This is a general format that you can prepare on your computer, and all the CA has to do is to certify it.This
particular statement here has lots of details...You can leave out the FD details, Shares details to shorten
your statement.




This is to certify that (Name of Father) and (Name of Mother), presently residing at (Address) , sponsors of their son (Your Name) for higher studies in USA, have the following assets in their name as on 1st June 2001 :

Description Indian Rs. US $(@ 1 US $ = Rs. 47 )
Movable Assets Rs. 40, 61, 235 $ 86, 409
Immovable Assets Rs. 37, 90, 000 $ 80, 638
Total Rs. 70, 51, 235 $ 145, 045




Total Rupees (In words)

Total US Dollars (In words)

We have verified the relevant documents to verify the validity of these figures and found them to be true and correct.


Place : Ahmedabad (Name of the Company).
Chartered Accountants
Date : 1st June, 2001


(Name of Propreitor)
Proprietor, M No 34975



MOVABLE ASSETS Rupees US$ (@1US$ to 47 Rs.)
(Annexure A)
1. Bank Balance (Part 1) 12, 46, 522 $ 30, 777
2. Fixed Deposits & other liquidable assets (Part 2) 8, 14, 474 $ 15, 201
3. Provident Fund & PPF (Part 3) 6, 45, 046 $ 16, 597
4. Jewellery (Part 4) 3, 55, 790 $ 9, 698
5. Equity Shares (Part 5) 7, 64, 403 $ 14, 136
---------------- ----------------
Rs. 40, 61, 235 $ 86, 409

IMMOVABLE ASSETS Rupees US$ (@1US$ to 47 Rs.)
(Annexure B)
1. Residential Flat at Ahmedabad 12,55,000 $ 20, 319
2. Ancestral Land at 24 Parganas, near Kolkata 28,35,000 $ 60, 319
---------------- ----------------
Rs. 37,90,000 $ 80, 638

TOTAL Rs. 70, 51, 235 $ 145, 045


Annexure A : Movable Assets

Part 1 : Bank Balance


Details :
1 Savings in the name of X and / or Y(SB Account : 53992, Bank Name, since Sept 27, 1999) Rs. 8, 50, 136
2 Savings in the name of Z(SB 46438, Bank Name since Jan 23, 1991) Rs. 4, 36, 522
Total Rs. 12, 46, 522


































Annexure A : Movable Assets

Part 2 : FDRs with Bank & Other Assets


a) Fixed Deposits with Banks

Sr. No Type Amount (Rs.) Maturity Value(Rs.)
1 INDIAN Bank. 1, 00, 000 1, 08, 780
2 INDIAN BANK. 75, 000 81, 585
3 Canara Bank 1, 00, 000 1, 08, 775
Total 7, 33, 937 5, 85, 108



b) Security Bonds

Sr. No. Type Number of Units Face Value(Rs.) Value(Rs.)
Name of Mother
1 CANPEP 1992 500 10 5, 000
2 ICICI Tax Saving Bonds 2 5000 10, 000
Name of Father
3 UTI MEP 1992 500 10 5, 000
4 CANPEP 1992 500 10 5, 000
Total 60, 000
















Annexure A : Movable Assets

Part 2 (contd.)


c) Policies

Sr. No. Type Amount Invested(Rs.)
Name of Mother
1 ULIP 30, 000
Name of Father
2 ULIP 30, 000
3 Jeevan Suraksha Pension Policy 47, 505
Yourself
4 LIC Policy 13, 032
Total Rs. 3, 20, 537




Total Invested Value ( a + b + c ) : Rs. 7, 14, 474

Total Maturity Value : Rs. 7, 65, 645

Annexure A : Movable Assets

Part 3 : Provident Fund Balance of Parent

(Through X years of service in W as on 31.3.2001)


Details:
1 Staff Provident Fund Rs. 6, 87, 505
2 Public Provident Fund (PPF) Rs. 92, 541
Total Rs. 7, 80, 046




































Annexure A : Movable Assets

Part 4 : Jewellery

(As per Valuation Report of X, Government Approved Registered Valuer (if done))


Details :
1 Diamond Jewellery Rs. 1, 76, 710
2 Gold Jewellery Rs. 2, 79, 080
Total Rs. 4, 55, 790





































Annexure A : Movable Assets

Part 5 : Equity Shares in Companies

(As on June 1, 2001)



Sr. No. Type Number of Shares Repurchase Price Per Share(Rs.) Value(Rs.)
Name of Mother
1 Henkel Spic 100 29.05 2, 905
2 HFCL 700 151.75 1, 06, 225
3 Reliance Petro 500 52.10 26, 050
4 Thermax 100 59.60 5, 960
5 HLL 100 193.50 19, 350
Name of Father
6 Moses Bayer Eq. 100 283.85 28, 385
Total Rs. 6, 64, 403




GRAND TOTAL ( Part 1 + 2 + 3 + 4 + 5 ) : Rs. 40, 61, 235
Annexure B : Immovable Assets


Details :
1 Flat Address Rs. 12, 55, 000
2 Flat Address Rs. 28, 35, 000
Total Rs. 37, 90, 000
















We have verified the validity of the above assets and value thereof by vouching necessary documents and found them to be true and correct. The information given above is true and correct to the best of my knowledge and is based on the information given to us.


Place : Ahmedabad (Name of the ompany).
CharteredAccountants
Date : 1st June, 2001


(Name of the propreitor).
Proprietor, M No 34975