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FINANCIAL DATA QUESTIONNAIRE

(on the letter head of the C.A.)


I (Name of the C.A.) member of the Institute of Chartered Acountants of India, hereby
certify that I have reviewed the financial status of (Name of the sponsor/parent of the
applicant) with a view of establishing his ability to pay 1
st
year educational expenses of
his/her son/daughter (Name of the applicant) at (Name of the university / College
Address, Country) which is estimated at (Total Expenses in foreign currency) as per their
( Offer Letter / I-20 / University Communication)
S.No. Source of Funds Indian
Currency
(Rs.)
Foreign
Currency
(USD)
Reference
1. Scholarships
2. Savings in India
Movable Assets A
Cash at Bank B
3. Savings outside
India
4. Immovable Assets C
5. Annual Income in
India
D
6. Annual Income
Outside India
TOTAL
Notes
a. The Applicant is sponsored by his/her parents.
b. The exchange rate adopted is Rs._______________ per (foreign currency)
c. This certificate is issued upon the request of the applicant/sponsor and as per
information/documents produced by the applicant /sponsor.
______________________________
Signature of the C.A.
Place: Seal of the C.A. Name:
Date: Membership No:
ANNEXURE
A. Movable Assets
S.No. Description of Assets Name Amount
1. UTI / MIP
2. ULIP / LIC
3. NSC / KVP / IVP / NSS
4. PF / PPF / Gratuity
5. Shares / Debentures
6. Fixed Deposits in non
banking COs such as ICICI,
Nagarjuna Finance etc.,
7. Household effects
(Furniture/Electrical
Equipment)
8. Jewellery
9. Vehicles
10. Advances
TOTAL
Notes: All figures must be supported by appropriate documents. In case of LIC / ULIP
Policies, the sum assured can be quoted. In case of Shares, the market value can be
quoted-certificate from any Share / Stock broker required, House Hold effects-self
declaration for reasonable amount / insurance policy can be taken, Jewellery valuation
report from a Jeweller is required, Vehicles-Sale Letter / Valuation Papers or Vehicle
documents along with registration documents.
B. Bank Balances
S.No. Nature of Account/
Name of the Bank,
Branch
Name of the
Account Holder
Amount
1. Savings Fund
2. Fixed Deposits
3. Recurring Deposits
4. Gold Bonds
5. Re-Investment plans
TOTAL
Notes: All figures must be supported by appropriate documents. Bank Passbook ,
Statements and certificate from the bank confirming the balances should be obtained. The
bank certificates should preferably be taken on the same day and should be type written,
Equivalent foreign exchange value should also be mentioned.
SEAL OF THE C.A.
C. Immovable Assets
S.No. Description of the Property Name Amount
1. Immovable residential property at
(Address of the property)
measuring ______ sq.ft. as per the
valuation report of (Name of the
valuer) of date ________
2. Immovable landed property at
(address of the property)
measuring________ (area) as per
the valuation report of (name of the
valuer) of date________
3. Immovable agricultural land at
(address of the property) measuring
__________ (area) as per the
Block Development Officers
certificate of date_________
4. Plant & Machinery at (address of
the property) as per the valuation
report of (name of valuer) of date.
D.Annual Income
S.No. Source of Income Name Amount
1. Income from Salaries as per pay
certificate issued by employer.
2. Rental Income from (address of the
property) as per the declaration of
the tenant / rental receipt
3. Business Income from (name and
address of the firm) as per the
Profit & Loss account of the firm.
4. Agricultural Income as per the
certificate issued by BDO/MRO
date.________
5. Interest and Dividends from
Investments, Shares, Fixed
Deposits etc.,
______________________________
Signature of the C.A.
Place: Seal of the C.A. Name:
Date: Membership No:

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