, in respect of information due to be furnished by me under the provisions of Sub Rule(i) of Rule 18 of the Central Civil Services {Conduct} Rule, fl,t.fl ¼1!.., a' S(r2 Note. This return shall contain particulars of all assets and liabilities of the Government servant either in his own name or in the name of any other person. 2. f,a government servant is a member of Hindu undivided Family with coparcener rights in the properties of the family either as a "Karta" or as a member, he should indicate in the return in item No. the valve of such share in such property and where it is not cossible to indicate the exact value of such share its appropriate value, suitable explanatory notes may be added wherever necessary.

2 V S Eno M MO.i!1.1 STATEMENT OF THE MMOVABLE PROPERTY AS ON {i.e. LANDS, HOUSE, SHOPS AND OTHER BULDHNG ETC.} Description property HK3 No. 72, HMUDA Colony Nalagath, Distt Solan, H.P. 2. Precise iocation{name. of District, tin Division, Tehsil and Viflage in Which the property is situated arid also its distinctive number etc. 3. Area of land{in case of land and building} Sq Meter. 4. Nature of land{in case of landed N. property} Extent of interest. Joint owner with my husband Sb. Sumarit Da n not own name state in whose do---- name held and blather relationship. ;f arty, with the Government Servant 7. Date of acqu isit ion a How acqulred(wflether by Purcnase' in lottery system Tram purchase, mortgage, lease, HMUDA. inheritance gift or otherwise) and name with details of persor;(s} from whom acquired{address and LrOJ,eudOfl of the.,o*mrn1jl Servant if any, with the personlpersons concerned please see not below} 9. Value of propertysee Note belowil 2 26,60,0001-(TWPnty Eight BM Sixty Thousand on!y) 10. Particulars of. sanctions Prescribed authorty, if any. 11. Total annual income from property. of Hon'ble High Court of Hirnacha! Pradesh has been informed. the....nfl... flâtc, (Jyot&. 9atwa ) Civil JudSr. Div-cum CJM Note:- 1 ) For purpose of Column 9 of the termlease would on a lease of immovable property from year to year or for any term exceeding one year or reserving a yearly rent Where, however, the lease of immovable property is obtained from a person feting official dea!inps with the Guvernment servant, a lease should be shovti n, this in respect of the term at the lease whether it is short term or rong term and periodically of the payment of the rent. n Column No. 10 shou ld be shown(a) where the property has been acquired by purchase, rncartgage or lease, the puce or premium paid fiar atnh cc thafti(b) wftttt t $flb bttn atufttd bw ttcav thy tt*o annual rent thereot also.

3 / ( - OPM fdfl1l ATEMENT OF LQUD ASSESTS ON 'Cash and Bank Balance exceeding three months emoluments. U} Deposits, loans advances and investments (Such as shares securities and debentures etc;} Descriptidn Ni!. " Name a nd Mdr s "t -. cornpany, Bank etc. 3. Amount 4. f not in own name and address of persons in whose name held and his/her relationship with the Government Servant. 5. Anqual income derived.. Mil S R flornark 'J. fl'w%alfl fla+a L401jLjdg r. Div)-CUM, CJM Snthià *F%n4n in Column 7, particulars regarding sanctions obtained or report made in respect of the various transactions may be The term"empluments" means the pay and allowances received by the Government Servant. C

4 FORM NO:lfl V'ATEMENT OF MOVABLE PROPERTY AS ON Si ng.20113l lil 1. Description of item 1. Maruti 800(car) HP Gold Jewellery. 2.. Price of value at the time of acquisition and/or the total payment made upto the date of return, as the case may be, in the case of articles purchased on hire a purchase of installment basis, S. f, not in own name, name and address of the persons in AA n,nc cn,4 hiclb lamel ' ! TV '.1.. t tc4l with '.S'SY',.!'- employee. rnla+,r%fl *,,+h fln11arnrna For car Approximately? 2,20,000/- taken as loan and same has been repaid. Gold Jewelery worth Rs. 4 lacs has beet-, 'acquired by the by wall gift from. my parents, in-laws and relatives at the time of niarrage. 4. -low acquired with 4Car acquired on approximate date of August and Jewelery on Au. jet flflflfl 5.. Remarks --,, LY Date: - Note: 1. ot$a( CjvH Judg k-tiv)-cum -. Shi n this form/information may be given regarding items like(a) jew&ery owned by him{total value}(b) Silver and other precious metals and precious stones owned by him not forming aart of iewefry{total value), (c) (1) Motor Cars (ii) Scooters/Motor Cycle (iii)refrigerators/air Conditions (iv) Radios/Radiograms/Television sets and an y other articles, the value of which individually' exceeds R-'; ,-41 Value of items of movable property individually worth less that "S other than articles of da ily use such as clothes, utensils, books, crockery etc. added together as lump sum 2. n Column 5 may be indicated whether the property, was acquired by purchase, inheritance git or otherwise. 3 n column 6 particular 0 rri9 sanctions obtained on report made in respect of various transaction's may be, flu'."

5 U Sr Nn FORM NO:!/ STATEMENT OF MOVABLE PROPERTY AS ON ance Nam Sum iamount PROVDENT FUND Nnle linsured! of Annu jt daosg 'Confrib ito Remalcs date of and idate of pmiurn OViden( Sance lution. i{in iqf there linair 1maturily ilundsltip spute t as made di lance F /cpfjiepuzted1subseq je39u19 jcom 1 Aecount by Ueueny dosing 1pany i No. AudYA. lbsanee joijongrupee) j the 9ure with jaccofcn9 1 oateotj. to the ii such.1 1govamm LMaPGO jent (n khotddb nç4oe nienhono.1 ldiflthis H fcumn. -, a 0 in - 93in[ 2012 Date: (Jyotsna. \ LgflCWa) CM! J.Lkig. Dv)-cum CJM Shirt U C C

6 rt1 - FORM NO:V STATEMENT OF DEBTS AND OTHER LABUTES(AS ON !j.J S Amount Name a nd arldrooe of rrarl 'M! 4'.. M!'4 address 'l creditor Date of incurrhig liability Detail of transaction, Remarks Ni! t 4 ' Date: GJM Note: 1. ndividual items of loans not exceeding three months emoluments of t Whichever is less need be included. 2. n Column 6 information regarding permission, if any, obtained from or report made to the competent authority ' hn rn, a a ic,, M'?'J d'.- given. The fn + means "nrn'nj. a ii ew a,e.rm mans pay ah0a11.1es received by the Government employee. 4. The statement should also include various loans and advances available to Government employee like advance For purchase of conveyances, house-building advance etc.{other than advances of pay and traveling allowance) advances from the G.P. Fund and loans of Life nsurance Policçs and fixed deposit.