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who k identified by Sril -.--
Advocatr ,rh afT tm^ e^3TfaTqT4ft ct Z-affuz
4.ch'ed
e' P U tai y rrz!- Y; Y !^_
11 A VITi
nre- .
Ikinr;'r mwN,r%-um" B it} (AJNIJII) ^.er."NY
Before the Returning Officer
For election to 4)!±!{(^L^E,(,it,R-11V^^sSt (name of the House)
From . .............^^constituency
(Name of the Constituency)
.......^^?'.^9....... .-.'^!....,1.__.... Son/dai ht ^^ ... }g erl ife
... kk W - 4 n . ..... o ... Q. ......}^ et '!Y... aged .. _. .L) Ye
^. NATION PAPER` Y i -
,...e... LL Da, f2 C/fr
re>d> ent of ..V^J1 . t..(^b:...l^ I^.U..C^i ......
Candidate at the above election , do hereby solemnly affirm and state on oath as under:-
(Strike out whichever not applicable)
1. The following case (s) is/'e pending against me in which cognizance has betaken by the court:-
0) Section of the Act and description of the offence for which cognizance:taken : 1 LS 14 . 19 $ I \A 9S -
I I 133 32 1 -3 7- 5 SO 332,
(ii) The Court which has taken cognizance: 0-'-T "- ^)AkGyIA^h7j}^
iii) Case No, c
Date of order of the court taking cognizance : J . D , p
Details of appeal ( s) / application ( s) for revision . etc. if any, filed agai sr
above order taking cognizance A- ,daTI lb L1 1s^^ erc'^C1` bpo L4 4,
2) That 1 give herein below the details of the assets(immovable, movable, bank
d dents and myselfnbalance, etc) of spouse, my epe
(A) DETAILS OF MOVABLE ASSETS
(Assets in joint name indicating the extent of joint ownership will also have to be
Spouse(s) Dependent-1
Name(s) Nametam
AI SI^1T SIt , I0 "T-TTJ^^V I
I Rsr__Oe?o^-'
Deposits in BanksFinancialInstitutionsAnd Non-BankingFinancialCompaniesBonds. Debentures Iand Shares in
ompanies
tOther financial
(t) 9 L- ' rS ,instruments , NS
postal Savings , LIC ^(^J ^^;QSl^kh IIPolicies, etc.
(v)
interests
Motor Vehicles(Details of make,etc.)
^5 Lo RT^^()I 0)A '7 19- 1-591
Net - '50 1"7 1i (ndJewellery (give CAo - t S
PJ iZS $S PS-QS. a IQ (co lI details of weight !6l-
and value) 045M^1- soon(
(vii) other assets, such1 „ftk5•}n^"^as values of claims/ 1
Note: Value of Bonds/ Shares / Debentures as perExchange in respect of listed companies and as per books in the
case of P. 01 11
I_)) L_ N " -
MI L
the latest market value it, St''ck
listed companies should be given. A fit ^^.^ ^ay,to nn the 1i1('NT
y c_ ^_. i s r m "aa a person substantiall}r de,.^
^ J
1 I-1 I t
^1 I L I t.1 11_ Iy
lIl-
di
B. DETAILS OF IMMOVABLE ASSETS
[Note : Properties in joint ownership indicating the extent of joint ownership w ill al
have to he indicated]
Descriptionti atne(s)
Dependent-IName
Se^N41I
r, ' iii9i-TA DPI
(i) Agricultural Land-- Locations(s)- Survey number(s)
l- Extent (TotaI measurement)
Current market value
ar ytll-S9A-tel t '' W 'n' "1o3oE .tpH•F.
A-P.6^* 19dk. Rsslakh6^bo loLskh a}itlrd
] (ii) Non-Agricultural Land- "l'pIsLocations(s) -Survey number(s) t l- ps.7t^l
- Extent (Totalmeasurement)
- Current market valueI 'I
^ Buildings (commercial o►and residential) v,- Locations(s)I 7cQk►- Survey - door
numbers(s)- Extent (Total
(iii) Houses Apartments,
measurement)- Current market value
- Locations(s)- Survey door
etc-
numbers(s)- Extent (Total
measurement)- Current market value
(iv) Others (Such as interestin property)
Self ' Spouse(s)
Jl-
ill
X11 l-- til ^ ^
I Dpendru-2 I i9ependeu,Nani etc Nan",
Sort ^ccaj
pJIvu tlnhLR^
N tt-
7J I L
N1L
N
ILI)
I give herein below the details of my liabilities ' over due to public financial
institutions and government dues:-
[Note : Please give separate details for each item)
(i) Loans from Banks
i Name & address of1 Bank/FlnancialInstitutions(s
Departments(s)
T At4 \c of . h I A-
Amount
outstandinL as
or, . ............
13^oAt^^s4^
(ii) Loans from financial institutions
^)I( - I-- ^'I1y.
(iii) Government dues:- Ps SsoOO`-QS as-n OO .
giL iu Vt4a, oYt
(a) dues to departments dealingwith governmentaccommodation
Vl^-
(b) dues to departments dealing withsupply of water
(c) dues to departments dealing with Isupply of electricity
(d) dues to departments dealing with
telephones
(e) dues to departments dealing withgovernment transport (includingaircrafts and helicopters)
t t-
N1L
" 1\
(f) other dues, if any
Number (PAN)]
[Also indicate the assessments yearto which income Tax Return AP-zpy -9 144
u
Wealth Tax [Also indicate the
assessment year up to which wealth
Tax return filed.]
filed. Give also permanent Account 7gI 9-10
t-- o
tA' mounDescription • - Name N address ofBanlo'Financial Institutions(s)i outstanding as
Depat?menc^ts) L on .-
(i) Income Tax Including surcharge
p
Sales tax [Only in case oproprietary business]
(iv) Property Tax
(4) My educational qualifications are as under :- (>q , A . eH'X^,.
` vat b`-j,^}til^tbl
DEPONENT
VERIFICATION
1, the deponent &v-- aarned , do hereby verify and declare that the content , of thi<
affidavit are truerdnd correct to the best of my knowledge and belief; no part of it is
false and nothing material has been concealed there from.
` .. ..^. :Verified at . .. ... ... this the........ ^.. d:ty 0 h f :. . . . . . . [
[GIVE DETAILS OF SCHOOL AND UN[VERSITY EDUCATION]
[Name of School ! University and the year in which the course was completed
hould also be given .] fI, g Y9 bpj {xe d h1 t.2T,kN , Ph.D,!P
L• N xy, c-1. Qtg4Z hA11tny^
!^P tl4l t^°"nen:--,
41 t&R afit 13fk
ffftDate fixed for notifylnthe requisite number c,
stamps and folios.folios.
L
-.^^ .,6 1/
Af tDate on which the copywas ready for delivery.
sdM iNT" itMr F
Date of making over thecopy to the applicant.
P91g110 I ¶3191(0
m fNam)d *t
MfRNDate of application for
the copy.
VW Tftff T(4 ED 4ol^
aftDate fixed for notifyingthe requisite number of
stamps and folios.
* at
Date of delivery of therequisite stamps and
folios.
qmf lili R i rl A
Date of making over theDate on which the copywas ready for delivery. copy to the applicant.
^r?J^ 23 7 '
7( 7
twilliigt I•i44 uI>I 1, ^ F 41
*4.61 trill
Slid i .. ... ... ...
Rio kv.i '$ .4
a!kj q I ► o
1q'd q ,, Zv ii '. -,a.l PI ) a c
"I'MIR *f a4i^1 ln,,oi
y.S
-3o
FORM A
COMMUNICATION WITH REGARD TO AUTHORISED PERSONS TOINTIMATE NAMES OF CANDIDATES SET UP BY RECOGNISED
NATIONAL OR STATE POLITICAL PARTY OR REGISTEREDUN-RECOGNISED POLITICAL PARTY.
[See paragraph 13(c), (d) and (e) of the Election Symbols(Reservation and Allotment) Order, 1968]
To,
1. The Chief Electoral Officer,
............?t ..........................................................(State/Union Territory)
2. The Returning Officer for the
S.................... ea$1 ........................................... Constituency.
Subject: General/$y( Elections to ..................
from ................. it.^A15 ............................................ (State/Uior-territory)-
Allotment of Symbols-Authorisation of persons to intimate names of
candidates.
In pursuance of paragraph 13(c), (d) and (e) of the Election Symbols (Reservation
and Allotment) Order, 1968, I hereby communicate that the following person(s) has/have
been authorised by the Bharatiya Janata Party, which is National Party in the State
of ........................W, iA21 .................................... to intimate the names of the candidates
proposed to be set up by the party at the election cited above.
Sir,
Name of person authorisedto send notice
Name of office heldin the Party
1 1 2
District(s)/area(s) constituency/constituencies in respect of
which he has been authorised3
2. The specimen signatures of the.above mentioned person(s) so authorised are givenbelow:-
1. Specimen signatures of Shri .........^..,^.... .
(i) ............ :. :.. r,:^ ....... (ii) ...l `J C''r .....................
(iii) ...........
2. Specimen signatures of Shri .................................................................................
(i) ......................................................... (ii) ..........................................................
(iii) .......................................................
3. Specimen signatures of Shri .................................................................................
(i) ......................................................... (ii) ..........................................................
(iii) .......................................................
Yours faithfully,
Place N e.w 'h ,-IT IN GADKARI)
q • p t) t) PresidentDate ................`^.:................ Bharatiya Janata Party
/A JAN
o-,ionj u.1*
N.B. :
1. This must be delivered to the Returning Officer and the Chief Electoral Officer notlater than 3 p.m. on the last date for making nominations.
2. Form must be signed in ink by the office bearer(s) mentioned above. No facsimile
V
FORM B
NOTICE AS TO NAME OF CANDIDATE SET UP BYTHE POLITICAL PARTY
[See paragraphs 13(b), (c) and (e) and 13A of the Election Symbols(Reservation and Allotment) Order 1968]
To
The Returning Officer for the
Q 6.'... 1 ..........................................Constituency.
Subject: General/Bye-Elections to m! .....................................from .. ^ ...........
..-.........-1. .......................................... (Name of the Constituency)in ...............1: 1. .1. ......................................... ( State/Un'1Da--T€rritory)--settingup of candidate.
Sir,
In pursuance of paragraphs 13(b), (c) and (e) and 13A of the Election Symbols (Reservationand Allotment) Order, 1968, I hereby give notice on behalf of Bharatiya Janata Party--
(i) that the person whose particulars are furnished in columns (2) to (4) below is theapproved candidate of the party above named, and
(ii) the person whose particulars are mentioned in columns (5) to (7) below is thesubstitute candidate of the party, who will step-in on the approved candidate'snomination being rejected on scrutiny or on his withdrawing from the contest, if thesubstitute candidate is still a contesting candidate, at the ensuing general/bye electionfrom this constituency :
Name of theconstituency
Name of Father's/ Postal Name of the Father's/ P t lthe Mother's/'
address of substitute candidate Mother'sos a
addre fapproved Husband s approved who will step-in on Husband'ss o
s b ticandidate name of candidate the approved s name ofu s tute
candidateapproved candidate's substitutecandidate nomination being candidaterejected on scrutiny
or on hiswithdrawing from
V
*2. The notice in Form 'B ' given earlier inSushri ................ favour of Shri/SmtJ.......................................candidate Shri/Smt./Sushri "" """"" as party's appro% ed
Party's substitute candidate is hereby rescinded.
13. It is certified that each of the candidates whose name is mentioned above is a member
of this political party and his name is duly borne on the rolls of membersof this party.
Place ....`.f ..............
Date ..^...o: o.. ^Y p I D.................
Yours faithfully,
(Name of theAuthnr;
arty)
N.B..
I • This must be delivered to the Returning Officer not later than 3 p.m. on the last datefor making nominations.
2. Form must be signed in ink by the office bearer(s) mentioned above. No facsimilesignature or signature by means of rubber stamp, etc., of any office bearer shall beaccepted.
3. No form transmutted by fax shall be accepted.
ss'
V-w^^yy
EV,URE _ YAr.N PARA 11)CHA^TE12 V[1,
EN SIGNATURE.Of CA^p1DATESCIM ACiF.N"rS NO &FORMAT FOR SFE T10N
AND THEIR ELECelection .
GeneralI B mial D -.
Name of'' kssemb yncy . . .Sabha Constitue
L.ok °_ .. ... .... .. ... ... ent are ^_IV OYr bt't0 A'v .O}' l le
oflicabe oiilt mcilicandidates and 0. eir t.l 11U1n Af(Delete whatever is not app
St matun of contesturg the Presiding; Off.ce, n, the lett^.; of apF
The specunen b ,natures byof their s,g - 5t, ^,nreupurl) ose of venfication Sis at the tune of Poll'. rv Namr, of hisl^
rn it, Wapolling Age pecrmen ccuon5 Gl `_Name of the Contesting
Sl. Cand,dateNo. \ niluAN
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..........Date:.........
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tar" TriTfuEmt,
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