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'^Ififfi"App F,Rresreri.'' *Rorrygr:Mfrary W *H,Mrum*@ (2)

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'^Ififfi .ffi;';oNEig;$Rs..J00 ffiH;00 fiUNEffiHmeEs ?*.*Ai ltd$gi$ l IN DIH @ el o nt gc kirrmr TEI-ANGAT.IA P 608596 TI,TBAT TATT.IX'*I"A **X- :,rs-b}$r, .1.*.1= .hrcrd bn Ybraer ". ro..r. lord y(la. "t tsz,S r" i* . &o xo. 2e - ll . tlliElS "t#tia2A il.t{o. lt - 2. 179, Ca;a A_,,-^"1,r/"*, t td,,,Jal Jrgdoch 7: Bir:rlrrhrtrm, Cril r logAf3ill,ll f-CI-F FORM (See i I -' t" it*ffi;NArtoN AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG PAPER BE- I t I I (NAME OF THE !r rof,T THE RETURNING oFFIcER-FOR ELECTION TO LOK SABHA I no[lsE) FRSM I6-MAHABUBABAD (sr) coNsTlruENcY (NAME oF THE coNsTlru- ENgY) PART - A **son tffi-nfU NARESH of NAGESWARA RAO aged 30 years, resident of H.No. SEETHANAGARAM VILLAGE, PARNASALA POST, DUMMUGUDEM MANDAL, KOTHAGUDEM DISTRICT (mention full address), a condidate at the ,n, do hereby solemnly affirm and state on oath as under:- ndidate set up by .......... ...(**name of the political party)/ lll r l-ru; '^ififfi"app f,rrEsrEri.'' *rorrygr:mfrary w *H,mrum*@ (2). MV name is enrolled in.... BHADRACHATAM ASSEMBTY CONSTITUENCY, TELANGANA STATE (Name of the constituency and the State), at Serial No. 119-83 -470 in Part No. 838. (3) My contact telephone number(s) is/are 9493674L70 and my email.ld is [email protected] any my social media account(s). (i). ....................... NrL (ii). ............. Nr1............. (iii). ............ Nr1............. (a). Detail of Permanents Account Number (PAN) and status of filing of lncome Tax return: Total lncome The financial year for which shown in lncome- PAN the last lncome-Tax return S!.No Names Tax return (!n has been filed Rupees) L, Self AZIPTL6T4Q NIL NIL 2 Spouse NIL NIL NIL 3 Dependent-1 NIL NIL NIL 4 Dependent-2 NIL NIL NIL (5). Pending criminal cases=======N OT APPLICABLf ========== (i). I Declare that there is no pending criminal case against me. (Tick this alternative if there is no criminal case pending against the candidate and write NOT APPLICABLE against alternative (ii) below) OR (ii). The following criminal cases are pending against me: (lf there are pending criminal cases against the candidate, then rick this alternative and score above, details of all pending cases the ATTESTED -'or;!l,irr-,.n 'o/ \z Attested 1745825 9l n,,r,,., /'t :1lassAr KANTHAIAH 1I.A. LL.B. #:,'ili)1!, ADVOGATE & T{OTARY GOM's No: 509 Telengena State &,u69 TABLE a) FIR No.With name and Bhadradri address of Police Station FIR No. 79/20L1 P.S.Dummugudem concerned Kothagudem lb) Case No.with Name of the Additional Court Judl.First CC.No.919/2073 Class Magistrate Nil Bhadrachalam c) Section(s) of concerned Acts/Codes involved (give Uls 468/471.tPc no. of the Section, e.g. Nil Nil Of lPC.,etc d) Brief description of offence Nit Nil Nil e) Whether charges have been framed (mention YES Nil Nil Nil or NO) f) ln answer against (e) above in YES, then give Nil the date on which charges Nil Nit were framed (e) Whether any Appeal/Application for revision has been filed Nil Nil Nil against the proceedings (Mention YES or NO) (6). Case of conviction. i). I declare that I have not been convicted for any criminal offence. (Tick this alternative, if the candidate has not been convicted) And write NOT APPLTCABLE against alternative (ii) below) OR (ll). I Have been convicted for the offences mentioned below: (lf the candidate has been convicted, then tick this alternative and score off alternative details in the Table below) --==NOT I TE rl Attested 'I g( ! \;i^*,,,r*i;;hl* J-i KANTHAIAH I ADVOCATE & NOTARY w9 GOIH's ilo: SOg Telangana State TABTE (a) Case NO. Nil Nil Nil (b) Name of the Court Nil Nil Nil Section of Acts/Codes involved (give no. of (c) Nit Nil Nil the section e.g. Section ......... of lPC, etc.,) Brief description of (d) offence for which Nil Nil Nil convicted Dated of orders of (e) Nil Nil Nil conviction (f) Punishment impose Nil Nil Nil Whither my appeal has been filed against (e) Nil Nil Nil conviction order (Mention YES or NO) lf answer to (g) above is YES, give details and (h) Nil Nil Nil present status of appeal (64). I have given full and up-to-date information to my political party about all pending criminal cases against and about all cases of conviction as given in paragraphs (5) and [candidates to whom this ltem is not applicable should clearly write NOT AppLtCABLE lN VIEW oF ENTIRES s(i)AND 6(i), fbgyel ATTES be entered cleorly legible in BOLD letters. (anil!,lia& Ga Attested KANTHAIA.i; s, Nmfl.t- GOIBI'sfPYgcArE No: S09 tetangana State 2. Detoils to be given seporotely for eoch case under different columns against each item. Details should given 3' be in reverse chronologicol order, i.e., the lotest cose to be mentioned first ond backwords in the order of dates for the other coses. 4. Additionol sheet moy be added if required. Condidate 5' is responsible for supplying oll informotion in complionce of Hon,ble Supreme Court's judgment in W.p(C) No. 536 of 20L1. (7)' That I give herein below the details of the assets (movable and immovable etc.) or myself, my spouse and all dependents. A. Details of movable assets: Note: l-. Assets in Joint name indicating the extent joint ownership will also have to be given Note: 2, ln case of deposit/lnvestment, the details including serial Number, amount, date Deposit, of the scheme, Name of the Bank/lnstitution 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 given. NoTE: "Dependent" 4, means parents, son(s), daughter(s) of the candidate or spouse and any other person related to the candidate whether by blood or marriage, who have no separate means of income and who are dependent on the candidate for their livelihood. NoTE:S, Details including amount is to be given separately in respect of each investment.] Sl.No Description Self Spouse Deponden Depondent- t-1 7 (i) Rs. Cash in hand Rs. 1,00,000/- Nil so.0oo/- Nil I Detarils of deposit in Bank 1). SBIA/c No. ,..ounts (FDR's) Term Depoists | 324!7934878, and all other types of deposits UB Road, inclu ding saving accounts), Bhadrachalam (ii) Dep< - rsits with Financial Nil Nil Nil Jrc.stil-tltions Nnn-Elrnlzin- Nit 2). AB A/c No. -'-. ,A-D Copanies and >.1 N( 004310100L32078 h * t_t,\ rerp\e societies and the Bhadrachapn, ?/ -*fiw\il\asr,such deposits D tal- Hffi ts,lrytsrl{ftsfr"4 tQ. o. fi l'-i:iJf,:,:l?lfx"" w Os {9 -----.------ Details of investment in Bonds, debentures/shares and units in (iii) Nil Nil companies/Mutual funds and Nil Nil others and the amount. Details of investment in NSS, Postal Saving, lnsurance Life lnsurance Policies and investment (iv) in any Corporation Nil Nil Financial instruments in pose lnsurance Nil Office or lnsurance Company Rs.2,OO,OOOf -, and the amount . Personal loans/advance given to any person or entity (v) including firm, company, Trust Nil Nil Nil Nil etc., and other receivables from debtors and the amount Bajaj Motor Pulsor Vehicles/Ai rcraft s*ya chts/Sh ips (New (vi) (Details of Make, registration Nil Vehicle) Nil Nil number etc, year of purchase There is no and amount) Number Rs.93,000/- Jewellery, bullion and valuable (vii) thing(s) (give) details of weight Nil Nil Nil Nil and value) Any (viii) other assets such oas value of claims/interest Nil Nil Nil Nil (ix) Rs. Gross Total Value Rs. 3,00,000/- Nil Nil 93,0001- B. Details of lmmovable Assets: Note :1' Properties in joint ownership indicating 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. Sl.No Disruption Self Spouse Dependent-1 Dependent-2 Agricultural Land @{gr(s) Survey Nil Nil Nil Nil r< .\ ATT .-- ,'l *1 AI,resrecr Gfurz4sE2s 1l) rNTHI\IAH GEIDIDESI ,) \o ,fA-ffi \ {ie #' ADVQCATE & NOTARY \-OF TUY *c )M's No: 509 Telangana Statl Area (tatal measurement in Nil Nil Nil Nil acres Whether inherited Nil Nil property (Yes or NO) Nil Nil Date of purchase in case of self-acquired Nil Nil Nil Nil property Cost of Land (in case purchase) of at the Nil Nil Nil Nit time of purchase Any investment on the land by way of development, Nil Nil Nil Nil construction etc., Approximate current market Nil Nil Nil Nil value Non-Agricultural Land: Location(s) Nil Nil Nil Nil Survey Number(s) Area (total measurement in Nil Nil Nil Nil sq.ft) Whether inherited Nil Nil property (Yes or NO) Nil Nil Date of purchase in case of self-acquired Nil Nit Nil Nil (ii) property Cost of Land (in case purchase) of at the Nil Nil Nil Nil time of purchase Any investment on the land by way of development, Nil Nil Nil Nil :onstruction etc., Approximate :urrent market Nil Nil Nil Nil lalue Commercial ings (including Nil Nil Nil Nil fr Survey 6 ] o Z\ .y' Area (total measurement in Nil Nil Nil Nil sq.ft) Built-up Area (tatal measurement in Nil Nil Nil Nil sq.ft) Whether inherited Nil Nil Nil Nil propertv (Yes or No) Date of purchase in case of self-acquired Nil Nil Nil Nil property) Cost of property (in case of purchase) at Nil Nil Nil Nil the time of purchase Any investment on the property by way Nil Nil Nil Nit of development, construction etc.
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