^.n l.$1,^^ :;,-_ q.,i!, ii','' '. i',',;i.,l,llll. FORM 26 (see RULE 4A)

Transcription

1 i;'r : -.' a. :;,-_ q.,i!, ii','' '. q FI R rj $, Ei 5 i',',;i.,l,llll '' "1,' 'l ii FORM 26 (see RULE 4A) Fl q] Affidavlto be furnished by the candidate before the returning officer for election to q.f-e.u.tt{.1.!-.ftt. S,TAT.hS. (name of the House)from......[-{.id...L;.**$.*.X*.t\:f ll.\a.s-.... Constituency (name of the Constituency) 8. h Pg T-t,telb"?' t, tseqrws T,:*..i,*8r.t"*\.h... son / dass$* / xib of $i.ttltlstrs$r.{ih.r"fr.!l ased aboutq Years, resident of R q.f...rr h,[ S qs.k, tl:i U *t*. r tr H] candidate oftthe above election do hereby solemnly affirm/state on oath as under: 1. I amh*r not accused of any offence(s) punishable with imprisonment for two years or more ln a pending case(s) in which a charge(s) has/have been framed by the court(s) of com$etent jurisdiction. lf the deponent is accused of any such offence(s) he shall furnish the following information:.ra ' (i) Cas&/First Information Report No./Nos....f*0.fr..r... (i i) ^.n l.$1,^^ Contd

2 '.:2:. (ilr) (9tD Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged....,.b[.h'... Court(s) which framed thg^charge(s).,n...h.,..r.r...dr... s q.r-r.a syi {-s t'i+lii b.; L"A-A'.,4dil i N ; N -,, WnEtfibi-att or'any of thcj pioc-*eeding(s)'f#ve been stayed by any court(s) competent jurisdiction....s$.,. h. " l.mhave not been convicted of an offence(s) (other than any offence(s) referred to in sub-section(1) or sqb-section(2) or covered in sub-section(3), of section B of the Representation of the people Act, 1951 (43 of 1951)) and sentenced to imprisonment for one year or more. lf the deponent is convicted and punished as aforesaid, he shall furnish the following information: (i) (ii) (iii) (vi) Case/First Information Report No./Nos...N'.h Count(s) which punished......tr\... h. Police station(s). b\'.h. District(s).hd'.h. States(s)... ld,. h..'... Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged...n..h... Date(s) on which the sentence(s) was/were pronounced..hs'.ft." Whether the sentence(s) has/have been stayed by any court(s) of competent jurisdiction..ks..ft.,. etace..h.$.d.ev rs,bd"*..... Date.,\.8F. '.()l{b. '..*u.00.ffi.. t'' \ \ \ f\.,/''' '' i. ' "-\'"nn.- Sigffature of Deponent. VERIFICATION l, the above named deponent, do hereby verify and declare that the contents of the affidavit are true and correcto the best of my knowledge and belief no part of it is false land nothing material has been concealed therein. Verified at..$lu.dexqbq{.. the......[ 5...tR Day of.. $Y\ rux sh".q oog.,-.--,.-:- *\ --- r;i;{ l'"-'"r' Sighature of deponent.!.1 X *[i..:.' Note: "The columns in this Form which argnot applicable to the deponent may be struck off." n nl r-.-{ iir. r \t ^-.-):"Tqf oo,., 'ri'tt ' ' :.. :,.,.;ltij ",-','1.,,,!t, ;ii,','t i;yr;i-44" i * ir ;.;.,'.'i I i *-'*{;;'l E^,.\e'roJ ;*- \)ookn'u'), s' Aro.5'L,.$f ts)s)08

3 \' i i I ' t,t,, lr,, ' n''.. _\, '':'",:,.. r: i:",'',:'. ' ir,., i,i u Annexure-1 Affidavit to be furnishedby candidate alongwith nomination paper Before the Returning Officer For election to &6\rtlt."!rL h? g?frts,s (name of the House) p Fromqg.su,* ntrrr,**n*ll*-t5t-h*b6,lbf,ffftfety (name of the constituency) Son / daughtc+/r*ife of k{ntt$t t{ hqfrf hh aged ge years, resident of $Lh,tnr{Atr*fiIrrH}"Flqfirn$T$:andidate at the above elec$on, do hereby solemnly affirm and state on oath ai under: (Strike out whichever not applicable) u E (1) TheTollowing cases(s) islare pending against me in which cognizance has been takqr by the court:- 6!i (i) $ection of the Act and description of the offence for which cognizance taken.,(ii) ' The Court which has taken cognizance. lt.f\. (iii) Qase No. f{. fl. 6ate of order of the Court taking cognizance tt, h. Details of appeal(s) / application(s) for revision, etc., if any, filed against above order fr r.l tfiking cognizance. hl.h o S.1t,^..* Jr"tP\--4{ * sg '/rf el s r-

4 ..2,, (Z) That I give hereinbelow the details of the assets (immovable, movable, bank balance' etc.) of myself, my spouse and dependents" A, Details of movable assets. (Assets in ioint name rndicating the extent of joint ownership will also have to be given) S.No Description Self Spouse(s) (s) Dependent-1 Dependent- 2 Dependent- 3 etc., (i) Cash (ii) Deposits in Banks, Financial lnstitutions and Non- Banking Financial Companies. (iii) (vi) (vii) Bonds, Debentures and Shares in companies. Other Financial instruments NSS, Postal Savings, LlC, Policies, etc. Motor Vehicles (details of make, etc.) Jewellery (give details of weight and value) Other assets, such as values of claims i interests. I F6 6,16,ill -t / = Ra\.oo,goo -- p,^lrtw'wretakh) q6q y{-attq.ttta neliaiu in SBlt,Remtrsj1qr, t{gdhto"lc.d. ] I Toyou o. gw*1i6 Arf\$?Wtc'.lol Note: Value of Bonds / Shares / Debentures as rer the latest market value lin Stock Exchange in respect of listect companies and as per books in the case of non listed companieshould be given. *Dependent here means a person substantially dependents on the income of the candidate. t,:ii'.

5 B. Details of lmmovable assets: (Note: Properties in joint ownership indicating the extent of joint ownership will also have to be indicated). st. No. (i) Description Agricultural Land Self Spouse(s) (s) Dependent-1 Dependenf2 Dependen!3 etc., - Survey numbe(s). Extent (Total measurement) (ii) Non-Agricultural Land - Survey number(s) - Extent (Total measurement) (iii) Buildings (commercial and residential) - Survey / door number(s) - Extent (Total measurement) Houses / Apartments, etc. - Survey / door number(s) - Extent (Total measurement) Vqlrx Others (such as interest in property) house" nl- SholLrtnq'SGv, Rqwrnqqc'Y.tliq h.t{o: t-tetsli $w*ff$&!$.anhx) i.tlo: llr Evrqmqrnttt l\dc"vqba.xl rusboroorooc lr-w!*x** l\lr\jau([ t. t- foo/: {hf-f fs,/ \.--' '' \ i\,"'. l, t- "" ' I '.,,.J " \"J'r 1 "

6 (3) (Note: Please give separate details for each item) S.No. Description (a) (i) Loans from Banks and address of I BankiFinanciat I Am.ount Institutions(s)/ :t$:ilu?;k": Department(s) (ii) Loans from Financial lnstitutions (a) (b) Due to departments dealing with government accommodation. Dues to departments dealing with supply of lwater. Dues to departments dealing with supply of electricity. (d) Io\ Dues to departments dealing with telephone Dues to departments dealing with government transport (including aircrafts and helicopters) (0 Other dues if any (b) (i) Income Tax including surcharge (Also indicate the assessment year upto which lncome Tax Return filed. Give also permanent Account Number (PAN) (ii) Wealth Tax (Also indicate the assessment year upto which Wealth Tax return filed.) (iii ) Sales Tax (only in case of proprietary business) Property Tax, Nuu^ lt, 'fa "t J f trl,^^.. r (r t'fl,r (iii) Government dues:- I give herein below the details of my liabilities / overdues to Public Financial lnstitutions and government dues:- 1.-, ';. ''.,-.,J\rn"".', J"*" 't \u'\, l t t:,

7 ::5:: (4) My educational qualifications are as under:- \,/(G VEDETA LSoFScHooLANDUN VERS TYEDUCATION) ttr*,.61vr*'tloe'?r{$'{ (Pw-vcn'h"e'i Lon.ru'fu't'qb-e'at'b''+\\1'n"ir'.*$.6''5t.'vr"rlx S,s-bS\6.. ( of School/ University and the year in which the course was completed should also be given.)., -,'i -}l'" I '', :',{' {",\, oeponerur. VERIFICATION. l, the deponent above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my inowledge and belief, no part of it is false and nothing material has been concealed therefrom' Verified at..hgatv.qths".&.. this the ['..tf\ " dav of ' 6..tn'-^-\ J,,.. B6t4tg*t' l,, A\- 1:)o:)oG