~ Affidavit to be furnished by the candidate before the returning officer for

Transcription

1 ~Ol~'ft ti9~ ~ ANDHRA PRADESH M.VENUGOPAL tic M. SUBBAIAH ANANTAPUR AN JorWhom: ~~SELF** FORM-26 (SEE RULE 4A) ~ Ex. Officfo Stamp Vendor SRO: ANANTAPUR ~ Affidavit to be furnished by the candidate before the returning ficer for I election to (name the house) from Anantapur Urban Assembly Constituency. I, M.Venugopal S/o M.Subbaiah, aged about 52 years, residing at ~ D.No , Neeruganti Street, Old Town, Anantapur candidate at the above I election, do hereby solemnly affirm/state on oath as under:- 1. I am not accused any fence(s) punishable with imprisonment for two ~ years or more in a pending case(s) in which a charge(s) has/have been framed by the court(s) competent jurisdiction. Contd..2

2 ,- ~J?~~~/2~~ ANDHRA P~~~:S~094 - ~uhfiased By. M. VENUGOPAL SIO it SUBBAIAH ANANTAPUR I For Whom: HS F U :: 2:: ~ Ex. Officio Stamp Vendor SRO:ANANTAPUR 48AA If t e deponent is accused any such fence(s) she shall furnish the following information:! (i)1. Case/First Information Report No./Nos. (ii) Police Station(s) Apilicable. - Not Applicable District(s) --_State(s) Not (iii)a Section(s) the concerned Act(s) and short description. which the candidate has been charged: Not Applicable the fence(s) for (iv~ Court(s) which framed the charge(s) Not Applicable Contd..3...

3 :: 3 :: If the deponent is convicted and punished as aforesaid, he shall furnish the following information. (i) Case/First Information Report No./Nos. (ii) Court(s) which punished Not Applicable Not Applicable (iii) Police Station(s) District(s) State(s) Not Applicable (iv) Section(s) the concerned Act(s) and short description which the candidate has been charged: Not Applicable the fence(s) for (vi) Date(s) on which the sentence(s) was/were pronounced: Not Applicable (vii) Whether the sentence(s) has/have been stayed by any court(s) competent jurisdiction: Not Applicable Place: Anantapur. Date: M'\!~%5lD~ Signature Deponent VERIFICATION I, the above named deponent, do hereby verify and declare that the contents this affidavit are true and correct to the best my knowledge and belief no part it is false and nothing material has been concealed therein. Verified at Anantapur this the 25 th day May, \i'--\ Y---~ Signature a-5p~ deponent Note: The columns in this Form which are not applicable to the deponent may be struck f.

4 APPENDIX VI-C STATEMENT OF SUMMALRY OF PARTICULARSIINFORMATION FURNISHED IN AFFIDAVITS {CHAPTER III PARA 4.5(3.1)} NO. & Name Constituency: 272 Anantapur Urban Constituency SI.No. Particulars Description 1. Candidate's Name M.Venugopal 2. Father's Name M.Subbaiah 3. Age 52 years 4. Educational Qualification s" Class 5. Convicted (Yes)/(No), if yes, -NOthen list section(s) 6. Cases pending (Yes)/(No) if - NILyes, then list section(s) 7. Assets: Movables Rs.45,000/- Immovables - 8. Liabilities/over dues - Public Financial Institutions and Govt. Dues. Date: Place: Anantapur. M V\J-~~OP~ Signature Candidate

5 ~o ~0gfJ"4l~ANDHRAPRADESH. \Il=NUGOPAL ~O M. SUBBAIAH ~ANTAPUR, AN ~orwhom:.. SELFu ~ Ex. Officio Stamp Vendor BEFORE THE RETURNING f NTAPUR For election to ASSEMBLY CONSTITUTENCY a From ANANTAPUR URBAN ASSEMBLY CONSTITUTENCY I, fv'i.venugopal S/O M.SUBBAIAH, aged about. Lyears, residing at D.No , NEERUGANTI STREET, OLD TOWN, ANANTAPUR candidate at the above election, do hereby solemnly1affirm and state on oath as under:- TNO~P ~Ot"'! (1) I am a candidate set up by 'FELUGU OESAM (name the political party). (2) Dettils PAN and status filing Income Tax Return: SI.No. I Names Permanent The financial year for Total Income II Account Number which the last Income shown in Income (PAN) Tax Return has been Tax Return (in filed Rupees) 1. ItSelf Spouse - 3. ladependent-1 4. Dependent-2 5. IIiDependent-3 - NILcontd..2...

6 . -1 ~~~ac~:.'~~ ANDHRAefilWl!Dlt8t;l M. VENU OPAL SIO M. S BBAIAH ANANTAiUR D.nomin~ff~A1"72972 For Whom: :: 2: ~ *"*SELP*' Ex. Officio Stamp Vendor (3) The following case(s) is/are pending against me in whic A Reen taken by the court:-i SI.No. Offence Description (a) The dttails cases where the court has taken cognizance, Sections the Act and NOT APPLICABLE descrftion the fence for which cognizance taken: (b) Nam~ the court, Case No. and date order NOT APPLICABLE takin cocnizance: (c) Detali~ Appeal(s)/Application(s) for revision NOT APPLICABLE (if an filed against the above order(s): (4) Cases in W~Ch I have been convicted by a court law (other than those referred to in Form 26).' (a) tls cases, Sections the Act and f the fence for which convicted: NOT APPLICABLE lna.~~i e' ourt(s), Case No. and Date(s) NOT APPLICABLE osed: NOT APPLICABLE Contd..3...

7 :: 3:: (5) That I give herein below the details the assets (movable and immovable etc.,) myself, my spouse and all dependents:- A. Details movable assets: (Note: 1. Assets in joint name indicating the extent joint ownership will also have to be given. 2. In case deposit/investment, the details including Serial Number, Amount, Date Deposit, the Scheme, Name Bank/Institution and Branch are to be given. 3. Value Bonds/Share/Debentures as per the current market value in Stock Exchange in respect listed companies and as per books in case non-listed companies should be.given. 4. Dependent here means a person substantially dependent on the income the candidate 5. Details including amount is to be given separately in respect each investment) SI. No. Description Self Spouse Dependant- 1 Dependant- Dependent- 2 3 (i) Cash in hand (ii) Details Deposits in Bank accounts (FDRs,Term Deposits and all other types Deposits including saving accounts), Deposits with Financial Institutions, Non Banking Financial Companies and Co-operative societies and the amount in each such deposit (iii) Details Investment in Bonds, Debentures/shares and units in Companies/Mutual Funds and others and the amount. (iv) Details investment in NSS, Postal Savings, Insurance Policies and Investment in any Financial Instrument in Post Office or Insurance Company and the amount. (v) Personal loans/advance given to any person or entity including firm, Company, Trust etc., and other receivables from debtors and the amount. (vi) Motor Vehicles/Aircrafts/Yachts/Ships (details Make, Registration No. etc., Year Purchase and amount. Rs.25,OOO/- Hero Honda Activa bearing No.AP-02-L Purchased in the year 2010 Value Rs.20,OOO/- Rs.10,OOO/ Contd..4...

8 :: 4:: (vii) Jewellery, bullion and valuable 7 tulas thing (give details weight and Gold value) ornaments worth - Rs.2,10, (viii) Any other assets such as value Claims/interest (ix) Gross Total Value RsA5,OOO/- Rs.2,20, B. Details Immovable assets:- (Note: 1. Properties in joint ownership indicating the extent joint ownership will also have to be indicated. 2. Each land building or apartment should be mentioned separately in this format). SI. Description Self Spouse Dependant-1 Dependant- Dependent- No. 2 3 (i) Agricultural Land: Location( s) Survey number(s) - Area (Total measurement in acres) Whether inherited property (Yes or - No). Date purchase In case self - acquired property. Cost Land (in case purchase) at the time purchase. Any investment on the land by way development, construction etc., ~ CV\ ' V--.a--CLJ. ~ ~ ~~ ~. 11~\o:.\' Contd

9 :: 5:: (ii) (iii) Approximate Current Market value NonAgricultural Land: Location(s) Survey number s Area (Total measurement in acres Whether inherited property (Yes or No). Date purchase in case self acquired propert. Cost Land (in case purchase) at the time urchase. Any investment on the land by way development, construction etc., Approximate Current Market value Commercial Buildings: (including apartments) - Location(s) Survey number s) Built up Area (Total measurement In s.ft. Whether inherited property(yes or No - (}/\.V~~ ~ o'p~ Contd

10 :: 6:: (iv) Date purchase in case self acquired propert. Cost property (in case purchase) at the time urchase Any investment on the property by way development, construction etc.. Approximate Current Market value Residential Buildings: Location(s) Survey number s) Area (Total measurement in acres Built up Area (Total measurement in sq.ft.) Whether inherited property (Yes or No) Date purchase In case self acquired propert. Cost property (in case purchase) at the time urchase. Any investment on the land by way development, construction etc., Approxima~te Curre. val...l ! MV~ g~ Contd

11 :: 7:: (v) Others (such as interest in - property) (vi) Total Current Market value - - (i) to (v) above. (6) I give herein below the details liabilities/dues to public financial institutions and government:- (NoteL Please give separate details name Bank, institution, entity or individual and amount for each item). - SI. Description Self Spouse Dependant- Dependant - Dependent- No (i) (ii) Loan or dues to BanklFinancial Instittion(s) Name Bank or - - FI amount outstanding nature loan Loan or dues to any individuals/entity Other than mentioned in (i) - above. Name(s) Amount outstanding Nature laon Any other liability - Grand total - NILliabilities - Government Dues: Dues to departments - dealing with government accommodation Dues to departments dealing with supply - - water. Dues to departments dealing with supply - - electricity Qv\ V~"L--l ~~ Contd..8...

12 :: 8:: Dues to departments dealing with supply - telephones/mobiles. Dues to departments dealing with government - transport (including aircraft and helicopters). Income Tax Dues - - Wealth Tax Dues - - Service Tax Dues - NIL Municipal/Property Tax dues. - - Sales Tax Dues - - Any other dues (7) Details pression or occupation: a. Self Electrician b. Spouse NIL (8) My educational qualification is as under: 9 th Class, Z.P.High School, Kuntimaddi, Anantapur District, 1976 (Give details highest School/University education with full form the certificate/diploma/decree course) Name 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 the candidate MVENUGOPAL 2. Full postal address D.No , Neeruqanti Street, Anantapur. 3. Number and Name the constituency and 272 ANANTAPUR URBAN ASSEMBY CONSTITUENCY, state.,andhra PRADESH. 4. Name the Political Party which set up the candidate (otherwise write Independent'). TELUGU DESAM 5. (a) Number cases in which conviction order passed (other than those referred to NIL in Form 26) (b) Total number Pending cases where the court(s) have taken coqnizance. 6. PAN Year for which last Income Tax Total Income shown Return filed (a) Candidate - - (b) Spouse - - (c) Dependents - - <M: V~~ 3--oPeJJ Contd

13 :: 9 :: 7. Details Assets and Liabilities in rupees SI. Description Self Spouse Dependant- Dependant -2 Dependent- I No. 1 3 A. Moveable Assets Rs.45,OOO/- Rs.2,20,OOO/- - - (Total value) B. Immovable Assets (i) Purchase Price and Development Cost Immovable Property (Total value). (ii) Approximate Current Market Price Asset (Total Value) 8. Liabilities (i) Government Dues (Total) - - (ii) Loans from Banks, Financial Institutions and - - others (Total). 9. Highest educational qualification: s" Class, Z.P.High School, Kuntimaddi, Anantapur District (Give details School/University education with full form the certificate/diploma/degree course) (Name the School/College/University and the year in which the course was completed.) VERIFICATION I, the deponent above named, do hereby verify and declare that the contents this affidavit are true and correct to the best my knowledge and belief, no part it is false and nothing material has been concealed from there. (a) There is no case 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 ANANTAPUR this the 25 th day May, DEPONENT