NET WORTH CERTIFICATE

We hereby certify below the position of Assets & Liabilities of the person mentioned hereunder as on
31.03.2010
The same has been verified from the records & other details produced before us
Name :
PAN :
Date of Birth :
Permanent Address : Office Address:
(A) Tota !a"e of Immo#ea$e Pro%ert&:
(This includes beneficial share owned in Land, Building, Flat, Factory, Shop, House etc.)
Nat"re of Pro%ert& 'ocation (ith Com%ete Address !a"e at Cost
( ` In 'acs)
!lat at
"hop
"hop
#ewellery
TOTA'
(B) Tota !a"e of Other Assets:
(This includes Cash, Bank balance, old, !ther "ewellery, #n$est%ent in Shares&'utual
Funds&F()s&L#C etc, *ehicles, Capital in Business etc.)
Nat"re of Asset Partic"ars of Asset) Com%ete
Descri%tion
Ot&* !a"e at Cost
( ` In 'acs)
$$! $$! %nvestment
"hares "hares
!&' & (an) !&' & (an)
*apital investment
TOTA'
(C) Tota 'ia$iities:
Borro(ed From Amo"nt + ,ec"rities
offered
P"r%ose O)s as on date
( ` In 'acs)
%&(% +ousin,
&eposit 'ent
'epayment of +. Loan
TOTA' --./0./-1)2
(D) Net Worth: (A 3 B 4 C) 5 )2 'acs
(In (ords 66666666666666666666666666666666666)
+e-"he is the .uarantor for various (orrowin,s by his-her friends - relatives - firm/s0 - company/s0 as
detailed below
7"aranteed to For the Borro(in8s $& P"r%ose Amo"nt
7"aranteed
( ` In 'acs)
Term Loan
1ehicles
*ash *redit
TOTA'
For 999 A,,OCIATE,
Chartered Acco"ntants
Partner
:em$ershi% N"m$er:
Date: