Qao Qo S O937110 (Receipt B。 ,K) 。9Q。 ゛Эq・ 曾 9… 81,卜 …れ|,… …………… Ι学性:ル隷
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Qao Qo s o937110 (Receipt B。 ,k) 。9Q。 ゛Эq・ 曾 9… 81,卜 …れ|,… …………… ι学性:ル隷 ,-, A,| v. ……60蜘 輸H |。Q・ m。 _… ………… ocP(FORMS)CIP‐30-30,000BkS-45‐ 122017 S― ヽよくヽ美 FORM 2B (See rt7/e4) NOM:NAT10N PAPER ElectiOn to the Legis a,ve Assembly of oDiSHA State ― 一 ・ 0 ― 」 , 一 一 STRIKE OFF PARTl oR PART‖ BELCIWⅥ州 lcHEヽER IS NOT APPLICABLE PART I ( To be used by candidate set up by recOgnised pOlit cal party) I nominate as a candidate for Electjon lo lhe Legislative Assembty from 29-Bangriposi the (ST ) Assembty Constituency. Candidate,s name SUDAM MARNDI lFathe/s/mother,s/husband,s name] LAXMAN MARNDI His postat address AT_B|JAYMMCHANDMPUR, pO _ BHANJPUR, PS -€ARIPADA, D|ST - MAYURBHANJ His name is entered at St. No. ,t96 an pad No. 33 of the electoral rol for 33 - BARIPADA (ST) Assembty constituency. My name is uMESH cHANDRA SINGH and it is entered at SL. No. 219 in part No 237 ofthe electOralro‖ fOrthe 29-BANGRIPOsl (ST) Assembly constituency υ″んん幻″%′ 、 Date 09 o4 2019 ・ をァ (Signature“ or proposer) PART I I (To be used by candidate NOT set up by recognized politicat party) for eleclion to the Legislative Assembty from the l:=:Ψ 輩 l背ド聖編y Constituency. Candidate's name Fathers′ mOthers′ husband's name postal address is entered at sI No in Part No Of ‖ fo「 Assembly consutuency ¨ 1曽 We enlere∬ 篇:∬:1鷺‖器駕111:ML31よ蔦∬::∬蹴 append our signatures below in token of subsc「 ibing to this nominat on:_ Particulars of the proposers and the ir signatures. SI No Elector Roll No. of Proposer Full Name Signature Date S No inthat 趾訳 part 1 2 \3 4 5 6 1 | \ | 2 \ | 3 \ | 4 ヽ \ 5 \ 6 \ 7 \ 8 \ 9 \ 10 N.B : There should be ten electors of constituency as proposers. PART III l, the candjdate mentioned in Part UDa+ll (Strike out which is not applicable) assent to this nomination and hereby declare that - (a) I am a citizen of lndia and have not acquired the citizenship of any foreign State ; (b)that I have completed 52 years ofage; ISTRIKE OUT b(D OR b(iD BELOW WHICHEVER IS NOT APPLICABLE] (c) (i) that I am set up at this election by the B|JU JANATA DAL party, which is recognised t'latioDal-PaCy/State Pa(y in this State and that the symbol reserved for the above party be allotted to me. (ii) that lam set up at thrs\edion by \ the................ ...........party, which is a registered-unrecognised polihcal paix{at lam contesting this etection as an tndependent candidate (Strike out which is not applicalie) and that the symbols I have chosen, in order of preference, are:- (i)........................................(iD. \…………(iil) (d) that my name and my father,s/mothe/s/husband,s name have been correcfly spelt out above in ENGLISH (name of the tanguage) (e) that to the best of my knowledge and betief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State. .*Caste/tribe 'l further declare that I am a member ofthe SANTAL which is a scheduled "'caste/tribe of the State of ODlSHA.in retation to MAYURBHANJ (area) in that State. I **..nominated also declare that I have not been, and shall nol be, as a candidate at the present general election /the bye-elections being held sjmultaneously, to the Legislative Assembly of ODISHA (State) from more than two Assembly Constituencies. Date:09042019 繁 SNよ (Signature― of Candidate) *Score out this paragraph, if not applicable. "Score out the Words not appticable. N.B.- A "recognised political party" means a political party recognised by the Election Commission under the Election Symbols (Reservation and A‖ otment)Order.1968 in the State concerned_ PART III A (To be filled by the candidate) Whether the Candidate - (i) has been convided - (a) of any offence(s) under sub-seclion (1); or (b) for cort'a\rertion of any law sFcified in su' sedion (2), of sedion I of the Representation of the People Act, 1951 No (43 of 1951); or (ii) has been convicled for any other ofience(s) for which he has been sentenced to imp{isonment for two years or more. ifthe answeris・ Yes' the candidate sha‖ furnish the fo‖ owing info「 mation:NOT APPLICABLE ()CaSelF rst infomalon repon No/Nos NOT APPuCABLE O)POICe slabon(s)_NA …… D stnd(S) NA …Slate(sl _ NA… … flu)鋼 On(s10f the∞ncemed Actls)and bneF descntton of the ofFence(Sl fOr WhCh he has been convcted _ NA _ (v)Date(s)Of∞ 中凛劫卜) …NA… nv cted the canddate _ NA (V)COun(s)which∞ … … …… ●りPunIShmenl(sl imposed lndi∽ 鯰 penod of mprsOnmentls)and/Or quantum of inelSll NA i)Date(s)Of release from p“ ● 動… … ……NA… … … … ……… … (宙i)WttVere any appea lSyrevに bnls)1に d aganstabOve∞ nMい。n(s)No (o Dale and Paniculas of appealsyappllは On(s)fOr reV● On lled NA … (xl Name ofthe∞ urt(s)before which the appeaKS)/appiCa1 0n(s)fOr reMsion tt ed _ _ NA … …… … (x, V\hetf.r the said appeal(s) / application (s) for revision has/have been disposed of or is/are petting… … …… …NA (Xil)ifthe sa,d appeaKSソ ap口 'CatOn(s)fOr revsion has/have been disposed of― (a)Date(s)Of diSposal … NA (b)Nature of orc er(s)passed… …NA… 2. whether the candidate is hording any office of profit under the Government of rndia or Stale Government ? No (yes/No) lf yes, detaits of the office hetd : NOT AppLtCABLE 3. Whetherthe candidate has been yes/No) ' declared insolvent by any Court ? No ( lf yes, has he been discharged from insotvency : NOT AppLtCABLE 4. Whether the candidate is under allegiance or adherence to any foreign country ? No ( Yes/No) ' lf yes, give detaits : NOT AppLtCABLE 5. Whether the candid.te has been disqualified under section gA of the said Act by an order of the President ? No ( yes/ No) lf yes, the period for which disqualified : NOT AppLICABLE 6. Whether the candidate was dismissed for conuption or for disloyatty while hotding office under the Government of yes/No lndia or the Government of any State ? No ( ) lf yes, the date of such dismissat : NOT AppLICABLE 7. Whether the candidate has any subsisting contract(s) with the covernment either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government o. for execution of works undertaken by that Government ? No ( Yes,/No) lf Yes, with which covernment and detaits of subsisting contract(s) NOT AppLICABLE 8. Whether the candidate is a managing agent, or manager or Secretary ' of any company or Corporation ( other than a cooperative society ) in the capitat of which the Central / Government of State Government has not less than twenty five percent share ? No (Yes/No) lf Yes, with which covernment and the details there of NOT AppLtCABLE 9. Whether the candidate has been disqualified by the Commission under section 10A of the said Act. No ( yes/No) lf yes, the date of disquatification : NOT AppL|CABLE P ace:BARIPADA ワ_♪←― S Date:09o42019 ( Signature of the candidate ) PART iV (TO be rllled byめ e Rertral"9 οrlcerl Serial No. of nomination paper...)5/.. Le.l.to.ll/...(O Th` no而 nat on was de"red o me a my Or∝ a21,P綸 ・●・rl on'1彙 |11 (darel by he'canddate′ proposer Date… ■7(lL'… 'Score out the word not applicable P′ Decision of Returning o価 cer Accepting or Relecting the Nomination Paper l have examined thも nomindon paper in a∝ odance vtth secton 36 of lhe Repl“enttOn Of he Peop e Ad.1951 and d∞deas b‖ぃvs Date. Returning Officer … … … … …… … … …… … …… … (PerfOration)… ……… …… ……………… …… … PART Vl Receipt ror NominatiOn Paper and Notice of Scrutiny A7oo771atroη Papeり Senal No点 liよ甜靭iltti軍鞘wTll: The nomination paper candidate he■…6や`1-雨 …`SemЫy∞nsbn" de vered a¨ qlJll… RItt IPm… ……… O on… ……… ldaり by he ′ dp"私 "。 nOm画¨ ぃ Ⅷ ●にnipぉ r scru・ 高 ■二 oも 二 h Ii響響 帖 ′′ ヽ ,^ Oο 。肛イ1'ル111… “ “ ^^^^ の… ……1:仲0」til"橿 ulヌ輌ど卜lx; Date… Rピ lu ……… 29-3a '111391o… +Score oul lhe word not applicable.l Kiosk operato′ ttshree l゛ oharlta 04 Balpada 旧llⅢlllllmmlll 認 ■覚311,461 “ COVERNMENT OF ODISHA omce oithe Tahas‖ dar,Barlpada Mlsce:laneous Certiflcate Case No:e CAS′ 666o12019 CASTE CERTIFICATE IRule 3()oflhe od sヽ a caste cer1lcate(for SChedu,ed Caste and Scheduled Tr be)Roles,19801 Date 100‐ 032019 Th s is to cerl,thatShH SuDAM MARNDI Son ofShriLAXMAN MARNDlofVllage″ own B:JAY RAMCHANDRA PUR P S BARlPADA TOWNinthe ds● ct Mayurbhattin the State ofOd sha belongs to SANTAL llbe which s reCOgnizeO as Scheduled Trlbo underthe consututiOn(scheduled Caste′ Scheduled Tlbe)Order 1950 as amended by the scheduled Caste and Scheduled Tribeヒ ist(ModinCat on)Orde「 1956 and Schedu ed Casle and Schedu ed THbe Orde「 lAmendment)Act,1976 Shri SUDAM MARND!and herhis fam‖ y ordina‖ ly res de(S)in vⅢ age′ Town B:」 AY RAMCHANDRA PUR oF Mayurbhanl D stlctin the State of Odisha Place:Ba「ipada Date 130‐03‐ 2019 Wh 響鮮L Signature of the Applicant Sgnatureofth8熊 嘉』羅°frcも NOTE : - tt is a digltally signed electonically generaled cenilicate and lherefo@ negds no ink-signed si?neluro amendmenls ih - rris ced,incste is,ssued € s per s,clion 1,5&6 of lnfomalloh Technology acl2ooo,and ils subseguenl AR&DM 2OOA and as per Revenue & Dtsaslet Manegement Depadment noljfaa].jon numbe^. IMU'13/1M2 dated dated 21 .10.2010, RDM-\MU-EGOV.(0O1-1241244 dated 10.09-2012 and RDM-\MU-EAOV-O001-2012/35042 12.09.2013 - Fot any query ot vetifrcation, AgencylDepartrnenvofrct nay visit hftpl/edbtictodisha.gov in' - Tempeing ol this csttificale will ettact penal ection.