Serial No: FORM (See Rule 4A )

Transcription

1 Date: 1 I 5/2012. ~~ ~ ~ ~ 10:1Itfl Serial No: ANDHRA PRADES Denomination: R 48AA SMT.. MURSHEEDA BEGUM WIO. RASHEED AHAMED ANA. APUR ForJ.om: 10 ~r HSElJH Ex. Officio Stamp Vendor SRO:ANANTAPUR I I, FORM.26.D. (See Rule 4A ) A1idavit to be furnished by the candidate before the Returning Officer for election to A.P.STATE LEGISLATIVEASSEMBLY from ANANTAPUR URBAN ASSEMBLYCONSTITUENCY. I, Mohammed Mursheeda O.No.11-68, Neeruganti Wife of M.Rasheed Ahmed, aged about 38 years, resident of Street, Old Town, ANANTAPUR , candidate at the above election, hereby SOlemnlY affirm/state 1. Begum on oath as under: I am not accused of any offence(s) punishable with imprisonment for two years or more in a &>ending case(s) in which a chargers] has! have been framed by the court(s) of competent jurisdiction. a If the deponent is accused of any such offence(s) he shall furnish the following AT~ESTED SOLEMNLY AFFIRMED & SIGN!=O BEFORE f)~~v\.o-i A. ~ MEON ~ VEED LI NbTARV Cell: ~. \ IS il- " /1 r-.j\vj\..6~q~='" /J 0 information:. ~u."r\jt., do

2 2 (i) Case / First information reports NO.1 Nos.: Not Applicable- (ii) Police station(s) District(s) state(s) : Not Applicable (iii) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged : Not Applicable (iv) Which framed charges:. Not Applicable. (v) Date(s) on which the charge(s): Not Applicable. (vi) Whether all or any of the proceeding(s) have been stayed by any court(s) of competent jurisdiction...: - Not Applicable. 2. I have not been convicted of an offence(s) [ other than any offences referred to in sub-section (1) or sub-section (2), or covered in sub-section (3), of section 8 of the Representation ofthe People Act, 1951 (43 of 1951) and sentenced to imprisonment for one year or more. Ifthe deponent is convicted and punished as aforesaid, he shall furnish the following information: (i) Case / First information reports No./Nos... : Not Applicable. (ii) Courts which punished : Not Applicable. (iii) Police station(s) : Not Applicable. (iv) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged... : Not Applicable. (v) Date(s) on which the sentence(s) was / were pronounced..:- Not Applicable. (vi) Whether the sentence(s) has / have been stayed by any court9s) of competent jurisdiction...: Not Applicable. Place: Anantapur. Date: 'L\ - s:-- '20 \'J-- \H. ~\}.AblQ~D~u.~ Signature of Deponent. VERIFICATION I, the above named deponent, 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 therein. Verified at ~/,vl on this ~_~-,---_Day of ~ :L<!) \'"1-. ATTESTED SOLEMNLY AFFIRMED & SIGNED BEFORE ME ON,. Signature of deponent.

3 Denomination: 10 48AA SMT.. MURSHEEDA BEGUM W/O M~RASHEED AHAMED ANANn\PUR. ForwLm: ~ HSELFf Ex. Officio Stamp Vendor.~ SRO:ANANTAPUR Affi1avit to be Furnished by the candidate along with Nomination Paper Before the Returning Officer For election to A.P.Legislative Assembly ~(name of the House) From 272- ANANAPURURBANASSEMBLY Constituency -(Name of the Constituency) I, M.,ursheeda Begum D.No.17-68B, Neeruganti son/da-ughter/wife of M.Rasheed Ahmed Veedhi, Kowdipeer Makanam, Aged 38 years, resident of Old Town, ANANTAPUR-SlS00S (mentiln full postal address), a candidate at the above Election, do hereby solemnly affirm and state on oath as under:- I (1) I am a candidate set up by Indian National Congress a national party (name of the poltical party)/ I am cqlltestjng as an Independent candidate.

4 ., 2 (2) Details of PAN and status of filing of Income tax return : The financial year SI. Names Permanent for Total No. Account which the last income Number Income-tax (PAN) return has been filed 1. Self - Mohammed Mursheeda Begum ATWPB5540K Not an Assessee. Not Applicable 2. Spouse - Mohammed Rasheed Ahamed AGIPM7994B Not an Assessee. Not Applicable 3. Dependent Daughter - Mohammed Gousia Not Applied Not an Assessee. Not Applicable 4. Masharath Not Applicable. Dependent Son - Mohammed Sultan Not Applied Minor Mohiuddin 5 Dependent-3 - Not Applicable Not Applicable Not Applicable Not Applicable (3) The following case(s) is/ are pending against me in which cognizance has been taken by the court:- SI. Offence Description No. (a) The details of cases where the court has taken' cognizance, Sections of the Act and description NIL of the offence for which cognizance taken: (b) Name of the court, Case No. and Date of order NOT APPLICABLE taking cognizance: (c) Details of Appeal (s) / Application(s) for NOT APPLICABLE revision (if any) filed against the above order(s) : (4) Cases in which I have been convicted by a court of law (other those referred to in Form 26): (a) The details of cases, Sections of the Act and description of NIL the offence for which convicted: (b) Name of the Court(s), Case No. and Date(s) of order(s) : Not applicable (c) Punishment imposed : Not applicable (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:

5 3 1. Assets in joint name indicating the extent of joint ownership wil Ialso have to be given 2. In case of depositlinvestment, the details including Serial Number, Amount, Date of Deposit, the Scheme, Name of Bank/ Institution and Branch are to be given 3. Value of Bonds/Share/Debentures 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) S. Description Self Spouse Dependent-l Dependent-2 Dependent- No. [M.Mursheeda [M Rasheed [M Gousiya [M.Sultan 3-Not Begum] Ahamed] Masharath] Mohaiuddin] Applicable. (i) Cash in hand Rs.99,800/- Rs.l,75,500/- NIL NIL NIL (ii) Details of landhra Bank, Deposits in Anantapur SB Alc 1. SBI, Gandhi Bank NO Bazaar, Accounts Rs.2,15,460/-. Anantapur. SB (FDRs, Term A/cNo. Deposits and all other types SBI,GandhiBazaar Rs.l,OOO/- of Deposits Branch, including Anantapur. SB : saving Alc accounts), No Deposits with Balance as on 19- Financial Rs.l 000/-. NIL NIL NIL Institutions, Non Banking 3. Chit Financial Subscription in Companies and Chalapathi Chit Cooperative Fund Pvt Ltd, societies and Anantapur. Ticket the amount in No.LTI6SA-36 each such amount subscribed deposit Rs.4,12,500/- (iii) Details of investment in Shares of Bonds, Rs Debenturesl sha res and units in NIL NIL NIL compan ieslmut ual Funds and others and the amount. NIL (iv) Details of l.postal Term 1. Insurance 1. Insurance. Insurance NIL investment in Deposit with Sub- Policies Policies Policies

6 4 NSS, Post Office, Postal Savings, Anantapur. Alc Company Name- Company Company Insurance No Policy No. Name- Policy Name- Policy Policies and Rs.2,50,000/-. Paidup Value. No. No. investment in a) Reliance Life Paidup Paid up any Financial 2. Postal RD Alc Insurance. Value. Value. Instrument in NO Policy a. Bajaj LIC ofindia, Post office or Rs.8,000/- Sub No.l Life Policy Insurance Post master,, ,13 Insurance No Company and Sainagar, Company 1 Rs.73647/- the amount Anantapur. Rs.3,75,000/- Ltd, b) Bajaj Life Policy 3. Insurance Insurance No.6403 Policies Company 6842Rs.9 Ltd, Policy 0,000/- Company Name- NO Policy No., Paidup Value , a) Reliance Life Rs.I,80,000/- Insurance. Policy c) LIC of India, No , Policy , No Rs.I,80,000/- 1, b) Bajaj Life Rs.I,04,400/- Insurance Company Ltd, Policy No , Rs.l,50,000/- (v) Personal NIL NIL NIL NIL NIL loans/advance given to any person or entity including firm, Company, Trust etc. and other receivables from debtors and the amount. (vi) Motor Toyota Qualis, NIL NIL NIL NIL Vehicles/ Aircra Make 2002 RC fts/ No.AP31AAI899, Yachts/Ships Year of Purchase (details of 2006 for Make, Rs.4,60,000/-. Registration No. etc, Year fvtr1'.jb.l. ADVOCATE E~;c~OTA;-V Appointed by Govt. OT A.P. I D. No S,Sai Nacar, } ;:; ~

7 5 of Purchase and amount) (vii Jewelry, Gold Jewelry Gold Jewelry Gold Jewelry NIL NIL ) bullion and 300 Grams Value 50 Grams Value 75 Grams valuable thing Rs.7,50,0001- Rs.l,25,000/-. Value (give details of approximate. approximate Rs.1,75,000/- weight and value) Silver Jewelry Silver Jewelry Aprroximate 100 Grams Value 150 Grams Value value. Rs.7500/- Rs.I0,0001- approximate approximate (vii Any other NIL NIL NIL NIL NIL i) assets such as value of Claims/interest (ix) Gross Total Rs.25,34,260/- Rs.9,96,350/- Rs.2,65,0001- Rs.73,647/- NIL value in Rs. B. Details of Immovable assets: (Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated 2. Each land or building or apartment should be mentioned separately in this format.) S.No Description Self Spouse Dependent Dependent Dependen. [M.Mursheeda [M Rasheed -1-2 t -3 N.A. Begum] Ahamed] [M [M.Sultan Gousiya Mohaiuddi Masharath] n] Agricultur NIL NIL NIL NIL (i) al Land Kakkalapalli, Location(s) Anantapur Survey Sy.No.86-1B4 number(s) Area (Total NIL NIL NIL NIL measurement 1.20 Acres. 111 acres) Whether NO. NO. NO. NO. inherited NO. (Yes or NO) Date of NIL NIL NIL NIL purchase in case of self acquired Cost of Land RsA,80,000/- NIL NIL NIL NIL (in case of

8 6 purchase )at the time of purchase Any NIL NIL NIL NIL NIL Investment on the land by way of development, construction etc. Approximate Rs.15,00,000/- NIL NIL NIL NIL Current market value (ii) Non- Land at NIL NIL NIL Agricultural NIL Bukkarayasamudra Land m Location(s) Survey No.7l2/5 Survey number(s) Area (Total NIL 0.10 Acres NIL NIL NIL measurement (iii) III sq. ft.) Whether NIL NO NIL NIL NIL inherited (Yes or NO) Date of NIL NIL NIL NIL purchase in case of self Oacquired Cost of Land NIL Rs.11,500/- NIL NIL NIL (in case of purchase) at the time of purchase Any NIL NIL NIL NIL NIL Investment on the land by way of development, construction etc. Approximate NIL Rs.3,00,000 NIL NIL NIL Current market value Commercial 4:~A~'-11-))'-'\Ji'. ~ \L,~ ~"'"' 1',i s.a.,rl ADVOCATE & NOT RY Appointed._y Govt. of A.P. I D. No ,Sai Nagar, LANANTAPUR '1.. Celt 'j6

9 7 Buildings (including NIL NIL NIL NIL NIL apartments) - Location( s) -Survey number(s) Built up Area (Total NIL NIL measurement NIL NIL NIL in sq. ft.) Whether inherited NIL NIL NIL NIL NIL (Yes or NO) Date of purchase in NIL NIL NIL NIL NIL case of self acquired Cost of (in NIL NIL NIL NIL NIL case of purchase) at the time of purchase Any Investment NIL NIL NIL NIL NIL on the by way of development, construction etc. Approximate Current NIL NIL NIL NIL NIL market value (iv) Residential Residential House Buildings bearingdoorno.l NIL NIL NIL NIL (including 7-68, Neeruganti apartments,) Street,Old town, -Location(s) Anantapur. - Survey Sy.No.98 number(s) Area (Total measurement 469 Sq Ft NIL m NIL NIL NIL sq. ft.) Built up Area (Total 938 Sq Ft NIL NIL NIL NIL measurement Ground Floor &. ~~va. lit fxveewa~i 'Z-))J)J1-Di- M.A.,S.L ADVOCATE s NO"TARY Appointed by Govt. of,-1\.p.. D. No S,Sai "agar, :ANANTAPUR CelL Q,

10 8 in sq. ft.) First Floor built up area Whether inherited NO NO NO NO NO (Yes or NO) Date of purchase in NIL NIL NIL NIL case of self acquired Cost of Rs (in NIL NIL NIL NIL case of purchase) at the time of purchase Any Investment Rs.3,50,000 NIL NIL NIL NIL on the land by way of development, construction etc. Approximate Rs.7,50,000 Current NIL NIL NIL NIL market value (v) Others (such NIL Undivided share in NIL NIL NIL as interest in Family ancestral ) landed at Pothulanagepalli villageof Dharm avann Manda1.1/5 th share Rs.l,OO,OOOI- (vi) Total of Current Rs.22,50,0001- Rs.4,OO,OOOI- NIL NIL NIL Market Value of (i) to (v) above

11 9 (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) S.No. Description Self Spouse Dependent- Dependent-2 Dependent- [M.Mursheeda [M 1 [M.Sultan 3 Not Begum] Rasheed [M Gousiya Mohaiuddin] Applicable. Ahamed] Masharath] (i) Loan or dues to NIL NIL NIL NIL NIL BanklFinancial Institution(s) Name of Bank or FI Amount outstanding Nature of loan Loan or dues to NIL NIL NIL NIL NIL any individuals/ Entity other than mentioned in (i) above. Name(s) Amount outstanding Nature of loan Any other liability NIL NIL NIL NIL NIL Grand total of NIL NIL NIL NIL NIL liabilities (ii) Government Dues: NIL NIL NIL NIL NIL Dues to departments dealing with government accommodation Dues to departments NIL NIL NIL NIL NIL dealing with supply of water Dues to departments NIL NIL NIL NIL NIL dealing with supply of electricity Dues to departments NIL NIL NIL NIL NIL dealing with supply of telephones/mobiles Dues to departments NIL NIL NIL NIL NIL dealing with government transport (including aircrafts and helicopters) Income Tax Dues NIL NIL NIL NIL NIL

12 10 Wealth Tax Dues NIL NIL NIL NIL NIL Service Tax Dues NIL NIL NIL NIL NIL MunicipallProperty NIL NIL NIL NIL NIL Tax Dues Sales Tax Dues NIL NIL NIL NIL NIL Any other dues NIL NIL NIL NIL NIL (iii) Grand total of all NIL NIL NIL NIL NIL Govt. dues (7) Details of profession or occupation: a. Self - House Wife b. Spouse - Land lord (8) My educational qualification is as under: Secondary School Certificate, Shantiniketan English Medium School, Anantapur, Board of Secondary Education, Andhra Pradesh, Year of Passing., March, 1989 (9) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (8) ABOVE: 1. Name of the candidate Smt. M.MURSHEEDA BEGUM 2. Full postal address D.No.17-68, Neeruganti Veedhi, Behind Post Office, Pld Town, ANANTAPUR Number and Name of the constituency and 272- ANANTAPUR URBAN ASSEMBLY state ~ONSTITUENCY, ANDHRA PRADESH. 4. Name of the Political party which set up the candidate (otherwise write 'Independent')!INDIANNATIONAL CONGRESS PARTY 5. (a) Number of cases in which conviction order NIL passed (other than those referred to in Form 26) (b) Total number of Pending cases where the court (s) have taken cognizance N1L & NOT APPLICABLE Total Income Shown 6. PAN of Year for which last Income Tax Return filed (a) Candidate ATWPB 5540 K NOT AN ASSESSEE N.A. (b Spouse: AGIPM NOT AN ASSESSEE N.A. (c) Dependent 1 NA NOT AN ASSESSEE N.A. (d Dependent 2 NA MINOR N.A. (e) Dependent 3 NA NOT APPLICABLE N.A. 7. Details of Assets and Liabilities in rupees Description Self Spouse!Dependent-I Dependent-II Dependent- M.Mursheeda [M Rasheed [M Gousiya [M.SuItan III Begum] Abamed] Masharath] Mohaiuddin] Not Daughter Applicable. /f- i,~~ )) \N. 't\, \l,~ ~ A. MVEE'iJ )(~LI 'Z-) r )1- M.t:\.,B.L ADVOCATE & NOTAR'I Appointed by Govt. of AP. Nagar, i O. No ,Sai } s! D!' c....!i.aa I

13 11 Son A. Moveable irs.25,34,2601- Rs.9,96,3501- irs.2,65,oooi- RS.73,647/- NIL Asset (Total value) B. Immovable Asset i) Purchase Price and Development Cost of Immovable NIL Property Rs.9,25,OOOI- Rs.l1,5001- NIL NIL (Total Value) ii) Approximate Current Market Price of Rs.22,50,OOOI- RsA,OO,OOOI- NIL NIL NIL Asset (Total Value) 8 Liabilities (i) Government NIL NIL NIL NIL NIL dues (Total) (ii) Loans from Bank, NIL NIL ~IL Financial NIL NIL Institutions and others (Total) Highest educational qualification: 9. Secondary School Certificate, Board of Secondary Education, Hyderabad, AP. Year of Passing,March, 1989, Shantiniketan English Medium School, Anantapur. VERIFICATION I, the deponent, above named, do hereby verify and declare that the contents ofthis 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. I further 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 on this 21 st Day of May, 2012 at Anantapur. 11'~L~ -lo~~&~(tl~ DEPONENT Solemnly signed and affirmed before me. I - \' A.TTESTED' I SOL EMNLY AFFIRMED & I '\rl. SIGNEp BEFORE M ON f1.. \, A_ JAVEED ALl 2-)}r )'\1- NOTA.RY Cell: n