Form B: Form B

FORM B [See sections 60, 110 & 137] STATEMENT OF ASSETS AND LIABILITIES I, .................................................................. candidate/ Member,*National Assembly/ Senate, Provincial Assembly, Punjab/ Sindh/ Khyber Pakhtunkhwa/ Balochistan from constituency ........................./ from the seats reserved for women/ non-Muslims hereby declare that no immovable and moveable property, including bonds, shares, certificates, securities, insurance policies and jewelry, other than specified herein below, is held by me, my spouse(s) and dependent children on 30th day of June,_________. ASSETS ASSET COST OF ASSET REMARKS 3 1 2 1. IMMOVABLE PROPERTY Open plots, houses, apartments, commercial buildings, under construction properties, agricultural property, etc. (a) Held within Pakistan* (i) ____________________ (ii) ____________________ (iii) ____________________ (b) Held outside Pakistan* (i) ___________________ (ii) ____________________ 2. MOVABLE ASSETS (a) Business capital within Pakistan (i) Name of business (ii) Capital amount (b) Business capital outside Pakistan (i) Name of business (ii) Capital amount (c) Assets brought or remitted from outside Pakistan* (i) Bank drafts/ Remittances (ii) Machinery (iii) Other (d) Assets brought out of remittance from abroad* Page 118 of 122 ASSET COST OF ASSET REMARKS 2 3 1 (e) Investments (i) Stock and Shares (ii) Debentures (iii) National Investment (Unit)Trust (iv) ICP Certificates (v) National Savings Schemes -- Defence Savings Certificate -- Special Savings Certificate -- Regular Income Certificate (vi) Unsecured loans (vii) Mortgages (viii) Any other (f) Motor Vehicles* Make Model Reg. No. (i) ______ ______ ______ (ii) ______ ______ ______ (g) Jewelry etc. (i) Weight_______________ (ii) Description___________ (h) Cash and Bank Accounts* (i) Cash in hand (ii) Cash at Bank Account No. Bank & Branch Current __________ ___________ Deposit __________ __________ Saving __________ ____________ Other Deposit ______ __________ (i) Furniture, Fittings &articles of personal use– (j) Assets transferred to any person– (i) Without adequate consideration, or (ii) by revocable transfer (k) Any other assets. *Details to be annexed. Page 119 of 122 LIABILITY LIABILITIES REMARKS AMOUNT (i) Mortgages secured on Property or land (ii) Unsecured Loans owing (iii) Bank Overdraft (iv) Bank Loans (v) Amounts due under Hire Purchase Agreement (vi) House Building Loans (vii) Advances from Provident Funds etc. (viii) Other debts due* (ix) Liabilities in the names of dependent children (in respect of assets standing in their names) Total *Details to be annexed. VERIFICATION I,...........................................................................................S/o,W/o,D/o..................... do hereby declare that, to the best of my knowledge and belief, the above statement of the assets and liabilities of myself, my spouse(s), dependent children is correct and complete as on 30th June……….. and nothing has been concealed therefrom. Date........................................... Signature of the Candidate/ Member ______________________________ Page 120 of 122

Effective date: 2017-10-02

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