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0000144190

INDIA NON JUDICIAL

Government of Puducherry

e-Stamp

Certificate No. IN-PY02145954690484M

Certificate Issued Date : 02-Apr-2014 12:06 PM

Account Reference : SHCIL (FI)/ pyshci101/ PUDUCHERRY/ PY-PU

Unique Doc. Reference SUBIN-PYPYSHCIL0102400913845266M

Purchased by : R K R ANANTHARAMAN

Description of Document : Article 4 Affidavit

Property Description : AFFIDAVIT

Consideration Price (Rs.) : 0 (Zero)

First Party : R K R ANANTHARAMAN

Second Party : ELECTION DEPT

Stamp Duty Paid By : R K R ANANTHARAMAN

Stamp Duty Amount(Rs.) : 20 (Twenty only)

at;

Please write or type below this line

FORM 26 (See Rule 4A)

Affidavit to be filed by the candidate along with nomination paper ing Officer for election to ...LOK SABHA

from...PUDUCHERRY PARLIAMENTARY Constituency ncy)

rl

Si NED 13EFORE ME

1 of this Stamp Certificate should bb verified at "www shcilestarnp.corn- . Any discrepancy in the details on this Certificate and as available on the website renders it invalid.

2. The onus of checking the legitimacy is on the users of the certificate. 3. In case of any discrepancy please inform the Competent Authority.

PART - A

R.K.R. ANANTHARAMAN son of. K. RAMATCHANDIRANE

aged... 41 years, resident of 18/1 School Street, Nonankuppam, Ariyankuppam

post, Puducherry — 605 007 (mention full postal address), a candidate at the above election, do hereby

solemnly affirm and state on oath as under:-

(1) I am a candidate set up by PATTALI MAKKAL KATCHI (name of the political party) am contesting as an Independent Candidate(Strike out whichever is not applicable)

(2) My name is enrolled in MANAVELY PUDUCHERRY (name of the Constituency and the State, at Serial No 191 in Part No 10

(3) My contact telephone number(s) is 9443265171 and my e-mail id (if any) is ... [email protected] and my social Media account(s), if any are [email protected]

(4) Details of Permanent Account Number(PAN) and status of filing of Income Tax return

SI.No. Name PAN The financial year for which the las Income Tax return has been filed

Total income shown in Income Tax Return (in Rupees)

1 R.K.R. ANANTHARAMAN

ADGPA7503B 2012 2013 Rs:221240/- NIL

2 Lavanya @ Mahalakshmi

ACOPL6812D 2012 2013 Rs:57830/- NIL

3 Aishwariya Nil Nil Nil Nil NIL 4 Sharani Nil Nil Nil Nil NIL 5 Dependent-3 Nil Nil Nil Nil NIL

(5)

I am/am not accused of any offence(s) punishable with imprisonment for two years or more in pending case(s) in which a charge(s) has/have been framed by the court(s) of competent jurisdiction.

If the deponent is accused of any such offence(s) he shall furnish the following information:-

(i)

The following case(s) is/are pending against me in which charges have been framed by the court for an offence punishable with imprisonment for two years or more:-

(a) Case/First Information Report No./Nos. together with complete details of concerned Police

NIL

Station/District/State. (b) Section(s) of the

concerned Act(s) and short description of the offence(s) for which charged.

Not Applicable

(c) Name of the Court, Case No. and date of order taking cognizance:

Not Applicable

NED BEFORE ME

$.(cer.r4

(d) Court(s) which framed the charge(s) Not Applicable

(e) Date(s) on which the charge(s) was/were framed

Not Applicable

(f) Whether all or any of the proceeding(s) have been stayed by any Court(s) of competent jurisdiction.

Not Applicable

(ii) The following case(s) is/are pending against me in which cognizance has been taken the court (other than the cases mentioned in item(i) above) :-

(a) Name of the Court, Case 1. Hon'ble Judicial Magistrate court II at Cuddalore. No. and date of order S.T.C. NO. 148/2013 , (Cr No 44/2013, Cuddalore NT Police taking cognizance: Station , Tamilnadu.) Date of order taking cognizance was

03/6 /2013 2. Cr No 400/2013 .Villupuram Town Police station , U/S 143, 188, of IPC RNV 7(1) (A) of the Criminal Law Amendment Act, Investigation is pending charge sheet not filed/ Cognizance not taken. 3. Cr No.32/2014 U/S 294,153-A(a)(c),153-B(c), 295- A,505(2)(c),505(2),509 IPC Orleanpet Police Station, Puducherry.

(b) The details of case(s) 1.Case is Pending,4 numbers of prosecution witnesses were where the court has taken examined and case posted for further witnesses on 20/4/2014. cognizance, section(s) of 2. Charge sheet not yet filed by the investigation officer the Act(s) and description Cognizance not taken. of the offence(s) for which 3. Charge sheet not yet filed by the investigation officer cognizance taken. Cognizance not taken.

(c) Details of Appeal(s)/ Application(s) for revision -NIL- (if any) filed against the above order(s)

Note : Detai s of all pending cases in which cognizance has been taken by the Court, irrespective of the quantum of punishment or framing of charges will have to be disclosed.(ECI's clarification no.3/4/2012/SDR dated 26.9.2012)

(6) I have not been convicted of an offence(s) other than any offence(s) referred to in sub-section (1) or sub-section (2) or covered in sub-section (3), of section 8 of the Representation of the People Act, 1951 (43 of 1951) and sentenced to imprisonment for one year or more.

If the deponent is convicted and punished as aforesaid, he shall furnish the following information:-

In the following cases, I have been convicted and sentenced to imprisonment by court of law :

(a) The details of case(s),section (s) of the concerned Act(s) and description of the offence(s) for which convicted.

NIL NIL NIL NIL

(b) Name of the Court(s), case No (s) and date(s) of order(s) NIL NIL NIL NIL

(c) Punishment imposed NIL NIL NIL NIL (d) Whether any appeal was/has

been filed against the conviction order, If so, details and the present status of the appeal:

NIL NIL NIL NIL

SIGNED BEFORE ME

(7) 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 1 : Assets in joint name indicating the extent of joint ownership will also have to be given Note 2 : In case of deposit/Investment, the details including serial Number, Amount, date of deposit,

the scheme, name of the Bank/Institution and Branch are to be given Note 3: Value of Bonds/Share Debentures as per current market value in Stock Exchange in respect

of listed companies and as per books in case of non — listed companies should be given. Note 4: Details including amount is to be given separately in respect of each investment. Note 5: Details including amount is to be given separately in respect of each investment.

SI.No Description Self Spouse Depe ndent 1

Depen dent2

Depen dent3

(i) Cash in hand Rs.75,000/- Rs.50,000/- NIL NIL NIL (ii) Details of deposit in Bank

accounts (FDRs), Term Deposits and all other types of deposits including saving accounts) Deposits with Financial Institutions Non-Banking Financial Companies and Cooperative Societies and the amount in each such deposit

Indian Bank Ariyankuppam Puducherry SB A/c No :6210577532 Amount : Rs:51,000/-

Indian Bank Ariyankuppam Puducherry SB A/c No :717641533 Amount : Rs:600/-

UCO Bank Puducherry Main SB Ak No :00590110023969 Amount : Rs:10200/-

Indian Bank Ariyankuppam Puducherry A/c No :6210972804 Amount: Rs 1000/-

Indian Bank Ariyankuppam Puducherry SB A/c No :717641464 Amount : Rs:638/-

NIL NIL NIL

(iii) Details of investment in Bonds, debentures/shares and units in Companies /Mutual funds and others and the amount.

NIL NIL NIL NIL NIL

(iv) Details of Investment in NSS, Postal saving Insurance Policies and investment in any Financial instruments in Post office or Insurance Company and the amount

NIL NIL NIL NIL NIL

(v) Personal loans/advance given to any person or entity including firm company, Trust etc, and other receivables from debtors and the amount

NIL NIL

/

NIL NIL NIL

0 P. SELLSOU 0 PUDUCHERRY 4 Itegd.No.7101

1%, +4,

ek

(vi) Motor vehicles/Aircrafts/Yachts/ ships (Details of make registration number etc. year of purchase and amount)

INNOVA Make:Toyota Innova Reg.No.PY 01 BQ 5171 Year of Purchase 2012 Rs.10,00,000/-

RENAULT SCALA Make:RENAULT Reg.No.PY 01 BY 9055 Year of Purchase 2013 Rs.8,50,000/-

NIL NIL NIL

Motor vehicles/Aircrafts/Yachts/ ships (Details of make registration number etc. year of purchase and amount)

TATA ACE Make :Tata M Reg.No.PY 01 AV 9237 Year of Purchase 2009 Rs.1,95,000/-

Suzuki Access Make :Suzuki Reg.No.PY 01 BL 0578 Year of Purchase 2011 Rs.31,000/-

NIL NIL NIL


TATA ACE Make :Tata M Reg.No.PY 01 AZ 6036 Year of Purchase 2010 Rs1,90,000/-

Tata Ace Make :Tata Reg.No: TN 16A 0191 Year of Purchase: 2012 Rs.3,50,000/-

NIL NIL NIL

Motor vehicles/AircraftsNachts/ ships (Details of make registration number etc. year of purchase and amount)

ASHOK LAYLAND DOST Make :Ashok Leyland Reg.No: PY 01 BV 0981 Year of Purchase 2012 Rs.3,75,000/-

NIL NIL NIL NIL


HONDA AMAZE Make :HONDA Reg.No:,PY 01 BY 5171 Year of Purchase 2013 Rs.6,50,000/-

NIL NIL NIL NIL


EICHER LORRY Make :EICHER Reg.No :PY01 BU 1065 Year of Purchase 2012 Rs.12,00,000/-

NIL NIL NIL NIL


MAHINDRA BOLERO Make :MAHINDRA Reg.No PY01 CA 5171 Year of Purchase 2014 Rs.7,00,000/-

NIL NIL NIL NIL


TATA MANZA Make :TATA Reg.No PY01 BC 0452 Year of Purchase: 2010 Rs.4,50,000/-

NIL NIL NIL NIL

SIGN $D BEFORE ME •

rnAgn4

P SELVARISSOU PODIKNERRY Regd.No.7101 /7

NED B FORE ME\ ,,(5j

(vii) Jewellery, bullion and valuable thing(s) (Give details of weight and value)

Ornamental Gold 5 Sovereign Value :Rs.1,00,000/-

Ornamental Gold 150 Sovereign Value :Rs.30,00,000/-

NIL NIL NIL

(viii) Any other assets such as value of claims/interest

NIL NIL NIL NIL NIL

(ix) Gross Total Value Rs 49,96,800/- Rs 42,82,638/- NIL NIL NIL

B. Details of Immovable assets :-

Note 1 : Properties in joint ownership indication the extent of joint ownership will also have to be indicated. Note 2 : Each land or building or apartment should be mentioned separately in this format

SI.No Description Self Spouse Depen dent/

Depen dent2

Depen dent3

( ) Agricultural Land: Location (s) Manavely Manavely NIL NIL NIL Survey number(s) RS.No.12/5 RS.No 12/5 NIL NIL NIL Area (Total measurement in acres)

7A .75 CA 16A.50 CA NIL NIL NIL

Whether inherited property(yes or No)

No No NIL NIL NIL

Date of purchase, in case of self acquired property

22/07/2011 18/10/2010 NIL NIL NIL

Cost of land (in case of purchase) at the time of purchase.

Rs.5,82,000/- Rs : 7,13,000/- NIL NIL NIL

Any investment on the land by way of development, construction etc.

NIL NIL NIL NIL NIL

Approximate current market value Rs.6,25,000/- Rs.9,00,000/- NIL NIL NIL

ii) Non Agricultural Land: Location (s) .Villianur

Commune Ariyankuppam Commune NIL NIL NIL

Survey number(s) RS No 283/2 RS No 14/8 NIL NIL NIL

Area (Total measurement in sq.ft)

1200 sq.ft 1000 sq.ft NIL NIL NIL


No No NIL NIL NIL


7/12/ 2011 20/07/2012 NIL NIL NIL


Rs.1,92,000/- Rs.7,00,000/- NIL NIL NIL


NIL NIL NIL NIL NIL

Approximate current marke Rs.3,00,000/- Rs.9,00/00/- NIL NIL NIL z3/4>,

71/4

SIGNE1E;ORE ME revwerl

Location (s) Mannadipet commune

Ariyankuppam Commune NIL NIL NIL

Survey number(s) RS No 28/7 RS No 27/2A RS No 27/28 RS No 29/11 RS No 30/1

i S No 76/1B NIL NIL NIL


13,120 sq.ft 1800 sq.ft NIL NIL NIL


No No NIL NIL NIL

Date of purchase, in case of self acquired property 28/05/2013 13/03/2009 NIL NIL NIL


Rs.13,15,000/- Rs.1,44,000/- NIL NIL NIL


NIL Nil NIL NIL NIL

Approximate current market value Rs.15,00,000/- Rs:3,00,000/- NIL NIL NIL

Location (s) Mannadipet Commune

Villianur Commune NIL NIL NIL

Survey number(s) RS No 26/12 RS No 27/2A RS No 27/28 RS No 29/11 RS No 30/1 RS No 30/2

. RS No 118/14

NIL NIL NIL


10,800 Sq. ft 1750 sq.ft NIL NIL NIL

Whether inherited property(yes or No) No No NIL NIL NIL



Rs.10,80,000/- Rs. 70,000/- NIL NIL NIL


Nil Nil NIL NIL NIL

Approximate current market value Rs:11,00,000/- Rs:1,00,090/-

I NIL NIL NIL ......-_____._-__,

SIGNED EFORE ME

Tevetry4

Location (s) Mannadipet Commune

Ariyankuppam Commune NIL NIL NIL

Survey number(s) RS No 27/2A RS No 27/2B RS No 29/11 RS No 30/1 RS No 30/2

RS No 147/2

NIL NIL NIL

Area (Total measurement in sq.ft) 10,673 Sq.ft 3475 Sq.ft NIL NIL NIL

Whether inherited property(yes or No) NO No NIL NIL NIL



Rs.10,70,000/- Rs.1,40,000/- NIL NIL NIL


Nil NIL NIL NIL NIL

Approximate current market value Rs.12,00,000/- Rs:2,00,000/- NIL NIL NIL

Location (s) NIL Manavely Commune NIL NIL NIL Survey number(s) NIL RS No 70/1/B NIL NIL NIL Area (Total measurement in sq.ft)

NIL 2781 sq.ft NIL NIL NIL


NIL No NIL NIL NIL


NIL 03.09.2012 NIL NIL NIL


NIL Rs: 20,86,000/- NIL NIL NIL


NIL NIL NIL NIL NIL

Approximate current market value

NIL Rs.25,00,000/- NIL NIL NIL

Location (s) NIL Thavalakuppam Revenue Village NIL NIL NIL

Survey number(s) NIL RS No 121/13 NIL NIL NIL


NIL 8 A NIL NIL NIL

Whether inherited property(yes or No) NIL No NIL NIL NIL


NIL 29.01.2014 NIL NIL NIL


NIL Rs.6,50,000/- NIL NIL NIL


NIL NII

NIL NIL NIL


NIL Rs.6,50,0001- NIL NIL NIL

iii) Commercial Buildings (Including apartments): Location (s) Manavely Revenue

Village NIL NIL NIL -1 NIL

Survey number(s) RS.No 14/3,14/10 NIL NIL NIL NIL Area (Total measurement in sq.ft)

7200 sq,ft NIL NIL NIL NIL


No NIL NIL NIL NIL


31/01/2000 NIL NIL NIL NIL


Rs : 71,000/- NIL NIL NIL NIL


Rs: 10,00,000/- NIL NIL NIL NIL


Rs: 12,00,000/- NIL NIL NIL NIL

(iv) Residential Buildings (Including apartments):- Location (s) Mudaliarpet

commune Ariyankuppam NIL NIL NIL

Survey number(s) R.S.No:44/6 pt R.S. No : 38/66 NIL NIL NIL Area (Total measurement in sq.ft) 600 sq.ft 1131.5 sq.ft

NIL NIL NIL

Whether inherited property(yes or No) No No

NIL NIL NIL

Date of purchase, in case of self acquired property 20 /06/ 2013 08/10/2003

NIL NIL NIL

c„-

SIGNED BEFORE ME


Rs : 9,00,000/- Rs : 70,000/- NIL NIL NIL


Rs : 10,00,000/- Rs : 10,0O,000/- NIL NIL NIL

Approximate current market value Rs : 19,00,000/- Rs : 20,00,000/-

NIL NIL l NIL

(v) Others (such as interest in property

NIL NIL NIL NIL NIL

(vi) Total of current market value of (i) to (v) above Rs. 78,25,0001- Rs.75,50,000/-

NIL NIL NIL

(8) I give here 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 before each item.

SI.No Description Self Spouse Depen dent/

Depend ent2

Dependent 3.

ID Loans or dues to Bank/Financial institution(s):- Name of the Bank or financial institution

Uco Bank Puducherry.

Indian Bank Ariyankuppam

NIL NIL NIL

Amount outstanding Rs.7,67,000/- Rs.4,77,000/- NIL NIL NIL

Nature of Loan 4 wheeler loan Home loan NIL NIL NIL

Name of the Bank or financial institution

Indian Bank Ariyankuppam Puducherry.

Sundaram Finance NIL NIL NIL

Amount outstanding Rs :5,85,000/- Rs.7,30,000/- NIL NIL NIL

Nature of Loan 4 wheeler loan 4 wheeler loan NIL NIL NIL Name of the Bank or financial institution

Sundaram Finance NIL NIL NIL NIL

Amount outstanding Rs :3,86,000/- NIL NIL NIL NIL

Nature of Loan 4 wheeler loan NIL NIL NIL NIL


Sundaram Finance NIL NIL NIL NIL


Nature of Loan 4 wheeler loan NIL NIL NIL NIL


Uco Bank Puducherry NIL NIL NIL NIL

Amount outstanding Rs.1,27,57,310/- NIL NIL NIL NIL

Nature of Loan CC, Term Loan NIL / NIL NIL ' NIL

SIGNED IrFORE

STONED B FORE ME

tee('


Uco Bank Puducherry NIL NIL NIL NIL


Nature of Loan Personal Loan NIL NIL NIL NIL

Loans or dues to any other individuals/entity other than mentioned above Name(s) NiL Nil Nil Nil Nil Amount outstanding Nil Nil Nil Nil Nil Nature of Loan Nil Nil Nil Nil Nil Any other liability Nil Nil Nil Nil Nil Grand Total of liabilities Rs.1,68,37,310/- Rs12,07,000/- NIL NIL NIL

(ii) Government Dues : Due to departments dealing with government accommodation.

NIL NIL NIL NIL NIL

Dues to departments dealing with supply of water

NIL NIL NIL NIL NIL

Dues to departments dealing with supply of electricity

NIL NIL NIL NIL NIL

Dues to departments dealing with supply of telephones/mobiles

NIL NIL NIL NIL NIL

Dues to departments dealing with government transport (Including aircrafts and helicopters)

NIL NIL NIL NIL NIL

Income tax dues NIL NIL NIL NIL NIL Wealth tax dues NIL NIL NIL NIL NIL Service tax dues NIL NIL NIL NIL NIL Municipal/Property tax dues

NIL NIL NIL NIL NIL

Sales tax dues NIL NIL NIL NIL NIL Any other dues NIL NIL NIL NIL NIL

(Hi) Grand total of all Government dues.

NIL NIL NIL NIL NIL

(iv) Whether any other liabilities are in dispute, if so, mention the amount involved and the authority before which it is pending

NIL NIL NIL NIL NIL

(9)

Details of profession or occupation

(a) Self: Business, Bharat Gas distributor (Sree Ramachandra Gas Agencies) (b) Spouse : Business

(10) My educational qualification is an under : a) Self : B.Tech, Pondicherry University 1997 (b) Spouse : BTech, Pondicherry University 1997

of highest School/University education menti ning the full form of the certificate/diploma/degree

ces

he School/College/University and the y r in which the course was completed.

P SEW SOU PUDLIC SKY i\tzi.No.7101

ti 4P.+4,

F. N

STONED FORE ME pff

rererre`4

PART - B

(11) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A:

1 Name of the candidate R.K.R. ANANTHARAMAN 2 Full postal address 18/1 School Street,

Nonankuppam, Ariyankuppam post, Puducherry — 605 007

3 Number & name of the constituency and state 01 - PUDUCHERRY 4 Name of the political party which set up the candidate

(otherwise write "independent" PATTALI MAKKAL KATCHI

5(i) Total number of pending cases where charges have been framed by the Court for offences punishable with imprisonment for two years or more

NIL

50i) Total number of pending cases where the court(s) have taken cognizance (other than the cases mentioned in item(i) above)

1 case (the other 2 cases are pending as charge sheet not yet filed)

6. Total number of cases in which imprisonment for one year referred to in sub-sections Representation of the Peo

convicted and sentenced to or more (except for offences (1) (2) or (3) of section 8 of the le Act,1951)

Nil

7 PAN of Year for which last income tax return filed

Total income shown

a) Candidate ADGPA7503B 2012 - 2013 Rs : 221240/- b) Spouse ACOPL6812D 2012 - 2013 ' Rs : 57830/- c) Dependents NIL NIL NIL

8 .Details of Assests and Liabilities in Rupees SI.N o

Description Self Spouse Depen dentl

Depe ndent 2

Depe ndent 3

A Movable Assets (Total Value)

Rs.49,96,800/- Rs.42,82,638/- Nil Nil Nil

B Immovable Assests I Purchase price of self

acquired immovable property

Rs.52,10,000/- Rs.45,73,000/- Nil Nil Nil

II Development/constructio n cost of immovable property after purchase (if applicable)

Rs.20,00,000/- Rs.10,00,000/- Nil Nil Nil

III Approximate current market price of (a)Self acquired assets (Total Value) Rs.78,25,000/- Rs.75,50,000/- Nil Nil Nil

(b)Inherited assests (Total value)

Nil Nil Nil Nil Nil

9 Liabilities I Government dues

(Total) Nil Nil Nil Nil Nil

II Loans from Bank Financial Institutions and other (Total)

Rs1,68,37,310/- Rs.12,07,000/- Nil Nil Nil

EPONENT

SIGNED BEFORE ME

AS2J4<cc';'141`iz'k

10 Liabilities that are under dispute : I Government dues

(Total) Nil Nil Nil Nil Nil

II Loans from Bank, Financial Institutions and other (Total)

Nil Nil Nil Nil Nil

11 Highest educational qualification

B.Tech Pondicherry University 1997

B.Tech Pondicherry University 1997

Nil Nil Nil

(Give details of highest School/University education mentioning the full from of the certificate/diploma/degree course, name of the School/College/University and the year in which the course was completed.

Note : Details of all pending cases in which cognizance has been taken by the court, irrespective of the quantum of punishment of framing of charges will have to be disclosed (ECI's clarification no.3/4/2012/SDR date 26.9.2012)

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief and no part of it is false and nothing material has been concealed therefrom, I further declare that:-

(a) there is no case of conviction or pending case against me other than those mentioned in items 5 and 6 of Part A and B above :

(b) I my spouse, of my dependents do not have any asset of liability, other than those mentioned in items land 8 of Part A and items 8,9 and 10 of Part B above

Verified at ...Puducherry this the 5th

day of .April. 2014

Note 1 Affidavit should be filed latest by 3.00 p.m. on the last day of filling nomination

Note2 Affidavit should be sworn before and Oath Commissioner or Magistrate of the First Class or before a Notary Public

Note3 All columns should be filed up and no column should be left blank. If there is no information to furnish in respect of any item either "NIL" or "NOT APPLICABLE " as the case may be, should be mentioned

Note 4 The Affidavit should be either typed or written legibly and neatly.

P.SELVARASSOU,B.A., LL.B, ADVOCATE 8s NOTARY,

Govt. of India, Regd. No. 7101,

No.13,New Street, Pillaichnady,

Puducherry - 605 014.

12

ANNEXURE XIV-A

Memo No

Dated

From: Returning Officer for Puducherry Parliamentary Constituency

To, (Name of the candidate)

Sub.: Election to the House of the People from Puducherry Parliamentary constituency -Filing of the required affidavit.

You have filed your nomination paper for the above election today, but you have not filed,

along with your nomination paper, the affidavit prescribed by the Election Commission vide its

Order No.3/ER/2003/JS-I1 dated 271h March 2003 and or the affidavit in Form 26. A copy each of

the said Form 26, Order and the format of the requisite affidavit is enclosed for your ready

reference.

You are required hereby to fumish the requisite information in the prescribed affidavit, duly

sworn before a Magistrate of the First Class or a Notary Public or Oath Commissioner appointed by

the High Court.

It should be noted that the requisite affidavit must be furnished by you immediately and

positively before 3.00 p.m on the last date of filing of nomination i.e

You may also note the consequences of not filing the requisite affidavit prescribed vide the

above referred order dated 27-3-2003 as explained in para 16(3) of the said Order of the

Commission.

(Retuming Officer)

DASANDS1A1A1 DOC \ AMEND TO ELEC LAW_NOte INSTNS_AFFIDAVITSVDlINOMINATION F0RMS1EN0LISHWorm-2A(House of the People)wl h revreed Tarn 26 eng.doc.doe

ORIGINAUDUPL1CATE

(Original to be kept with nomination paper and duplicate to be handed over to candidate)

CHECK LIST OF DOCUMENTS IN CONNECTION WITH FILING OF NOMINATIONS Name of Constituency Name of Candidate Date and time of filing nomination paper SI.No. of nomination paper

SI. No. Documents

Whether filed (write yes/no) (if there is any

defect/shortcoming in the documents, the same should be

specified) 1 Affidavit in Form 26

a) Whether all columns are filled up

b) If not, which are blank column(s) (Please specify):

c) Whether the affidavit is sworn before an Oath Commissioner or Magistrate of First Class or before a Notary Public)

2 Certified extract of electoral roll (when candidate is an elector of a different constituency)

3 Form A and B (applicable in the case of candidates set up by political parties

4 Copy of caste certificates (if the candidate claims to belong to SC/ST)

5 Security deposit (whether made)

6 Oath/affirmations (whether taken)

The following documents which have not been filed should be filed as indicate below:

a) should be filed latest by.

b) Above mentioned columns in the Affidavit in Form 26 have been left blank. You must submit fresh Affidavit with columns duly filled up before the commencement of scrutiny of nominations, failing which the nomination paper will be liable to be rejected.

c) should be filed latest by

Received

Signature of Candidate Signature of RO/ARO

Date & Time: Place: N.B

1 The afficlaWt in Form 26 and Fonns A & B have to be filed latest by 3.00 P.M on the last date of filing nominations 2 The nomination paper will be rejected if a candidate fails to fill the blanks in Form 28 even after reminder by RO

by the hour fixed for scrutiny of nomination paper. 3 Oath has to be taken after filing nomination paper and before the date fixed for scrutiny 4 Certified extract of electoral roll can be filed upto the time of scrutiny 5 Security deposit should be made either before Ming of nomination paper or at the time of filing of nomination

paper. Therefore, there is no question of issuing notice for making the security deposit

c)

andidate

R 'ved

ORIGINALJDUPLICATE

(Original to be kept with nomination paper and duplicate to be handed over to candidate)

CHECK LIST OF DOCUMENTS IN CONNECTION WITH FILING OF NOMINATIONS Name of Constituency Name of Candidate Date and time of filing nomination paper SI.No. of nomination paper

SI. No. Documents

Whether filed (write yes/no) (if there is any

defect/shortcoming in the documents, the same should be

specified) 1 Affidavit in Form 26

a) Whether all columns are filled up

b) If not, which are blank column(s) (Please specify):

c) Whether the affidavit is sworn before an Oath Commissioner or Magistrate of First Class or before a Notary Public)

2 Certified extract of electoral roll (when candidate is an elector of a different constituency)

3 Form A and B (applicable in the case of candidates set up by political parties

4 Copy of caste certificates (if the candidate claims to belong to SC/ST)

5 Security deposit (whether made)

6 Oath/affirmations (whether taken)

The following documents which have not been filed should be filed as Indicate below:

a) should be filed latest by

b) Above mentioned columns in the Affidavit in Form 26 have been left blank. You must submit fresh Affidavit with columns duly filled up before the commencement of scrutiny of nominations, riling which the nomination paper will be liable to be rejected.

should be filed latest by

Signature of RO/ARO

Dat & Time: Pla : N.B

1 The affidavit in Form 26 and Forms A 6 B have to be filed latest by 3.00 P.M on the last date of filing nominations 2 The nomination paper will be rejected if a candidate falls to fill the blanks in Fonn 20 even after reminder by RO

by the hour fixed for scrutiny of nomination paper. 3 Oath has to be taken after filing nomination paper and before the date fixed for scrutiny 4 Certified extract of electoral roll can be filed upto the time of scrutiny 5 Security deposit should be made either before filing of nomination paper or at the time of filing of nomination

paper. Therefore, there is no question of Issuing notice for making the security deposit.

*iv rriles*;

Documents

iv rriles;