ABSTRACT STATEMENT OF ELECTION EXPENSES

PART - I

I Name of the Candidate Sh./Smt./ Km. fh3j)UL KAJ-fJMn Number and name of Constituency 7&;- rJUf-J .

III Name of State/Union Territory /-I/lR YANf1 .IV Nature of Election

(Please mention whether General C,E ,AI? I?fJLElection to State Assembly / LokSabha / Bye- election)

V Date of declaration of result /;)- /0 - 201-9VI Name and Address of the Election USI=JI0AAcentVII If candidate is set up by a political

party, Please mention the name of . H~(2. YFJ<1\II} .rAN, " ( 1/)the political Darty .J-t.:::J. ~ CV_)

VIII Whether the party is a recognised Yes/No YE~political party

Annexure 15 .

Date:k)~(j/M/ ~,,~

Signature of the Candidate

Name Jf)g-fJ td 'l_" i<J}11 7 fVl ..Place:

103

PART-II : ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE OF CANDIDATE

f---'--S. No. Particulars Amt. Amt. Amt. Total Election expenditure

Incurred Incurred/ IncurredI Auth. by authorize / (3)+(4)+(5)Candidate d by Pol. authorize/ Election Party d byagent(in (in Rs.) othersRs.) (in Rs.)

1 2 3 4 5 6I Expenses in public meeting, rally, procession

etc.:- __,.I. a: Expenses in public meeting, rally, ..,,-----.- - ---...procession etc. (ie: other than the ones with ~.Star Campaigners of the Political party(Enclose as per Schedule-r)I. b : Expenditure in public meeting rally,procession etc. with the Star Campaigner(s) - _....._ - -(ie: other than those for general partypropaganda) (Enclose as per Schedule-2)

II Campaign materials other than those used in';l60c1- :2.600fJ/-the public meeting, rally, procession etc. ~ -mentioned in S.No. I above(Enciose as per

Schedule-3)III Campaign, through print and electronic media

including cable network, bulk SMS or internet - - - .---and Social media (Enclose as per Schedule-4)

IV Expenditure on campaign vehicle(s), used by ~'2..~.2\)Q f-- ,/)_!)8?2~O 1-candidate(Enciose as per schedule-S)V Expenses of campaign workers / agents I\'~°l- \\ r;co/-(Enclose as per Schedule -6)VI Any other campaign expenditure 1'--\311q~ Lt~' ICfUl-Grand Total I~q, '-A~.if .l.9 -l 4 'fS-

PART III : ABSTRACT OF SOURCE OF FUNDS ,RAISED BY CANDIDATE ~5 No Particulars Amount (in Rs.)1 2 3I Amount of own fund used for the election campaign

{,~44.~~/r-(Enclose as per Schedule - 7)II Lump sum amount received from the party (ies) in cash or cheque etc.

(Enclose as per Schedule -8)III Lump sum amount received from any person/ company/ firm/ assodations / body of

persons etc. as loan, gift or donation etc. ___.r(Enclose as per Schedule -9) .Total t<Cf,_y'1'\ 7,-

I

104

'."FORMOFAFFIDAVIT

Before the District ElectionOfficer ~.~.~.~::~ (District, State/Union Territory)

Affidavit of Shri/Smt/Ms .~.~.~.\.:).L....g.A~.;.!'0 (s/o, W/o,D/o)..................................................... I son/wife/daughter of.............rS.H.~.~..... aged ..1-:-/..8. years, rio U.J)t\#.:fL...... do herebysole _nl and sincerely state and declare a'sunder:-

IlAO~""::;.,,_ . ntesting candidate at the general election/bye election to the House of the People/-- ., ._."""pf H.t.1..~.'i.f.t.I\[p'! r: 7.'.~~from ~.7:-:::.:'7. .::-::"~.y. ..

Assembly constituency,. the result of which was declared on

inclusive.

(3) That the said account was maintained in the Register furnished by the Returning Officer for thepurposeand the said Register itself is annexed hereto with the supporting vouchers/bills mentioned inthe said account.

(4) That the account of my election expenditure as. annexed hereto includes all items of electionexpenditure incurred or authorised by me or by my' election agent, the political party which sponsoredme, other associations / body of persons and other individuals supporting me, in connection with theelection, and nothing has been concealedor withheld/suppressed therefrom (other than the expenseontravel of leaders' covered by Explanations 1 and 2 under section 77 (1) of the Representation of thePeopleAct, 1951).

(5) That the Abstract Statement of Election Expensesannexed as Annexure II to the said account alsoincludes all expenditure incurred or authorised by me, my election agent, the political party whichsponsoredme, other assooatlons I body of persons.and other individuals supporting me, in connectionwith the election.

(6) That the statements in the foregoing paragraphs (1) to (5) are true to the best of my knowledgeand belief, that nothing is false and nothing material.has been concealed.

Deponent ~ t%/,r"L---Solemnlyaffirmed/sworn by at this day of 201 before me.

(Signature and seal of the Attesting authority, i.e. Magistrate of the first Classor OathCommissionor Notary Public) .

105

Schedules- 1 to 9: Details of Elections Funds and Expenditure of Candidate

Schedule- 1

Expenses in public meeting, rally, procession etc. (ie: other than those with Star Campaigners of the Political party)S. Nature of Expenditure Total Amount Source of ExpenditureNo in Rs.

Amt. incurred / Amt. Amt. incurredAuth. by incurred / by othersCandidate / by Pol.agent Party with

name1 2 3 4 5 61 Vehicles for transporting visitors -- - --~2 Erecting Stage, Pandal & Furniture, Fixtures, - ~...".....--

poles etc. ---3 Arches & Barricades etc. ..-- ..,_-- ~ ~4 Flowers/ garlands - -- ..-- -5 Hiring Loud speakers, Microphone, amplifiers, _' - -_

comparers etc. ..----

6 Posters, hand bills, pamphlets, Banners, Cut- ..----- .,...---- --outs, hoardings

Beverages like tea, Water, cold drink, juice etc.7 .------ _--------8 Digital TV -boards display, Projector display, -tickers boards, 3D display .----- - -9 Expenses on celebrities, payment to musicians,

other artists remuneration etc. ~ ...----- -10 Illumination items like serial lights, boards etc. ' .----- ,.......__ -~11 Expenses on transport, Helicopter/ aircraft /

vehicles/ boats etc. charges ( for self, celebrity -or any other campaigner other than Star - - -Campaigner) ---12 Power consumption/ generator charges ~ - c---

13 Rent for venue -...-- ~14 Guards & security charges - .----- ~15 Boarding & lodging expenses of self, celebrity,

party functionary or any other campaigner - - --- ~including Star Campaigner

16 Others expenses - -- ~

Total -- --- ~Schedule- 2

Expenditure in public meeting rally, procession etc. with the Star Campaigner(s) as apportioned to candidate (ie: otherthan those for general party propaganda)

~~\'f'YI-_107

(

,..;. No Date and Name of the Star Amount of Expenditure on public meeting Remarks, if anyVenue Campaigner(s) & Name of Party rally, procession etc. with the Star

Campaigner(s) apportioned to the candidate(As other than for general party. propaganda) in Rs.

1 2 3 - 4 51 - -- - --2 - ~~3 ~ ~ .---- ---4 --- - -'---.

Total .....----Schedule-3

Details of expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners, cut-outs, gates &arches, video and audio cassettes, CDsI DVDs, Loud speakers, amplifiers, digital TVI board display I 3 D display etc. forcandidate's election campaign ( ie: other than those covered in Schedule- 1 & 2)S. Nature of Expenses Total Amount Sources of Expenditure Remarks, if anyNo. in Rs.

Amt. By Amt. By Pol. Amt. By otherscandidate I Partyagent

1 2 3 4 5 6 71

11b1lW\...~\..-J ~·o.lJJ. ~txxl/~ ~d - ~,_.

2 . f>~') 1i.~. bo~- 1~'1, ..-- r==: -3 'R i. \\0•. \~b~/-- Iq-<..)J ~ ---- .,....--.-

4

Total ~6t:.d)t- - .---- r----- -.Schedule- 4

Details of expenditure on campaign through print and electronic media including cable network, bulk SMSor internet orsocial media etc. for candidate

S. Nature of Name and address Name and address of Total Amount Sources of ExpenditureNo medium of media provider agency, reporter, stringer, in Rs.

(electronic I (print /electronic company or any person to .Amt. By Amt. By Amt. Byprint) and Isms I lIoice/ cable whom charges / candidate/ ·Pol. othersduration TV, social media commission etc. paid/ agent Party

etc.) payable, if any Col. (3)' +(4)1 2 3 4 5 6 7 81 r+: .--- .--'- .---- ,...-- -,..---

2 -- - - - - ,-----.-- - ---3 - ---

4 -- ..-- - --- .----Total

:'J.I,

Schedule-SDetails of expenditure on campaign vehicle (s) and poll expenditure on vehicle (s) for candiCiate'telection

, "'i "___~?mpalgn, l<'t

Sr. I Regn. No, Hiring Charges of vehicle No. of Total Source of Expendiurre.No, I of Vehicle Daays (, amt.

& Type of Reate for Fule Driver's for incurredz'Vehicle hring of " charges charges which auth. In f--A':___m~t.~b~y----'----'------l

vehicle/ (if not (if not used " Rs, /candidatemaintenance covered. covered'.under under '-.

".

hiring) hiring)' ~.

Amt. Amt.by Pol. By~any others.

.7 8

~ .. -..z::,. ""-:-<--r-:- --",--- ,,---- f"'--

agent

-

1 2 3a 3b 3c 4 5' ' 6

" 1/ u. ',t II

" v-, I,

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Proforma S.K

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Schedule-6Details of expenditure of Compaign workers/agents.Sr. Date Expenses on Compaign Workers. Total Sources of Expenditure.No. and Nature of Qty. No. of amt.

Venue Expenses Workers/ incurred/ Amt. by Amt. by Amt. Byagent auth. in candidate/ Pol. Party others.

Rs. agent1 2 3a 3b 3c 6 7 8 9,~ ,.

I. Compaign- ,

workers ___.. - -- - -honorarium/Salary etc.Boarding -~~ ~"oo)- ~. - ~Lodging -- --- ~ ..,..___,._ ~ -Others. (Tea) ~~OSbJ,_ ~, ..--- ,....--.

2 ~~ Compaign\~ workers - ----- -honorarium/ - .,.--- ---

Salary etc.Boarding ---' -- - __.J - ----.J

Lodging - - - .,....--... ~ -....-Others. (Tea) ~1"Ur/,...- "Sd1. ~ -3. ~~ Compaign

\"( workershonorarium/Salary etc.Boarding .- ---- ~ ~ ----- ~Lodging --- .___ ----.. - .--- ---Others. (Tea) 4i~~" ~. - ,..-

4 , \0 Compaign'"\--- workerst~ .------- r---honorarium/ - - - .___Salary etc.. Boarding ~ ~ .-- - -- -Lodging - -- - .-- ..---- ...---.Others. (Tea) $(,'''bl.-- -S-<J-) • - r--

5 ~- \'" Compaign\'1 workers - -- - -honorarium/ r--....

Salary etc.Boarding - - -=---- - c:---- .---..Lodging - c-- ~ - .--- -.

~Others. (Tea) It ?..'6oo) ,,- ~. ~ ....------

Total

Proforma S.K

Others. (Tea)7 \.0· Compaign1\\1 workers -- - ..----- r-- ...----

honorarium/Salary etc.Boarding _.. -_ - -- -~Lodging --=-- ~ -=-- - -- .,.....,..

I Others. (Tea) ~4ool- ~U. - -H g~ Cornpaign

,

\.'i workers - - -honorarium/ r---

Salary etc.Boarding - -- ,......----- -Lodging -- ..-- .------ ~ -- -Others. (Tea) \::\~t:lJ- S-eJ~. ,-- -

9~~

Compaignworkers ..---- , -------- ------- ~ .,..___\'1 honorarium/ t-

Salary etc.Boarding - -- ----- --- - --Lodging - - - .---. - -Others. (Tea) ~l$b/- ~. - --10 t ,10 Compaign

0- workers~~ - - ------ ,---__

honorarium/Salary etc.Boarding - - .--- --- . -Lodging -- - - - - -Others. (Tea) ~\Sb S--d--! .- ~ ,--

11 \ \ \0 Compaignworkers - _,.----\'1 -- .,---. .-----honorarium/Salary etc.Boarding - --- r-- --- ,,--- ;--

Lodging r--- -- ----- .-- ~ r--Others. (Tea) 1:\,--\\Q7- ~..elj • -- r--

12 Compaignworkershonorarium/Salary etc.BoardingLodgingOthers. (Tea)

Total ~4.o56SI·,

Proforma S.K