08AA 556008 Orm 26 TA E .La a Ti ) )- \Rli'/.AS Advctv-Rtr, S -T 'F 1

$08AA 556008 Orm 26 TA E .La a Ti ) )- \Rli'/.AS Advctv-Rtr, S -T 'F 1$

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EftqTqIT HARYANA 08AA 556008 orm 26 TA e .lA a tI ) )- \rli'/.AS Advctv-rtr, s -t 'f 1 . No. lili3ii . Pcgc. fi, . ill.1g-G"ri 2 i ... , n hlSriR

L. i. AFFIDAVTT BE FILED BY 'I'HE ,dNDIDATII ALONGWITH NOMINATION PAPER BEFORE THE RETURNING OFFICER F'OR ELECTION TO LOK SABHA (NAME OF THE HOUSE) FROM O4-HISAR CONSTITUE\C'! (NAI,IE OF THE CONSTITUENCY)

PART A l, DUSHYANT CHAUTALA * * son/daugh+,-.+n+i{e of SH. ,{JAY SINGH CHAUTALA Aged 31 years, resident of H. NO.803, RAM COLONY, WAI{D NO. 5, SIRSA-125055, (mention full postal address), a candidate at the above election, do hereby solenrnly aftirm and state on oath as under:-

(1) I am a candidate set up by JANNAYAK JANTA PARIY

(**name ofthe political pany) / 8 *a*+eor r+t sriag-rs a*J*.lependen+eandila+e

(**strike out whichever is not applicable.

(2) My name is enrolled in 45-SIRSA, HAR!'AI{A, (\'eme of the constituency and the state). at Serial No. 694 in Part No. 20. c\-^i-L T .rh ht k\ T &uI'*'" ) \t) Ve ndot) Sansh r dchau ni.rt C lHiia

.)._' \o.

t., ' I

(3)Mycontacttelephonenumber(s)is/are+91.9811600003andmye.mailid(ifany) IS dchauta mail.com and my social media account(s) (ifany) are

(it Facebook: dchautala. (ii) Twitter; dchautala. (iii) lnstagram; dchautala

({)DetailsofPermanentAccountNumber(PAN)andstatusoffilingoflncometaxreturn: financial Total Income shown ln SI No. Names PAN The year for which Income-tax return (in the last Income- Rupees) for the last five tax return has financial years comPleted been filed (as on 31" March) F.Y.2017-2018 (i) Rs. 62,46,820-0 0 I Self AJHPCS90TC (ii) Rs.7s,18,920-00 T (iii) Rs.44,41,340-00

),1!i{AS (iv) Rs.49,36,560-00 Ad (v) Rs. 46,39,700-00 .J. i.i.). 1 :)lilJ (i) Rs. I1,1s,970-00 u AZHPAT55OR F.Y.2017-2018 iirSrrit i- Meghna (ii) Rs. 3,24,070-00 oF. lawat) (iii) Rs. 2,s9,s90-00 (iv) NIL (v) NIL

(i) Rs. 60,7s,740-00 J HUF (lf Candidate is AAFHAI584A F.Y. 2017-2018 (ii) Rs. 70,2s,860-00 Kasa/Coparcener) Ajay Singh Chautala (iii) Rs. 60,15,350-00 (iv) Rs.63,15,28 0-00

(v) Rs. 64.28.360-00

NIL I NIL 4 Dependent 1 NIL (ii) NIL lll NIL (iv) NIL NIL

I NIL Dependent-2 NIL NIL 5 ii) NIL t NII- NII, (v) NIL

I NIL Dependent-3 NIL NIL 6. ii) NIL iii) NIL lv NIL (v) NIL

Note:ltismandatoryfbrPANholdertomentionPANandincaseofnoPAN'itshouldbe clearly stated 'No PAN allotted"'

(5) Pending criminal cases (Tick this alternative if (i) I declare that there is no pending criminal case against me' the Candidate and write NOT APPLICABLE Gt criminal case pending against \\ )- S (ii) below) lCvocate tt3r3 * OR * Re3C. No. Exp. DL 19-CS-?1 ilisAR (ii) The following criminal cases are pending against me: NOT APPLICABLE V then this alternative (If there are pending criminal cases against the candidate' tick Table below) off alternative (i) above, and give details ofall pcnding cases in the Table

NIL (a) FIR No. with name NIL NIL and address of Police Station Concerned IL (b) Case No. with name NIL NIL of the Court IL (c) Section(s) of NIL NIL Concerned Acts I Codes involved (give no. of the section, for example section ...... of IPC etc. IL (d) Brief descriPtion of NIL IL offence NIL IL IL (e) Whether charges have been framed (mention YES or NO) IL (0 If answer against (e) NIL IL above is YES, then give the date on which charges were framed. IL (g) Whether any APPeal NIL IL lication for revision has been filed against the proceedings (mention YES or NO)

(6) Cases 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 APPLICABLE against alternative (ii) below)

(ii) I have been convicted for the offences mentioned betow: NOT APPLICABLE

(Ifthe candidate has been convicted, then tick this alternative and score offalternative (i) above, and give details in the Table below) Table

(a) Case No. NIL NIL NIL ( (b) Name of the Court NIL NIL NIL /-t (c) Sections of Acts/ Codes NIL NIL vtli-4 S /rdvocala involved (give No. of *L, the sections, e.g. * 9C. tlc. 1i 389 section....,.of IPC, ur..1g-00-21 r-irsAil etc.) (d) Brief description of NIL NIL NIL t offence for which x cii convicted (e) Dated of order of NIL NIL NIL Conviction (0 Punishment imposed NIL Ntt. (g) Whether any appeal NIL IL NIL has been filed against conviction order (mention YES or NO) (h) If answer to (g) above NIL NIL L is YES, give details and present status of appeal

(6A) I have given full and up-to-date information to my political pa(y about all pending criminal cases against me and about all cases ofconviction as.given in paragraphs (5) and (6).

[candidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), abovel: NOT APPLICABLE

Note: l. Details should be entered clearly and legibly in BOLD letters. /( 2. Details to be given separately for each case under different columns against each item. 3. Details should be given in reverse chronological order, i.e., the latest case to be mentioned first and backwards in the order of dates for the other cases. 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court's judgment in W. P (C) No. 536 of 2011.

(7) That I give herein below the details ofthe assets (movable and immovable etc.) of myself, my spouse-and alldependents:

A. Details of movable assets :

Note: I . Assets in joint name indicating the extent ofjoint ownership will also have to be given.

Note: 2. In case of deposit/lnvestment, the details including Serial Number, Amount, date of deposit, the scheme, Name of Bank/lnstitution and Branch are to be given.

Note: 3.Value of Bonds/Share Debentures as per the current market value in Stock Exchange in respect of listed companies and as per books in case ofnonJisted companies should be given.

Note: 4. 'Dependent' 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: 5. Details including amount is to be given separately in respect ofeach investment

Note: 6. Details should include the interest in or ownership of offshore assets.

Explanation,- For the purpose of this Form, the expression "offshore assets" includes, details of all deposits or investments in Foreign banks and any other body or institution abroad, and details of all assets and liabilities in foreign countries'1 (As (Smt. HtJl' Snouse Cooarcener in Dependent Deoendent ependent S. Description Self 'Meshna ,.) No. ahliuatt A'iay Sinsh Chautala Hl.lF) z (i) Cash in hand Rs.3,55.800 -00 Rs.1 ,38,760-00 Rs. l3,l 5,700-00 NIL I Detail of deoosits in Bank accbunts 5 (FDRs. Term 6i.ate denosits and all a) Savins" Bank at Savins" Bank Regd. o. 113a9 other types ol fjenosit a) Saving- Bank Deoosit Exp. Dt 19-09-21 denoslts Rs:63,62,1 t 6-t o Deoosit Rs:r6,60,765-18 Hi inilud ing saving Rs18,3l,l04-83 accounts ). b) FDR's & b) FDR's & Term Deoosit:- (ii) Denosits with ferm Deoosit:- NIL NIL F inancial i) Orientdl Bank i) State Bank of Institutions- Non- of Commerce NIL India Rs.8.88.679-00 Bankine [.s.3 8,76.s 79-00 Financi.-al ii) ICICI Bank Comoanies and ii) lndian Bank NIL Rs.2,55,90,975- Coorierative Rs.56,882-00 00 Soc ieties and the amount in each such deposit. 7

Shares in Non- Non- Shares in Non- Listed Shares in Listed Comoanies Listed Comoanies Comoanies Rs.10.00.000- Rs.5.06.49.170- Rs.22,96,740-00 Detail of 00 00 investment in Bonds. Share Share Share Debeniures/ Aoolication Aoolication Aoolication ( Monev in iii) shares and units Monev in Non- Non- Mcinev in Non- NIL NIL NIL in comoanies/ Listed Listed Comnanies Listed Mutuaf Funds and Comnanies Comoanies others and the Rs.0l00 Rs.0l00 amount. Rs.0j00 Share in Listed Share in Listed Comoanies Share in Listed Comoanies Rs.0j00 Comoanies T 4 Rs. 0-oo Rs.0l00 ,a K a) SBI Life Irisurance Policv 1'u,rNs No. ') Advoc; 53008733503 e!d. hlo. 11: havins surrender rp. St.. 19-09 value" HlSAil Rs.6,34,21 8-40 b) SBI Life r.l: Insurance Policv No. Detail of 56059772802 investment in havins surrender NSS, Postal value" Sav in g. Insurance P.s.6,44,472-00 a) Baiai Allianz PoliciEs and LIP Po-licv No. (iv) investment in anv c ) Baiai Allianz 032146611t Financial LIP Prilicv No. NIL havins NIL NIL NIL Instruments in 03299s9128 surrender Value Post office or havins surrender Rs.9,24,364-66 Insurance value Company and the Rs.2,37,501-26 amount. d) LIC Policv No. t79122786 havins surrender value Rs.7,34,272-00

e I LIC Policv No. 179123734 havins surrender value - Rs. 4,40,563-00

Personal loans/advance given to any . Loans & nerson or entrtv Loans & Loans Advances and & Advances and lnc ludrns tr rm. Advances and debtors (v) debtors debtors NIL NIL NIL Comoan-v. Trust Rs.6,71,36,819- Rs.2,60,3 1,675- Rs. 14,24, 125-00 etc. a'nd 6ther 00 t2 receivables from debtors and the amount.

Ne Motor Vehicles/ Toyota Fortuner. Tafe Tractor. Aircrafts/ Yachts/ Mridel 2012. IMF r 035 Dr- R Shios ldetails Res. No. Model 2006. of HR- Res. No. HR- (ri) Make, 240-4977. NIL registration Purihased in 241-s0s7, NIL NIL NIL nuinber etc. Year F.Y.2013-14. Purchase of Purchase and Amount Amount amount). Rs. 10,00,000-00 Rs.3,15,000/-

la) Gold [ewellery 550 gms. approx. a) Cold a) Gold Jewellerv Jewellerv I100 lvalue li 2500 sms. gms. apfrox. R.s. 16,99,500-00 Jewellerv. bullion aooroi. value value and valu'able Rs. 77,25,000-00 b) Silver 'v!l(r Rs. 95,79,000-00 Utensils l2 Ks. ,ic (vii) th ins( s ) (sM NIL -& b) Diamonds & aoorox. value" --1. f^]{ details of-weight Valuable b) Diamonds & li and value) Other Other Valuahle Rs'.4,90,120-00 i9-c3-Zi Stgnes approx. value Stones approx. hiit 1..P, value c) Diamonds & Rs. 62,90,000-00 Rs. Other Valuable 78,50,000-00 Stones approx. vatue i"d Rs.3,50,000-00 Anv other assets (viii) such as values of . 57,54,4t1-96 Rs. 5,03,200-00 Rs. I 8,10,895-00 NtL NIL NIL claims /interest

(ix) Gross Total Rs. Rs. value 15,18,97,804-72 2,26,24,929-83 6,20,77,874-16 NIL NIL NIL

B. Details of Immovable assets:

Note: l. Properties in joint ownership indicating the extent ofjoint ownership will also have to be indicated

Note: 2. Each land or building or apartment should be mentioned separately in this format

I Note: 3. Details should include the interest in or ownership ofoffshore assets.

HUF (As Spouse st. Coparcener in Dependent Dependent Dependent Description S elf (Meghna No. Ajay Singh -t -.) Ahlawat) Chautala HUF) (i) a) Agricultural pand at Village Land at Village Village NIL NIL L Land pambi, Teh. Nejadela Chautala, Teh. -Location(s) Dabwali & Distt. Kalan, Teh. & Mandi Dabwali, Srrsa Distt. Sirsa Distt. Sirsa.

-Survey Khasra No. Khewat No. Khewat No. number(s) 541/13,1411, 713 Khata No. 144 I , Khatauni 1412, 17t1, t7t2, 818 Kite 4 No. 1688. 18,23,24. Khasra No. 58/t3, 4,7 ,gfi, 8t2, 13,14, t7/1, 17t2, 18, 19, A I ,., I

)t) )'1, )4 No 9/12,3,4,7 8 9 -Area (Total I Acre 4 Kanal 15 Kanal 6 1 Acre (approx.) IL NIL IL measurement in I 0 Marla Marla TKanal- acres) 16.5Marla) 07o ownershi NIL IL -Whether ES No o IL inherited property (Yes or No IL -Date of purchase 26.03.2019 I 3-06-201 1 IL NIL in case of self ac uired ro IL -Cost of t,and (in .A Rs 18,s2,250- . 6,23,000-00 IL NIL case of purchase 00 at the time of urchase IL -Any Investment L NIL IL IL NIL on the land by way of development, construction etc. L -Approximate 7,50,00,000- Rs. 18,52,250- .10,00,000- IL NIL Current market 0 00 value IL b) Agricultural and at Village IL Land ambi, Teh. -Location(s) abwali, Distt lrsa

-Survey hewat No. 29. number(s) atoni No. 36, tte 9 IL -Area (Total Acres L l\t^ measurement in Exp. Dt. 1 acres IL -Whether o IL inherited prope(y rcr Yes or No IL -Date of purchase 710412008 IL IL IL in case of self a uired ro tL IL -Cost of Land (in s. 33,60,000-00 IL IL IL case of purchase at the time of urchase) IL -Any Investment L L IL IL IL on the land by way of develo ment. tl t

constructlon etc.

-Approximate Rs. 3,00,00,000- NIL NIL NIL NIL NIL Current market 00 value c) Agricultural ll-and at Village NIL IL L NIL NIL Land [Kambopura, Teh -Location(s) l& Distt. Karnal

-Survey As per number(s) Jamabandi 2008- 09 Khewat No. 85/70 Khatoni No. 98 Khasra No. 357( l0 Biswa), 363/2//1 (10 Biswa), 366/1 (3 Bieha) -Area (Total % Share in 4 NIL NIL NIL NIL NIL measurement in Bigha acres) -Whether No NIL NIL NIL NIL NIL inherited property (Yes or No) -Date of purchase 2310212012 NIL NIL NIL Ftr NIL in case of self I acquired property \ -Cost of Land (in Rs. 40,22,500-00 NIL NIL Nilir,{."1e'NII case of purchase d. Nc. f i3r;9 l-E at the time of . 3t. ig-L'r?'21, I purchase) FilsAR .// -Any Investment NIL NIL NIL NI xl+---. ". :1 NII on the land by way of Lc'f") development, construction etc. -Approximate Rs l ,10,00,000- NIL NIL NIL NIL NIL Current market 00 value d) Agricultural Land at Village NIL NIL NIL NIL NIL Land Kambopura, Teh. -Location(s) & Distt. Kamal

-Survey As per number(s) Jamabandi 2008- 09 Khewat No. 140/123 Khatoni No. 162 Khasra /)

p I

o. 362 l3Biswa), 363/l 3 Bigha 7 ) iswa) -Area (Total Y, Share in 4 NIL NIL NIL NIL NIL measurement in igha acres -Whether o NIL NIL NIL NIL NIL inherited property (Yes or No -Date of purchase 23/02t2012 IL IL NIL IL NIL in case of self acqu ired property -Cost of Land (in Rs. 40,22,500-00 NIL NIL NIL NIL NIL case of purchase at the time of purchase) -Any Investment NIL NL NIL NIL NIr NIL on the land by way of development, construction etc. -Approximate Rs. 1,10,00,000- NIL NIL NIL NIL IL Current market 00 value e) Agricultural [-and at Vittage Ntt- IL IL L Land bhautala, Teh. N,' -Location(s) Dabwali & Distt Sirsa o t \^ -Survey Khasra No. (v iilicaate number(s) 417il2/Ut (tK- ,Rrg d" 02M),417il9t2 :xp. 19-C9-21 lK-l6M) Hi (Total -Area 2 Kanal 18 MarlaNIL NIL IE} IL measurement in I acres) -Whether o NIL NIL NIL NIL NIL inherited propefty (Yes or No) -Date oi purchase 2v0812003 NIL NIL NIL NIL L in case of self AC uired ro rt -Cost of Land (in . 46,000-00 NIL NIL NIL NIL IL case of purchase at the time of urchase

t, .?>

-Any lnvestment NIL NIL NII, N]L NIL NIL on the land by way of I development, construction etc. -Approximate Rs. 7,00,000-00 NIL NIL NIL NIL NIL Current market value ( ii) Non-Agricultural IL N]L and at Ajronda IL NIL IL Land ore, Village -Location(s) ronda, Tehsil adhkal, Distt. -Survey aridabad number(s) rv.)

ewat hatauni No l5l 16. Mustadi o. 37, Kila No. 17/3^ -Area (Total NIL IL 3 Kanal-19 NIL NIL NIL measurement in Marla sq. ft.) -Whether NIL IL es (gifted by NIL NIL NIL inherited property ) (Yes or No) -Date of purchase Gifted by Karta NIL NIL IL in case of self on 09.0 I .201 8 acquired property .J'P-'-X--\" -Cost of Land (in IL IL Gifted NIL NIL case of purchase -<'., at the time of & purchase) PtE AdIt,C;-r -Any Investment NIL NI Nr*, .^p. Lr r. 19-09 on the land by Hi3A.i'i way of development, construction etc. -Approximate IL IL 5,1 0,00,000- IL NIL IL Current market value ( iii) a) Commercial d & Building hopping IL IL IL Buildings t Barnala Road, plex at (including Village amala Road, apartments) aidwala, Teh irsa -Location(s) Distt. Sirsa

-Survey asra No. asra No. number(s) 21t23130.24t2 8/t6nt2-6/2^- No. /t I

7l/lll.Khasra [o. s8//6/l/1. 6/2/2,7 /2/1, 712t2,13/2, t411/2, 14t2, t5/Ut, t5/12, t5/2 Area (total 112439.25 sq. ft. NIL 6 Kanal-4 Marla NIL NIL NIL measurement in otal Area> 2 sq.ft.) cre 4 Kanal 13 la -Built-up area Built-up Area:- IL p,s00 Sq. Ft. NIL NIL NIL (Total I 1900 sq. ft. measurement in ft.) -Whether No IL No NIL NIL NIL inherited property (Yes or No) -Date ofpurchase t9/0U2011 NIL 27-t0-2004 NIL NI -! in case of self (-! acquired property ,K,}\ -Cost of Property Rs. 56,25,000-00 NIL Rs. 1,65,000- NIL 5 lql- \ (in case of 00 (, vccele \ purchase at the RegC. N 11i.-.3 l* exp. time of purchase) '\ Dt..'i l-09-.?1/ -Any lnvestment Construction NIL Rs. 25,00,000- NIL \ on the land by done by Lessee. 00 )i way of t development, construction etc. -Approximate Rs.l 7,75,00,000- NIL Rs. 68,00,000- NIL NIL IL Curent market 00 00 value b) Commercial IL IL Excise & IL NIL IL Buildings Taxation (including Building at apartments) Chautala -Location(s) Road, Dabwali

-Survey Khasra No. number(s) 476il 1t1- v41,476iltl1, 477 Area (total NIL NIL 2Kanal - NIL NIL IL measurement in 2.25Marla sq.ft.) -Built-up area IL NIL 1,800 Sq. Ft. NIL NIL IL (Total measurement in al sq.ft.)

/ -Whether IL IL No NIL NIL IL inherited property (Yes or No -Date of purchase NIL IL 28-02-2001, L NIL in case of sell l 8-04-2001 , acquired property 22-05-2001, 04-09-2001, t0-12-2001, 28-03-2002, t5-04-2002, 30-04-2002, 30-07-2003 -Cost of Property IL NIL Rs. 1,28,805- IL IL IL (in case of 00 purchase at the time of urchase) -Any Investment NIL NIL Rs. 10,00,000- NIL IL L on the land by 00 way of development, c I construction etc. -Approximate NIL NIL Rs. 55,00,000- L Ad'r'oc Current market -',h^( 00 RegC. No. ti s,l*\ value Dr.. 19- n1f I i'iiS;\f, ./ .v- / c) Commercial IL NIL d& NIL N$)/ Buildings uilding at \ oF. (including v hautala Road, apartments) wali, -Location(s)

-Survey hasra number(s) o.2033//2t2/2, 03312/l,20331 I Area (total IL NIL Kanal-0 Marla NIL IL IL measurement in ft.) -Built-up area NIL NIL ,200 Sq. Ft. IL IL NIL (Total measurement in .ft -Whether NIL NIL No IL IL IL inherited property Yes or No /)

l,/t I -

-Date of purchase IL NIL t4-04-2002 NIL IL IL in case of self acquired property I -Cost of Property NIL NIL NIL IL NIL (in case of .2,81,540-00 purchase at the time of purchase) -Any lnvestment NIL NIL 28, t0,000 NIL NIL NIL on the land by 0 way of development, construction etc. -Approximate NIL NIL Rs. 3,10,00,000- NIL NIL IL Current market 00 value

d) Commercial NIL NIL Land & NIL IL IL Buildings Building at (including Chautala Road, apartments) Dabwali -Location(s) -Survey Khasra No. number(s) t082ll2l3l4l2l13 latoutznt+tzt t3t3t812 ,-'a:---:-> Area (total NIL NIL I Kanal-10 r,w /' measurement in Marla sq. ft.) l'&,ry,ff I -Built-up area NIL NIL * IL No. 1i3 }( (Total 1,500 Sq. Ft. i:p. Dt.. 19-03 2\ measurement in \. HIST.R sq. ft.) -Whether NIL NIL No NIL \ ui-, ryr inherited property (Yes or No) -Date of purchase NIL NIL I 6-01 -2003 NIL NIL NIL in case of self acquired property -Cost of Property NIL NIL Rs. 84.462-00 Nil. NIL NIL (in case of purchase at the time of purchase) -Any lnvestment NIL NIL Rs. 3,00,000-00 NIL NIL NIL on the land by way of development, construction etc. -Approximate NIL NIL Rs. 70,00,000- Nil_ NIL NIL Current market 00 value / \

e) Commercial NIL NIL NIL NIL NIL Buildings (including apartments) Shop at Anaj -Location(s) Mandi, Dabwali

-Survey Shop No. l5 number(s) Area (total NIL NIL NIL NIL NIL measurement in sq. ft.) -Built-up area N]L NIL 2500 sq. ft. NIL NIL NIL (Total measurement in sq.ft.) -Whether NIL NIL No NIL NIL NIL inherited property (Yes or No) -Date of purchase NIL NIL NIL NIL NIL in case of self 23-06-1990 acquired property -Cost ol Property NIL NIL Rs. 1,86,000-00 NIL ryrL (in case of purchase at the 1 time of purchase) NI Nr[.^r]d IL -Any [nvestment NIL NIL NIL I on the land by A.C'roci:t. 'l way of efld. No. 1 ,ji * :p. Dt.. 19-C3-; I development, n'i^o construction etc. i , -Approximate NIL NIL Rs 80,00,000- NIL E Current market 00 \ Y value I) Commercial NIL NIL NIL NIL NIL Buildings (including Property at Vill. apartments) Chautala in Lal -Location(s) Dora

-Survey number(s) Area (total NIL NIL I Kanal -0Marla N]L NIL NIL measurement in sq.ft.) -Built-up area NIL NIL NIL NIL NIL (Total 2,500 Sq. Ft. measurement in sq.ft.) , 7 r

IL IL IL -Whether IL ES inherited property es or No A IL IL -Date of Purchase in case of self uired I.t IL tL -Cost of ProPertY (in case of purchase at the time of urchase IL IL IL -Any lnvestment L L s. 3,50,000-00 on the land bY way of development, construction etc. 20,00,000- IL L IL -Approximate IL . Current market value IL IL IL g) Commercial IL I at Buildings roperty (including ector l5-A , ronda More, apaftments) .I -Location(s) aridabad (1

No. 124' viir... -Survey lot ht I,rOCi]l e S numb R. IL ,747 sq. yds. Area (total IL ;rl L\" 19-09-2.. measurement in iitsAii

S ft. Sq. Ft Built-up area IL IL 10,000 otal measureme n ft IL IL IL -Whether IL o inherited property Yes or No 0-07-2003 IL L IL -Date of purchase IL IL in case of self I uired ro ert L I L -Cost of ProPertY .13,05,042- (in case of 0 purchase at the of urchase time IL IL IL -Any lnvestment IL IL .1,90,48,864- 0 on the land bY . way of t. development, construction etc. . 9,85,00,000- IL NIL IL -Approximate IL IL 0 Current market value

I t\ I (iu) Residential Flat in Maharishi NIL NIL NIL NIL NIL Buildings Dayanand Co-op. (lncluding Group Housing apartments) Society Ltd., At -Location(s) Plot No. B-4, Vasant Kunj, Adjoining to Pocket B-5 & 6, New Delhi- I 10070

-Survey Membership No. number(s) 250 -Area (Total 2280 sq.ft NIL NIL NIL NIL NIL measurement in approx. sq.ft.) -Build up area Under NIL NIL NIL NIL NIL (Totai Construction measurement in sq. ft.) (. -Whether No NIL NIL NIL N[ inherited property i\ (Yes or No) h -Date of purchase l3-06-201 3 NIL NIL N $IIK;. T:,: in case of self ,. t" i9-09_2. acquired property iii-alia ry -Cost of Rs. 85,00,000-00 NIL NIL NI vv property(in case ofpurchase at the time of purchase) -Any investment Under NIL NIL NIL NIL NIL on the propefty by Construction way of development, construction etc. -Approximate Rs. 1.50,00,000- NIL NIL NIL NIL NIL Current market 00 value (v) Others (such as NiL NIL NIL NIL NIL NIL interest in property) (vi) Total of Current Rs. Rs. 18,52,250- Rs. NIL NIL NIL Market Value of 32,02,00,000-00 00 21,08,00,000-00 (i) to (v) above

(8) I give herein below the details of liabilities/dues to public financial institutions and government:-

(Note: Please give separate details ofname ofbank, institution, entity or individual and amount before each item) SI Description Self Spouse HUF (As De n ent- en n ent- I I 7, (

o er n h C oan or ues to ank/ Financial st tution(s) ame of Bank or NIL NIL NIL NIL lnancl al NIL NIL institution, mount utstandins. Nature f loan. oans or ues o a v n a av n autala UF uta vldua s/E ntity Rs.99.19"460-00 IL .77.60.366-10 thc r than ( Unsecured Loan) nse'cur'ed mentioned in bt'Cha'utala" Aiav Sinsh bove ames(s Rs.1.41.31.000-00 L ount (Unsecured Loan) NIL NIL NIL utstan d rng c) Ariun Sinsh ature o fr.oan Rs117.oo.0oo-oo (Unsecured Loan) IL I d) Dev & Co. NIL NIL NIL Rs.4,00,000-00 (lJnsecured Loan) e) Errudite Comouters Pvt. NIL NIL t.td. Rs.21.25.000 IL 1 00 (Unsecured Kumar Loan) 'ra 0 Karan Sinsh /, \.rl:(j1S. Rs.5.00.0O0-00 IL ( U nsecured Loan) na tJ. s0d c) Kushal Mittal \ p. Dt.19-09- Rs.1 'r-{lSAil h) NI NIL IL t Loan) I t.j i) oan)

ny ot er la NIL NIL NIL

ran o S NIL NIL NIL liatrilities 0 ll overnmen Dues: A) Has the Deoonent been in occupation of accommodat ion provided. by YF,SA]O Dues to the Covemment at anr time ddring the last ten years betore tne oate ( Please tick eDartments of notillcation of the c'urrent electiSn? the ehlins with appropriate altematrve ) overn"ment mmodation B ) I f answer to (A) above is YES, the foltowing declaration may be ' fumished namelv:

(i) The address ofthe Goue,nrent Accommodation: 18, Janpath' New Delhi-110001 iii,; There is no. dues payable in respect. of above Government accommodatton towards:-

(a) Rent: as on 31.03.2019 lb1 Electricitv Charses;' as on 11.04.2019 tcl water ch6rges: as on I I .04.20 I 9 7 (

(d) Telephone charges as on 18.03.20I9 (date) / Ithe date should be the last date of the third month Drior to the month in which the election is notified or any date thereafterl' Note - 'No Dues Cenificate' lrom the Asencies concemed in respect of Attached rent. electricity charges. water charges -and telephone charges lor the ahove Governirent aclommodation sllould be subhitted. (iii) Dues to deDartment dealin s with s6vernment transi'prt (in_c I udi ng NIL NIL NIL NIL NIL NIL arrcratts and helicopters)

(rv) lncome tax dues Rs.2,010-00 NIL Rs.5,79.220-00 NIL NII- NIL HU!'(AS Snouse Conarceier in Dependent- Dependent Dependent- Self (Meghna) Aiav Sinsh J Cha"ufala tIUF) (v) GST dues NIL NIL NIL NIL NIL NIL

(vi) M un ic iDal / Propert'y Tax dues NIL NIL NIL NIL NIL NIL (vn) Any dues other NIL NIL NIL NIL NIL NIL (viii) Grand total of all Government dues Rs.2,0r0-00 NIL Rs. 5,79,220-00 NII, NIL NIL (rx) W hether anv other liahilities art in d ispute. ifso. 'i mentron the amount NIL NII- NII- IE} NIL involved and the authoritv before which if is pending ,/z> "' Regd. No. 1i ili,3 Exp. Di.. i9-0+2i /irl

f/' (9) Details of profession or occupation: I C

(a) Self : Agriculture

(b) Spouse : Housewile

(9A) Details of source(s) of income:

(a) Sell: Agriculture, Salary and lnterest

(b) Spouse : Salary and Interest

, f (

(9B) Contracts with appropriate Government and any public company or companies \ \,!ir x s l.;i{rcr14 (a) details ofcontracts entered by the candidate : Not Applicable -a- .-l RegC. llc. 1i:;g Exp. Dt..19-0S'2 i (b) details ofcontracts entered into by spouse : Not Applicable Htstut

(c) details of contracts entered into by dependents : Not Applicable t", I CF (d) details of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest : Not Applicable

(e) details ofcontracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners : Not Applicable

(f) details ofcontracts, entered into by private companies in which candidate or spouse or dependents have share : Not Applicable

(10) My educational qualification is as under:

(i) Matric from Central Board of School Education in 2004 from Lawrence School, Sanawar( Himachal Pradesh)

(ii) Bachelor of Sciences in Business Administration from Califomia State University, Bakersfield (USA) in 201 I

(iii) LLM (Pro) from National Law University, Delhi in 2018

(iv) Masters of Arts in Mass Communication from Guru Jambheshwar University of Science & Technology, Uisar in 201\

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

PART _ B

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

l Name of the candidate Sh./Sn*t-JKt*m. Dushyant Chautala 2 Full postal address H. No. 803, Ram Colony, Ward No. 5, Sirsa-125055 Number and the Name the constituency J of 04-Hisar-Harvana and state Name of the Political nartv which set uo 1 Jannayak Janta Party the candidate (orherwise ri rite ' Indeperident' I

5 Total number ofpending criminal cases . NIL

6 Total Number of cases in which convicted . NIL Year for which last 7 Income Shown AN of lncome Tax Return filed. Total

(a) Candidate .IHPC89O7C F.Y.2017-20r8 Rs. 62,46,820-00

(b) pouse (Meghna) HPA755OR F .Y . 2017 -2018 Rs. I I,15,970-00

Ajay Singh Chautala FHA I584A Y . 2017 -2018 Rs. 60,75,740-00

(d) ependents ot Applicable Not Applicable Not Applicable

8 Detail of Assets and Liabilities (including offshore assets) in Rupees

HUF (As Soouse Conarcener in Dependent Dependent Dependent Description Self (Megh na) Aiav Sinsh Cha"ufala tfuF)

Moveable Assets Rs. l 5, 1 8,97,804- P.s.2,26.24,929- Rs. 6,20,77,874- (Total Value) 72 83 NIL,/ o 16 /;.: tu\ B 'ac"r. I ,1> il.'e -L Immovable Assets Regd. l.Io. 1 i i Exir. Dt.. i9-01 I F( r tiAX Purchase Price ol Rs. 2,55,76,000- l?, I self acouired Rs.18,52,250-00 Rs.27,73,849-00 NIL immovhble property 00

Develonment / Constriction cost of Rs.2,60,08,864- NIL I I immovable ProDertvNIL NIL NIL NIL after nurchase df ' 00 applitable.l

/ I

(

Aooroximate III Cirrrent Market Price of-

(a) Self Rs. acouired Rs. 18,52,250-00 ass'ets (Total 24,52,00,000-00 lRs.15,78,00,000 Value)' -00 NIL NIL NIL Inherired {b) Rs. NIL assets (Total 7,50,00,000- Rs.5,30,00,000- Value) 00

9 Liabilities

Govemment dues (i) (Total) NIL NIL NIL NIL NIL NIL

S lrom Bank, Loan from Loan from ii) I nanc a I Others c stitutions and Rs. 5,36,84,480- NIL Others Rs. NIL ther (Total) 00 t,40,66,063-10 viir.:'s Itr * ,1egd. l'1,r. 1 l-r r3 iabilities that are under dispute i:,$. ilt. i9-C3-21 HiSATI

(r) Government Dues L,J (Total) i_, NIL N]L NIL NIL

I ( ll Loan tiom tsank. Financial Institutions and others (Total) NIL NIL NIL NIL NIL NiL

1t ighest educational qualification:

(i) Matric from Central Board of School Education in 2004 from Lawrence School. Sanawar (Himachal Pradesh)

(ii) Bachelor of Sciences in Business Administration from Califomia State University, Bakersfield (USA) in 2011

(iii) LLM (Pro) from National Law University, Delhi in 2018

(iv) Masters of Arts in Mass Communication from Guru Jambheshwar University of Science & Technology, Uisar in 20196

G I e detal I L)f h I ghest Schoo y Un I VETS Itv educatI on ment I on rqg the fu I I from the certificate d I pIoma () egree course, n am f the Sc hoo I Co l6,ge I UnI ers Itv and the year I n hIch the cours was comp I etc ) ,

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 paft of it is false and nothing material has been concealed there from. I further declare that:-

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

(b) l, my spouse,-or-my4epe*dents do not have any asset or liability, other than those mentioned in items 7 and 8 ol Part A and items 8, 9 and l0 of Part B above

Verified at Hisar this the 20th da

vrl(As Ati'/o*ii€) EPONENT

Note: I . Affidavit should be last day ol filing nominations.

Note: 2. Affidavit should be missioner or Magistrate of the First Class or before a Notary oi:. Note:3. All columns should be filled up and no column to be left blank. Il 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.

Note: 5. Each page of the Affidavit should be signed by the deponent and the Affidavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavit is swom. \ -*4r*" (Ministry of Law & Justice Notification No. Hl l0l9(4)i20ls-Leg.ll. dated 106 October, 2018 and Notification No . H- I 1 OlgI 13 l20t 6-Leg.Il, dated 266 February, 20 I 9) , ,f --e,*o anW'>L XAn \- 1..4,o*, Certified that the above was declared on oath before.me on this.....k,li'..'.day .20t9 at...!,!h*?-. ..,.in the presence of,l Who is by

Certified furlher has h i:l,r read & explained i(r oc who deemed perfectly lo at the time making thereof

Ad.,^: rte & NOTARY Hb.rt{ (llaryaoa) lodla N EISAR o n )"1