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Transcription

1 ... SCHEDUL FORMS Nomination Paper (See Section 36) as amended Election to the Municipal Corporation of the city o~~o 1. Name of the Ward 2. Name of the Candidate 3. Father's /Husband's name 4. Age 5. Address 6. If the candidate is a member of the Scheduled Castes or Scheduled Tribes or Backward Classes. 7. Number and Name of the ward electoral rolls in which the name of the candidate is included. 8. Part Number and serial number of the candidate in the ward electoral roll. 9. Name of the proposer 10. Part Number and Serial Number of the proposer in the ward electoral roll concerned. 11. Signature of the proposer \.b... :.JL.rYJ>.rfu.f~~.~... :~ft:1~~.r1...s.ite:ijc_ :.~.e.mu.l.n~~~fs- : Z.8.~~.. :~~~&~ ~..is..~~ / :.TI..NJ).! '2,;.l..b.9. :k.l.?~...npy..o.n.t.lo.>t, _j)fj.~f\.\/h1..h.~j.d).k-1 Pr :k6.0.,...ndj).t2.'kb.k. ~)7 :...D.:.. ej\~... :... Declaration by candidate I hereby declare that I agree to this nomination. Date 'l-~ I~ ~-b Aca-J? t-./ 'AK'lV/. v-ib.t RETU NING OFFICER 1';:'I'mmmr1'nll~'~ Mun" Ie' t":~1 rcipa orporation s/(e.~ Signature of Candidate r w~mq,--'2--

2 " I.., SI.NO~'Oa~ iiebangana. fo~ ~"tdto: ~:.z::~ ~ k~ '-::Y t VI Whome - l--~.. CJVI. I I (Order No. 588/SEC-FlI2011, Dt ) Licence Stamp Vendor l No' TI95,Rl,No' /16 rls~ COU~~~~3",ma~2C~ 9!~atg3810 Dfclaration to be obtained from the contesting candidates regarding Criminal Antecedents,. Assets & Liabilities. Atidavit sworn before a Notary Public or a Magistrate of the First Class on the required stamp paper to be furnished by the candidate contesting the office of Member or Municipal Cotoration along with Nomination. I F0,election to Paper before the Returning Officer Khammam Municipal Corporation From 2 Division I, Rajeem Shaik S/o Nagul Meera Aged: 38 years, resident of H.No , Pandurangapuram, Khammam Corporation Khammam District a candidate at the above ~~ EI~tion, do hereby solemnly affirm and state on oath as under.-.

3 .J (I) I am a candidate set up by Indian National Congress. (2) Details of PAN and status of filing ofincome Tax return: SI.No Name Permanent The financial Total Income Account year for which shown In Income Number (PAN) the last Income Tax Return (in -tax return has Rupees) been filed 1 Self Rs. 2 Spouse 3 Dependent 1 4 Dependent 2 5 Dependent 3 (3) The following case (s) is/are pending against me in which cognizance has been taken by the Court:- Sl.No Offence Description (a) The details of cases where the court has taken cognizance, Sections of the Act and description of the offence for which cognizance taken: (b) Name of the court, Case No. and Date of Order taking cognizance (c) Details of Appeals (s) /Application (s) for revision (if any) filed against the above (d) order (s): (4). Cases in which I have been convicted by a court oflaw (other those referred to in Form 26): (a) The Details of cases, Sections of the Act and description of the offence for which convicted: (b) Name of the Court(s), Case No. and Date (s) of order(s): (c) Punishment imposed: (5) That I give herein below the details of the assets (movable and immovable etc.) of myself, my spouse and all dependents: A. Details of movable assets: (Note:...-: _ ".. 1. Assets in joint name indicating the extent of joint ownership will also have to be ~O..... ". given ~ ~J 1?/li~ PA ;-'~» Sl?~ * VEKKlRAl(AA~B\.'e{\~ B."'. LL.B., I.i ~OVOCATE&NOTt.R't'i ;' 0e KHAMMAM T.~ './.. \'_>;'-~~) G') ~~~~

4 2. In case of deposit/investment, the details including Serial Number, Amount, Date of Deposit, the Scheme, Name of Bank/ Institution and Branch are to be given. 3. Value of BondslSharelDebentures as per the current market value in Stock Exchange in respect of listed companies and as per books in case of non-listed companies should be given. 4. Dependent, here means a person, substantially dependent on the income of the candidate. 5. Details including amount is to be given separately in respect of each investment) SI.No Description Self Spouse Depend Dependent Depen ent -1-2 dent -3 (i) Cash in hand Rs.50,000/- Rs.50,000/- (ii) Details of Andhra Bank, Deposits in Bank Ballepalli Branch, accounts (FDRs, Khammam Account Term Deposits No and all other types 05 Rs.1200/- of Deposits, including saving i accounts), Deposits with Financial Institutions, Non Banking Financial Companies and Cooperative societies and the amount in each such deposit (iii) Details of investment in Bonds Debentures/ shares and units in companies Mutual Funds and I others and the amount. (iv) Details of investment in NSS, Postal savings, Insurance Policies and investment in any Financial Instrument in Post Office or Insurance Company and the ~ R - ~,~ount O~~_~ ~ ~#\~f" Z I~~!!~,.~":~?' ~)I.. 'fr0~""'''~ QO#~'''~; (i"'jr'-f;:' i..'... f _--r " =~... ~...l. ',.;.:"_..

5 ~~'S ~ :4 's w!1 it, ~''''7'Y ~,,~t~ JO ~W!l ~l{l '." ;; ~ lu (ossqornd jo ~SUO ~ - U!) puu'1 JO lsoj -. l!n UN UN UN UN,w~d01d p~l!nbou Jps JO osao l!n UN UN UN UN U! ~su1.(omdjo ~lua (ON 10 s~a),w~d01d l!n UN UN UN UN P~l!l~1.(U! l~1.(l~1.(a\ (S~lOU U! iuoumnstn UN UN UN UN UN IUlOj) u~lv (s) l~qwnn A~Alns (s) uouaooq UN UN UN UN UN puu'1ltunnn3!.i~ (!) -l Z 1 uapuodorj -lu~pu~d~a -lu~pu~d~a osnodg JPS uond!l0s~a N'IS (luidloj S!1.(lU! APlUlUd~s pououuaur oq PIno1.(s iucunmda 10 5u!Punq 10 PUUI 1.(OU3 'Z 'P~lUO!PU!oq oi ~AU1.( OSIUIl!M d!1.(sl~umonno] JO lu~lx~~l{l5unuo!pu! d!1.(sl~umolll!of U! S~!ll~dold'l :3,0N) :S,3SSU31quAommIJOSI!U,3U 'g I!N UN UN -IOOO'OS 'S"M -100z:'68 's"m ~nlua IUlOl ssold (xt) ls~l~lu!/ sw!uij JO ~nlua su qons UN UN I!N UN I!N Sl~SSU l~1.(lo AUY (ma) (~niua pun l1.(5pm JO SUUl~P ~A!5) 5u!l{l ~JqunluA pun I!N UN I!N UN UN uoqjnq 'AlI~M~f (HA) (nmoum puu ~su1.(olfld JO lu~a 'Ol~ 'on UOnUllS!5~"M l~~w JO SI!Ul~p) -1000'0 's"m sd!1.(s/sl1.(ou A LOOZ 'SZ l 0 OZdY ISY1U01!V1 l!n l!n I!N UN uunuld fufug S~P!1.(~A 10lOW (!A) 'lunoulu ~l{l puu sroiqop WOl] S~IqUApO~l 1~l{l0 puu 'Ol~ lsrul 'AuudwoJ 'IDlY 5u!pnpu! AlIlU~ 10 UOSJ~d, I!N I!N I!N I!N AUU Ol u~a!5 ~owapufsueol UN,euosJgd (A) I

6 (ii) (iii) purchase Any investment on the land by way of development, construction etc. Non-Agricultural Land Location(s) Survey number (s) Area (Total measurement in sq.ft) Whether inherited property (Yes or No) Date of purchase in case of self acquired property Cost of Land (in case of purchase ) at the time of purchase Any Investment on the land by way of development, construction etc. Approximate Current market value Commercial Buildine:s (including apartments) -Location(s) - Survey number (s) Built up Area (Total measurement in sq.ft) Whether inherited property (Yes or NO) Date of purchase in case of self acquired property Cost of Property (in case of purchase) at the time of purchase

7 (iv) the property by way of development, construction etc. Approximate Current market value Residential Buildings (including apartments) -Location(s) H.No , Pandur agapur am, Kham mam -Survey number(s) Area (Total 144 measurement in Sq.Yar Sq.ft) ds Built up Area 500 (Total measurement Sq.ft in sq.ft) Whether inherited property (Yes or NO) Date of purchase in case of self acquired property Cost of property (in case of purchase) at the time of purchase Any Investment on the land by way of development, construction etc. Approximate (Current market value) (v) Others (Such as interest in property) (vi) Total of Current Market value of(i) -.-:::-:~.KQ. (v) above No Self acquir ed propert y Rs 2,10,0 00/- 15 lakhs Rs15 lakhs

8 (6) I give herein below the details of liabilities /dues to public financial institutions and government:- (Note: Please give separate details of name of Bank, institution, entity or individual and amount for each item) Sl.No Description Self (i) Loan or dues to BanklFinancial Institution( s) Name of Bank or FI Amount outstanding Nature of loan Loan or dues to any individualslentity other than mentioned in (i) above. Name(s) Amount outstanding Nature of loan AI!! other liability Grand total liabilities (ii) Government Dues: Dues to Departments Spouse(s) Dependent Dependent-2 Dependent -1-3 of dealing with Government accommodation ~--_'~D~u-e-s--t-o--d~e-p-artm---e-m-s~N~il~--~N~il----~--~N~il~~--~N~il----+-~N~i~l--~ dealing with supply of water Dues to departments dealing with supply of electricity Dues to departments dealing with supply of TelephoneslMobiles Dues to departments dealing with GovernmentTransport( including aircrafts and helicopters) Income Tax Dues WealthTax Dues ServiceTax Dues Municipal /Property Tax Dues Sales Tax Dues Any other Dues Grad Total of all Govt. d.es

9 (7) Details of profession or occupation: a. Self Business b. Spouse House wife (8) My educational qualification is as under:l0th class, Z.P.P.S Singarayapalem village of Konijerla Mandai, Khammam District. (Give details of highest School/ University education with full form of the certificate/ diploma/degree Course) (Name of the school/college/ University and the year in which the course was completed). (9). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (8) ABOVE : 1. Name of the candidate Rajeem Shaik 2 Full postal address Rio H.No , Pandurangapuram, Khammam Corporation Khammam District. 3 Number and Name of the 112-Khammam Assembly Constituency, constituency and state Telan_gana State. 3 Name of the Political party Congress Party which set up the candidate, (otherwise write I Independent') 4 (a) Number of cases in No which conviction order passed (other than those referred to in Form 26) (b) Total number of No No pending cases where the court(s) have taken cognizance 5 PAN of Total income shown (a)candidate: (b)spouse : (c) Dependents 6 Details of Assets and Liabilities in rupees Description Self Spouse Dep Depen Dependent i ende dent - -III nt-i II A. Movable Asset (Total value) B. Immovable Asset (i) Purchase Price and Development cost of Immovable AOT'~ property -~~ 1::::;:,,-.(Total value) V... ;p I )c gl(~ ~~8.4LA 1.4M. '\~-' G), '848ii 'I 01 ADVOCA: A. LL.e. It. '- ~ "E&~O'J J.,-" HA4fM, rary ~ i. ~1 ~M l's.,":1..' ~:. e-.; l \,,- ~'.

10 , 8 7 ) current Market Price of Asset (Total Value) Liabilities (i) Government dues_(total) (ii) Loans from Bank, Financial institutions and others (Tota!} Highest ed~~ation qualification: 10th class, Z.P.P.S Singarayapalem village of KonlJerla Mandai, Khammam District. (~ive details of schoolsluniversity Education with full form of the certificate /di~lomajdegree course) (Name of the schoollcollegeluniversity and the year in WhIChthe course was completed) VERIFICATION I, the deponent, above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief, no part of it is false and nothing material has been concealed there from. Ifurther declare that: (a) there is no case of conviction or pending case against me other than those mentioned in items 3 and 4 above; (b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 5 and 6 above. Verified at Khammam this the 24th day of February 2016 Slc ~Bt~11 DEPONENT v) VEKKIRALA RArl~~{ ~!J E. 1 :.. ADVOCATE & HOi':. KHAMMAM Telang"::,, ~' Ceii: i.:il

11 DECLARATION TO BE FILED BY THE CANDIDATE FILING NOMINATION ON ACCOUNTS OF ELECTION EXPENDITURE 1"".R..h-.j.G..G..ro,,:~1}f.r.J.~ s/o"tj.b.cty..ln~~esident Of. -\~ Municipal corporation~ving filed the nomination for the office of Member of ".1l-.:~:v:\~';1..". Municipal Corporation hereby acknowledge that I have been supplied with a copy of the State Election Commission's Order No.S37/SEC-Fl/2011, dated relating to maintenance of accounts of election expenditure by the contesting candidates and also the Notification Prescribing maximum limit on expenditure which can be incurred by the contesting candidates for the said offices. I hereby declare and undertake to keep my election expenditure within the limit prescribed and also to maintain true and day to day accounts of the expenditure in the manner prescribed. I, further, declare that I am fully conversant with the legal provisions contained in Greater Hyderabad Municipal Corporation Act, 1955 and rules issued thereunder dealing with election expenses and I hereby undertake to act in accordance with these provisions of Law and the rules made thereunder and in the true spirit of democracy while contesting the election for the above mentioned office. The above declaration is signed before me st~ Signature of the Contesting Candidate ~ ReturninlU)ffi~'CER RETURNING or-i'" Khammam Municipal Corporation

12 Declaration regarding disqualification to be obtained from the contesting candidate DECLARATION (to be filed by contesting candidate along with nomination papers) I I(_A-l C "'\~S H-A1;u_ 5/0 NIfrC,12 L~l:..=n hereby declare that I am not disqualified to the best of knowledge and belief for being chosen Ward Member-of the Municipal Corporation of ~e~.-( c1/vy) under sections 21A, 21B and 22 of Greater Hyderabad Municipal Corporation Act, Date:.~..1.~ l~ ~(CW~ Signature of the Candidate Signed before me on this ~.t!j..day ofw..20/. ~ ~fmjeofficer Khammam MunicipaJCorporation