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TEN N^ O RUPEES i Al M I'L M, _ l ' ^,^ - Ll IJ V V L n^ o TEN ^1 n4N : RUPEES a r^' rim r / V. 1"o IN®► IA ^r` I N D I A N ^^ N .1'IJ^D I^CrI A L- r "^ 4 Zi tt I ^ ^c f / j FORM 26 (See Rule 4-A) ^ViT^ ' BEFORE THE NOTARY PUBLIC,UMERKOTE,DIST:NABARANGPUR AFFIDAVIT. Affidavit to be furnished by the candidate before the Returning Officer for election to ODISHA LEGISLATIVE ASSEMBLY (name of the House ) from 74- JHARIGAM , Constituency (Name of the constituency). 1. Sri, Ramesh Chandra Majhi S /O Late Jadav Majhi, aged about 31 years, residence of Dandamunda , P.S:Chandahandi , Dist:Nabarangpur, candidate at the above election, do hereby solemnly affirm/state on oath as under - 1. I am not accused of any offence(s) punishable with imprisonment for two years or moire in a pending case (s) in which a charge (s) has 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. Case / First information Report No/Nos- No ii. Police- station (s) : ...... ... .... District ............... State .. I.n..... iii. Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged : ................... r-{c, iv. Court(s) which framed in charge(s)- ..................... 44 v. Date(s) on which the charge(s) was/were framed - .............. ia'- vi. whether all or any of the proceeding (s) have been stayed by any Court(s) -No- 1A a44-a Signature of Deponent. j. MOHANT' Cont.... p/2 NOTARY pUBL10 UMSRKOT$ // 2 // 2. 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 :- i. Case/ First Information Report No . / Nos....................................... A'0 ii. Court(s) which punished ...................................... iii. Police-station (s) .........Wit:........ Dist...... 0..o.....State(s).... Nev...... iv. Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has never been charged ........... :: ............. v. Date(s) on which the sentence(s) was/were pronounced .......... !.:......... vi. Whether the sentence ( s) has/have been stayed by any Court(s) of competent jurisdiction .................................:'Ja ......................................... 0^1 Place : Umerkote ^, If P Date : 30.03.2009 '^( 4Aeg, ^/;' C`-. Signature of Deponent. VERIFICATION I the deponent above named , do hereby verify and declare the contents of his affidavit are true and correct to the best of my knowledge and belief , no part of it is false and nothing material has been concealed therein . Verified at Umerkote this the 30th day of March 2009. Identified by P .S.Patra) L Advocate, Umerkote Signature of Deponent. The d ponentAnwing been Identttteb ^:.. e.^@a :°-.......... ..Advocate- q Sr1...CQ: befere me .^^e icy Z O .:...... AN1/Pig( E^4, -..cyar iznd explained The contei t^ h ving . ed to have correctly to the det ^n nt wh seen ► eme of thi. under stood the Lel t'.nts End tl. ftidovit at the tune of sweannt]. VS-" J. MOHANTtI VOTARY PUBLIO UMBP. OT 5 * j. d4r ORISSA 05AA 931988 Annexure -t ► tiagdttl& 31/93 1 BEFORE THE NOTARY PUBLIC. UMERKOTE AFFIDAVIT \' .'y For election to Odisha Legislative Assembly (Name of the house ) from Jharigam, ^r F constituency ( Name or the constituency) I SRI, Ramesh Chandra Majhi, Son of Late Jadav Majhi, aged 31 years, resident of Danilamunda, P.S:Chandahandi, Dist: Nabarangpur, candidate at the above election, do hereby solemnly affirm and state on oath as under. (1) The following case(s) is/are pending against me in which cognizance has been taken by the court:- No cases are pending against me in any court. (i) Section of the Act and description of the offence for which cognizance taken : No (ii) The court which has taken cognizance : No (iii) Case No: No (iv) Date of order of the Court taking cognizance : No (v) Details of appeal(s)/application(s) for revision, etc, if any filed against above order taking : .3 DEPONENT (Cont... P/2) i. MOHANT I 40TARY PUBLIQ uMBRCOTs I • HANTy I p _ 1I1INW v a. b'1 1 * . 'P ,/mJ 1 ) ^"lEPKOTE [ `F k. ^ // 2 // (2) That I give herein below the details of the assets (immovable , movable, bank balance etc) of my self my spouse and dependents* A. Details of movable assets (Assets in joint name indicating the extent of joint ownership will also have to be given) SI. Description Self Spouse(s) Depend- Depen- Depen- No ent-1 dent-2 dent-3 (i) Cash Rs.1,50,000/- 20,000/- Nil Nil Nil (ii) Deposits in U.Co Bank, Nil Nil Nil Nil Bubaneswar Branch, Banks, Financial Rs. 15,000/- Institutions and Non-Banking Financial companies (iii) Bonds, Nil Nil Nil Nil Nil Debentures and Shares in Companies (iv) Other Financial Rs.20,000/- in Nil Nil Nil Nil instruments Bajaj Allianz NSS, postal Rs. 15,0001- in savings, LIC, Max New York policies etc, life (v) Motor vehicles Mahindra Bolero GLX Nil Nil Nil Nil Regd.No.OR-24-3333 (details of make Hero Honda Glamour etc. Two wheeler (vi) Jewellery (give 30 Grams Gold 80 Grams Nil Nil Nil details of weight Rs.48,000 Gold and value) Rs. 1,12,000/- (vii) Other assets, Nil Nil Nil Nil Nil such as values of claims/ interests DEPONENT J,IfOHANT) (Cont.....P/3 ) dOTARY PUBLIC VMSRKOTIF O7q;\ l I fA of,ApityIt J'7) 3 37,89 1 4, I G RorF / // 3 // etails of immovable assets Sl. Description Self Spouse(s) Depen Depen Depen No. Name(s) dent-1 dent-2 dent-3 (i) Agricultural Land Palsapara Nil Nil Nil Nil Location(s) Khata No.208 Survey number(s) Ac.4.27 cents Extent(Total San Dhuruapara measurement) Khata No.110, Current market Ac.0.50 cents value Dandamunda Khata No. 49 Ac.10.84 cents Total Value Rs. 5,00,000/- (ii) Non-agricultural Dandamunda Nil Nil Nil Nil Land Khata No. 102 Location(s) Ac. 1.57 cents Survey number(s) Gharbari Extent (Total Value measurement) Rs. 10,00,000/- Current market value (iii) Buildings Residential Nil Nil Nil Nil (commercial and building at residential) Dandamunda Location(s) Of Khata Survey. door No.102 number(s) Total 3380 Extent (Total Sq.feet plinth measurement) area Current market Rs. 13,52,000/- value (iv) Houses/Apartments Nil Nil Nil Nil Nil etc. Location(s) Survey/door number(s) Extent(total measurement) Current market value (v) Others Nil Nil Nil Nil Nil (such as interest in property) 6,^ a/1- 0&*,, DEPONENT (Cont.....P/4 ) .1. MOf1ANTI NOTARY PUBLIC UMERKOT E ^O T A R\ J. MOMARTK ai ARP Its 37j93 r F (3) I gi erein below the details of my liabilities over dues to public financial institutions and Government dues Si. Description Name and address of Amount outstanding No. Bank/Financial as on........... Institution(s)/Department(s) (a)(i) Loans from Banks Housing loan From SBI,Umerkote, Branch Rs. 4196S9 7 • X3 30.03.2009 A/cNo. 11.25-S737073 (ii) Loans from financial Nil Institutions (iii) Government dues Nil (a) dues to Departments Nil dealing with Government accommodation (b) dues to Departments Nil dealing with supply of electricity (c) dues to Departments Nil dealing with supply of electricity. (d) dues to Departments Nil dealing with telephone (e) dues to Departments Nil dealing with Government Transport including Aircrafts & Helicopters) (f) other dues, if any Nil (b)(i) Income Tax including Nil surcharge[Also indicate the assessment year up to which income Tax Return filed Give also permanent Account number (PAN)] (ii) Income Tax [ Also indicate Nil the assessment year up to wealth Tax return filed]. (iii) Sales Tax[ only in case of Nil proprietary business] (iv) Property Tax Nil DEPONENT r3 (Cont .....P/5 ) .a. MOHANTI NOTARY PUBLIO UM.RCOTR j J. M014ANTK 1 ) Regd. No 37,199, O\ UME.RKOTE //5 // F (3) My educational qualifications are as under:- (GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION) Name of school, University and the year in which the course was completed should also given) 1. Passed H.S.C. Examination in 1993 from Govt. Boys High School , Unit -I , Bhubaneswar (Board of secondary Education Odisha) DEPONENT VERIFICATION I the deponent above named , do hereby verify and declare the contents of his affidavit are true and correct to the best of my knowledge and belief , no part of it is false and nothing material has been concealed there from. Verified at Umerkote this the 30`o day of March 2009. DEPONENT Identified by U.S.Patra Advocate,Umerkote Rie dep nent having been Ident%tteS Advocate. q Srr...^ ' r €'^O -,affirm befere me on this ,h, ....^..... duy Lcut...e. ....Alai ZQ " the eont?z hev+r^,g t -+- reat, c Ir and explained to the er-rn-nt vrih^) s:rnied to have correctly End theme of thin ender st +,rid the LOO t.nts IfrdavA at the time of swaarhno. j. MOfiANI I e1OTARY PUBLIO UM ERKOTE.
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