"ملف رقم ١٦\٦٨ تبديل أوراق مالية وعُمْلات قديمة ومشوهة." [ظ‎‎٢‎٩] (١٢٨/٥٨)

4
64 THE GAZETTE OF INDIA EXTRAORDINARY, JAN. 12,1946
4. District or circle in which declarant is assessed to income-tax.
5. If declarant is engaged in business, profession or vocation, name in which
carried on or in the case of a firm, the firm’s name.
6. Principal place of business, profession or vocation of declarant, location,
and style of each branch.
7. Name and address of each partner, if declarant is a firm. '
8. Name and address of each firm or firms, if declarant is a partner in a firnu
9. If declarant is a salaried person, amount of the salary per annum.
10. If declarant is a Government servant, Government Department and
post held.
11. If declarant is a retired Government servant, last post held, the Govern
ment Department under which such post held and date of retirement.
12. If declarant is a retired servant of a non-Government employer, parti
culars of last post held.
18. If declarant is not a retired employee, particulars of former profession or
vocation.
If declarant is a lady, name of husband or guardian and his address.
If declarant is a lady with a vocation, or employment, particulars.
14. Particulars of high denomination notes tendered:
Denomination Numbers* Total value
Rs.600 Rs.
1.000 * List to be attached
10,000 separately.
15. Reasons for keeping above amount in high denomination notes rather
than in current account;, fixed deposit or securities.
16. When and from what source did declarant come into possession of bank
notes now tendered?
17. If notes in question represent re-import of bank notes sent out of British
India, quote number and date of Reserve Bank of India’s licence.
18. Does the value of bank notes now tendered represent business profits in
whole or in part? If so, specify name of business and year or years in which
such profits made and place of business.
19. If amount in 18 above is in excess of profits referred to therein, indicate
the source of excess with evidence in support.
20. Has any other declaration been made by declarant dr on his behalf else
where? If so, state full particulars.
I/We hereby declare that the particulars furnished above are full, true and
correct to the best of my/our knowledge and belief. I/We further declare that
the bank notes tendered herewith belong to me/us and are not benami holdings.
I/We undertake to advise the Reserve Bank of India, Bombay, if any other
high denomination bank notes are tendered for exchange by me/us for exchango
at any other station(s).
Signature
Date Permanent address
I/We (if Bank) hereby testify that 1/We know the declarant and certify that
the above declaration was signed in my/our presence.
Seal > Signature
Date - Designation
I/We (if an Office of the Reserve Bank of India) hereby acknowledge the
receipt of the high denomination bank notes tendered by..." with
the above declaration at p.m. today.
Signature'
Date Designation of receiving authority
Seal
WAVELL,
Viceroy and Governor-Generals
G. H. SPENCE,
Secy In the Govt, of India'
Published by the Manager of Publications, Delhi
Printed by the Manager Government of India Press, New Delhi