ANNEXURE 10
(cHAPTER 5, PARA 5.5.1)
FORM 2A'
FORM 24
(See rule 4) orr | 6n l:otr leo NOMINATION PAPER Election to the House of the People
Z
I t t
STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PART I
(To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the House of the People from the 02- SRIKAKULAM Parliamentary constituency. Candidate's name VIIAYAKUMARI KINIARAPU Fathers/methe+s/husband's name YERRANNAIDU LATE. His postal address NIMMADA VILLAGE PRIYAGRAHARAM VIA, KOTABOMMALI MANDA L. SRIKAKULAM DISTRICT. HeT name is entered at S.No 704 in Part No 288 of the electoral roll for TEKKALI* (Assembly constituency comprised within) 02-SRIKAKULAM Parliamentary Constituency.
My name is RAVEENDRABABU ARAVALA and it is entered at S.No 56 in Part No 83 of the electoral roll for SRIKAKULAM * (Assembly constituency comprised within) 02- SRIKAKULAM Parliamenta ry constituency. Date: 25.03.2019 A.qzi,fu, Signature of Proposer PART II
(To be used by candidate NOT set up by recognised political party) we hereby nominate a candidate for election to the House of the people from the- Parliamentary Constituency.
we declare that we are electors of the above parliamentary Constituency and our names are entered in the electoral roll for that Parliamentary Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:_
Particulars of the proposers and their signatures
S. Name of Elector roll no. of Full Name Signature Date No component Proposer Assembly Part No. S. No. constituency of in that Electoral part Roll 1 2 3 4 5 6 7 1 7 3 1 .-----.--..---.- NOT APPLICABLE 5 6 7 8 9 10 N.B. - There should be ten electors of the constituency as proposers. PART III
I, the candidate mentioned in Part I/Part tr{ (Strike out which is not applicable) assent to this nomination and hereby declare that -
(a) I am a citizen of India and have not acquired the citizenship of any foreign State or country. (b) I have completed 55 years of age; [STRIKE OUT c(i) or c(ii) BELOW WHICHEVER IS NOT APPLICABLE] (c) (i) that I am set up at this election by the TELUGU DESAM parry, which is a recognised Na+ienaf+arB,/State Party in this State and that the symbol reserved for the above parly be allofted to me.
OR
(cXll)
€rd€+€+f+efu+€n€+ffe:- (d) my name and my Fathel-s/Methe+-s/Husband's name have been correctly spelt out above in ENGLISH (name of the language);
(e) to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the House of the People.
*I r,,.rL^- ,l^-l--^ +L^+ I rL^ ** r---'^ /r-.rl- ,,,] ;-L i. -'- - -^-L^- ^r ^ -
---Staie I also declare that I have not beery and shall not be nominated as a candidate at the present general election/the bye-elections being held simultaneously, to the House of the People from more than two Parliamentary Constituencies.
Date:25.03.2019 l(usrP' r-.r'-'-'-* Si gna tusre of Candida te
+Score out the words "assembly constituency comprised within" in the case of Jammu and Kashmir, Andaman and Nicobar Islands, Chandigarh, dadra and Nagar haveli, Daman and Diu and Lakshadweep.
*Score out this paragraph, iI not applicable.
**Score out the words not applicable
N.B.-A "recognised political party" means a political Party recognised by the election Commission under the etection Symbols (Reservation and allotment) Order, 1968 in the State concemed.
PART IIIA (To be filled by the candidate)
Whether the candidate--- (i) Has been convicted ---- (a) of any offence(s) under sub - section (1); or (b) for contravention of any law specilied in sub-section rles/ No (2), of section 8 of the Representation of the people Act, 1951 (43 of 1951); or (ii) Has been convicted for any other offence(s) for which He has been sentenced to imPrisonment for two years or more. If the answer is "Yes", the candidate shall furnish the following information: (0 Case/first information report No./Nos. - NOT APPLICABLE - (ii) Police station(s) - Nor eppllceslr -District(s) - rcr allrrceor-r - State(s) - Nor APPLTcABLE - (iii) Section(s0 of the concemed Act(s) and brief description of the offence(s) for which he has been convicted -Noreprutceslt- (iu) Date(s) of conviction(s) - ror enn-rcaor-e - (") Court(s) which convicted the candidate- r.:or eppuceslu ("i) Punishment(s) imposed [indicate period of imPrisonment(s) and/or quantum of fine(s) - tror *ruc,ror-r - (vii) Date(s) of release from prison - NoTApILICABLE - (viii) Was/were any appeal(s)/ revision(s) filed against above conviction(s) Yes/ No (ix) Date and particulars of appeal(s)/ application(s) for revision filed _ NorAppLrcABLE _ (x) NlT! gf the court(s) before which the appeal(s)/ application(s) for revision filed _ NOT APPLICABLE - (*i) Whether the said appeal(s)/ application(s) for revision has/have been disposed of or is/are pending - Norarrrrceou - (xii) If the said appeal(s)/application(s) for revision has/have been disposed of -- (a) Date(s0 of disposal -rorernucoorr- (b) Nature of order(s) passed , r,ror AIpLTcABLE- (2) \Arhether the candidate is holding any office of profit under the Government of India or Stare Government? rles/ No If Yes, Details of the office held - ruor AppucABLE (3) Whether the candidate has been declared insolvent by any Court? fV*Z i(O If Yes, has he been discharged from insolvency - ror AppLTcABLE - (4) Whethegthe candidate is under allegiance or adherence to any foreign country? (Y*/If,o) -If Yes, give details - Nor arrr-rceorr - (5) Whether the candidate has been d]pqualified under section 8A of the said Act by an order of the President? (Yes/ No) (6) Whether the candidate was dismissed for corruption or for disloyalfy while hold,ing office under the Govemment of lrdia or the Government of any State? (Yes/ ]do1 If Yes, the date of such dismissal - uor erprrcaau- (4 Whether the candidate has any subsisting contract(s) with the Government either in individual capacity ot by trust or partnership in which the candidate has a share for supply of any goods to tl'1gi Governmenl. or for cxecution of works undertaken by that Govemment? (Yes/ No)
-If Yes, with which Govemment and details of subsisting contract(s) - r'ror alluceor-e - (8) \A/hether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other$n a cooperative society) in the capital of twenty-five percent share? (\As/ No) -If Yes, with which Govemment and the details there of - Ncrr apelrcaeLr -
(9) Whether the candidate h19,been disqualified by the Commission under section 10A of the said Act---- (\Asl No) -If Yes, the date of disquali{ication un arrurceru -
Place: SRIKAKULAM. Date: 25.03.2019. Ku*6>.* Signature of Candidate
PART IV (To be filled by the Returning Officer)
Serial No. of nomination paper ...... This nomination was delivered to me at my office at . (hour) on (date) by the *candidate/ proposer. (name of proposer ...... )
Date
Returning Officer PARTV
Decision of Returning Officer Accepting or Rejecting the Nomination paper
I have examined this nomination paper in accordance with section 36 of the Representation of the People Act 1951 (43 of 1951) and decide as follows:-
Date ...
Returning Officer (Perforation)
PART VI
Receipt for Nomination Paper and Notice of Scrutiny
(To be handed over to the person presenting the Nomination Paper)
Serial No. of nomination paper ......
The nomination paper of a candidate for election from the Parliamentary constituency was delivered to me at my office at (hour) on (date) by the *candidate/ proposer. All nomination papers will be taken up for scrutiny at (hour) on (date) at (Place).
Date
Returning Officer
"Score out the word not applicable. I
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eeo&Fdf, srr*rytvr ANDHRA PRADEsH CG 936540 g5 ,,. i iah ii:.io S r'/o .Daregpg4gRs.ssl- i rr -r I B il1 KW't* N.S. o, IT'E8'ED No R/617/2009 13/2018 Ranni?d Valid u 1-0 l-2024 I SRIKA LAM TOVVN I I s **am (1) I am a candidate set up by TELUGU DESAM PARTY (*'name of the political party) / @. (**strike out whichever is not aPPlicable) (2) My name is errolled in 03 - Tekkali Assembly Constituency in Andhra Pradesh (Name of the Constituency and the state), at Serial No. 204 in Part No.288 - Nimmada (3) My contact Telephone Number(s\ is/ are949346839 and my e-mail id (if any) is - NIL - and my social media account(s)( if any) is/are (D - NrL- (ii) -NrL- (iii) - NIL- (4) Details of Permanent Account Number(PAN) and status of filing of Income tax return: Sl.No Names PAN The financial Year Tota.l income shown in lncome Tax for which the last Return (in Rupees) for the last five Income-tax return Financial Years completed (as on 31't has been filed March) 1 Self APTPK6179-A 20"t3 - 2014 (D 12,60,30't / - 2011- 2015 (ii 1-t,80,542 / - 2075 - 20"t6 (iii ) 75,26,057 /- '15,74,394/ - 2016 -2017 | (ir ) 2017 - 2018 (rl '15,77 ,555 / - 2 Spouse NlL NIL (') NIL NIL (ii) NIL NIL (iii) NtL NIL (iu) NIL NIL (v) NIL 3 HUF (lf Candidate is NOT NOT (') NOT APPLICABLE Karta/Coparcener APPLICABLE APPLICABLE (iD NOT APPLICABLE (iii) NOT APPLICABLE (iv) NOT APPLICABLE (") NOT APPLICABLE .1 Dependent 1 AI APR9645-P 201,3 - 2014 (i) 1.-1 ,78,695 / - -rs,26,705/ 2074 - 2075 (ii) - 2015 - 2016 (iiD 13,63,765/- 20^t6 - 2017 (iv) 't6,37,568/ - 2077 - 2078 (v) 15,-t5,^142/ - 5 Dependent 2 NOT NOT (i) NOT APPLICABLE 4 N.S. Kv63"f^u"''" lt?g8rEo R.9d.No /617i 2009 NR/3913/2018 z Valid upt 1-O3-2024 SRII Note: It is mandatory for PAN holder to mention PAN and in case of no PAN. lt should be clearly stated "No PAN allotted". (5) Pending crimina.l cases (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: (If there are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give details of all pending cases in the Table below) Table NOT NOT NOT (u) FIR No. with name and APPLICABLE APPLICABLE APPLICABLE address of Police Station concerned NOT NOT NOT (b) Case No. with Name of the APPLICABLE APPLICABLE APPLICABLE Court NOT NOT NOT (c) Section(s) of concerned APPLICABLE APPLICABLE APPLICABLE Acts/Codes involved (give no. of the Sectior! e.g. Section of [rc, etc.). NOT NOT NOT (d) -Brief description of offence APPLICABLE APPLICABLE APPLICABLE q v N.S. o,-.-." ( v n*qr tc'''""-'-'-"-" Reg No /6r 7/2009 s.NFY3913/2018 rTrE ftD Valid upt 1-03-2024 SRIKAKU LAM TOWN 3 NOT NOT NOT (") Whether charges have been APPLICABLE APPLICABLE APPLICABLE framed (mention YES or NO) NOT NOT NOT (0 If answer against (e) above is APPLICABLE APPLICABLE APPLICABLE Yes, then give the date on which charges were framed NOT NOT NOT (g) Whether any APPLICABLE APPLICABLE APPLICABLE Appeal/ A pplication 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 altemative (ii) below) OR (ii) I have been convicted for the offences mentioned below: NOT APPLICABLE (lf the candldate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the Table below) Table NOT NOT NOT (a) Case No APPLICABLE APPLICABLE APPLICABLE NOT NOT NOT (b) Name of the Court APPLICABLE APPLICABLE APPLICABLE NOT NOT NOT (.) Sections of Acts/Codes APPLICABLE APPLICABLE APPLICABLE involved (give no. of the Section, e.g. Section of IPC, etc.). - NOT NOT NOT (d) Brief description of offence for APPLICABLE APPLICABLE APPLICABLE which convicted NOT NOT NOT (") Dates of orders of conviction APPLICABLE APPLICABLE APPLICABLE NOT NOT NOT (0 Punishment imposed APPLICABLE APPLICABLE APPLICABLE \1 N.S. a tL: l{:Vtf.otPtc:'uut-<' R.gd 17t200e r'7darED Reis ,Ed Vld6 NR/391 3,201 8 Valid upt 1-03-2024 SRIt (6A) I have given full and up-to date in{ormation to my politicat party about all pending criminal cases against me and about all cases of conviction as given in paragraphs (5) and (6). [Candidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES tN 5(i) and 6(i), abovel Note 1. 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 fol 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 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 deposits/Investnxent, the details including Serial Number, Amount, date of deposit, and the scheme, Name of the Bank / Institution and Branch are to be given' Note: 3. Value of Bonds/Share Debentures as per the current market value in Stock Exchange in resPect in listed companies ancl as per books in case of non-listed companies should be given' Note: 4. 'Dependent means parents, son(s), daughter(s) of the candidate or spouse and ',1 N.S. O,-.'-r,-. Kv6c-&.\cr*'-{-'^., rtrE ltD Regd.No R/617/2009 s.NfU3913/2018 Valid u 1-03-20?4 LAM TOWN 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 of each lnvestment. Note: 6. Details should include the interest in or ownership of offshore assets. Explanationi 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'; sl. Description Sclf Spouse HUF Dependent-l Depe Depe No nden nden (Son) t-2 r-3 (i) Cash in hand Rs 1,35,000/- NIL NOT Rs 1,26,000/- NOT NOT APPLICABLE ABLE ABLE (ii) Details of deposits in 'l)Rs2,28,022/ - in NIL NOT 1-\Rss,n,999/-in NOT NOT APPLICABLE Bank accounts (FDRs, Andhra Bark-RCB, Andhra Bank(RCB- ABLE ABLE Term Deposits and aII Sklm SB Ac No. Sktm) SB A/c other types of Deposits 071110011006502 No.071110100060939 including saving accounts), Deposits 2)Rs. 6,33,941l- in 2)Rs 5000/- in Andhra with Financial SBI-Sklm, SB Ac BanI(RCB-Sklm) lnstitutions, Non- No.20077764672 SB A/c Banking Financial No.071110.1002.19942 Companies and 3) Rs. 5000/- in Cooperative societies Andhra Bark-RCB, 3)Rs.54,562l - in ICICI and t}le amount in Sklm, A/c No. Banl< -Sklm, SB A/c each such deposit No.070001501179 071110100220151 4\Rs.35,43,574 / - ln SBI-Sklm, A/c No.32980419642 5)Rs 11,10,337l- in Andhra Bank-New Delhi, SB Ac No. 708970027200160 '.1 N.S. KVO A Ro9d !617t2009 N Fr391 3/201 8 Valid uPt 7-03-2024 LAM TOWN SRIKAKU 6 6)Rs.43,49,899/ - in SBI, Parliament House, New Delhi, A/c No. 339"t8533579 7)Rs. 74,85,299 / -in Andhra Bank-RCB, Sklm, FDR No.071120100042012 Dated: 06.05.2018 8)Rs.67,32,299/-n SBI- Sklm FDR No.3410154n 28 Dated 30.08.2017 floint with mother) 9) Rs.71,85,560/-in SBI-Sklm FDR No. 32980015333, Dated 06.05.2018, 0oint with Mother) 10) Rs.73,03,065/-in Andhra Bank-Sklm FDR No. 071 1 201 00042003, Dated: 06.05.2018, (oint with Mother) 11)Rs.3,41,09/- in Canara Banl<,Sklm FDR No.29194955 Datecl 10.10.2018 12) Rs. 20,00,000/- in Andhra Banl<, Sklm FDR A/c No. 07-t^1201_001_09u9 14 p-"^^-t'^r N.S. o,.^,-".". K voayl' Regd o 17t2009 NFv391 3/2018 ^ffElrcD Va lid upto 1-03-2024 SRIKA KULAM TOVVN 7 Dated: 11.04.2018 NOI (iii) Details of investment NIL NIL NOT NIL ^"OT APPLICABLE in Bonds, ABLE ABLE Debentures/Shares and units in companies/ Mutual Funds and others and the amount. (ir) Details of investment 1)LIC NIL NOT 1)LIC Policy No. NOT NOI APPLICABLE APPLIC APPLIC in NSS, Postal Savings, No.696432952 69537969^t DOC: ABI-E ABLE lnsurance Policies and DOC: 24.02.20-l^l 28.01.2009 Premium investment in any Premium Rs Rs. 33,450/-PA x Financial lnstrument 34,978/ -PA x llyears in post office or 9Years = Rs, = Rs 3,67,950/- Insurance Company 3;t4,804- and the amount. 2)LIC Policy No. 2)LrC 696782299 No.696784929 DOC: 07.03.2013 DOC: 26.03.2013 Premium Rs. Premium Rs. 7,36,827 /-PA x 83,858/-PA x 7\ears=Rs 9,57,789/- 6Years = Rs 5,O3,14E- 3)HDFC Life Policy No.15771839 DOC 3)HDFC Life Policy 31.01.2013 No.75777762 Premium Rs DOC:31.01.2013 2,50,000/-PA x Premium Rs. 5Years=12,5O000/-) 2,50,000 / - PA x SYears 4) LIC Policy No. = Rs 12,sO00U- 602918776 BOC:'13.^12.20^17 Primium Rs. 1,37,401/- PA x 2Years = 2,74,802 NIL (u) Pe$onal NIL NIL NOTAPPLICABLE NOI NOT loarls/advance given ABLE ABLE to any person or entity including firm, com an , Trust etc \q N.S. o RC 't 7/2009 KVr;.'f' NF/3913/2018 Valid upt 1-O3-2024 ^ttE8tto SRIKAKULAM TOWN 8 and other receivables from debtors and the amount. ("i) Motor NIL NIL NOTAIJFLICABLE Vehicle: Fortuner NOT i-ol' Vehicles/ Aircrafts/ Sigma a (MT) BSIV ABLE Yachts/Ships (Details Reg. No: AP 30 AG of Make, registration 5679, number etc. year of Reg. Year: 2017 purchase and amount) Amount 3265,900 (Purchase Value) 1230 grms 465 grams (vii) Jewelry, bullion and Jewelry: NIL NOT APPLICABLE Jewelry: NO'T NOT valuable thing(s) (give Rs 37,76,0@/- Rs.14.27 Lakhs ABLE ABLE details weight and value) (viii) Any other assets such NIL NIL NOIAPPLICAsLE NIL NOT NOT as value of claims/interest ABLE ABLE (i*) Total value Rs 68,45,91 Rs. 4,26,04,1,34/- !_OI NOI Gross 3/- NIL NOTAPPLICABLE AELE ABLE B. Details of Immovable 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 apartrnent should be mentioned separately in this Format Note; 3. Details should include the interest in or ownership of offshore assets S. Description Self Spouse HUF Dependent-1 Depend Dependen No ent-2 t-3 1/5ih Share Lands (0 AExicultural Land L.Ramachadnra NOT in NOT NOT Locations(s) puram village APPLICABLE in APPLICABLE Survey number(s) S.No.65/7,8,6,"1"1, 1)Nimmada village:- 10, 9 NIL S.No.s 2. Ramachandra 58 / 6a,6b,1,2,3b3a; pura.m village "109 / 2a,5,8c; S.No.6511,12 e0 /2b,75 /1.3,70 / e,7^L /70, $ O,.^r.'. N.s. \tvrP+Pru""'-t,, Regd.No 17/2009 rrrEltED NR/3913i2018 o 1 -o3-2024 LAM TOWN SRI 9 "17, "13,"14c,74d;7 6 / 3,4; '109/ 4a,4b,3; 11'1/ 7 ,8,9;t't, 12;14,16;17;8'l /'la; 731_ /-t4,59 /'La, 60 /^1a,126 /5a;"138 / 19 b,"1"1,1: 7a9/k; /9;93/25b; -t30 ^t;98 / 3;9 / / L4,1-5, 16; a7/4;a8/3;772/'t,2,4 2)Chittivalasa village:- S.No;220 3)Peddabammidir S.No-s 97 c;8,4,6,17,1-2,^1,3; 7aB /7;95 /7; 96 /-t,2,4; ^105/2,5,6 4)H.C.Puram villagei S.nos. 109 / 1_,6,^t^t,^t0,^t8,21_ 363 /'t,2;J64 / ),4p;364 /3,4,4pt 5) Narasingapalli:- 5.Nos,.277 / 1,4,5,6,2a, -1,4,9,"1 2b,8,1 a;27 4 / 0,L 1,12; 27'1. /"t, 2; 273 / 2; 3s2 /7; 360 / p, 363 /sp. 6) D.L.Puram village:- 5.No.367 /2;4@/? 7) Veduruvada village S.No.s,28l1,2,3 \1 N.S. Kvtsotf^ lL'r'tr') Rcgd. 617/2009 A'TESTEO NFI/3913/2018 Rene,,red Vide Valid u 1 -03-2024 LAM TOW N SRIKA 10 Item no.1.= 1 .95ac Item No: 1 to 6 Area (Total NOT NOT No't measurement in Item No.2=0.98 ac APPLICABLE =13..00ac APPLICABLE APPLICABLI acres) Item No.7=01.53ac Total Ac 0 2.93 Total AC 14.53 Whether inherited NIL NIL Yes NOT NOT NOI property (Yes or APPLICABLE APPLICAALE APPLICABLE No Date purchase NIL NIL of in Item NOT NOT NOT case of self - No.1=09/07l11 AIPUCABLE APPLICABLE APPLICABLE acquired property Item No.2=18/03/08, And 76 03 11 Cost (in of Land ItemNol=Rs0.78L NIL NOI NIL NOT NOT case of purchase) at akh APPLICABLE APPLICABLE the time of ItemNo.2=Rs2.61 purchase Lakh on NIL Any lnvestment NIL NOI NIL NOT NOT the land by way of AIIPLICABIT AIPUCABLE APPLICABLE developmeng construction etc. Rs 43.95 Rs 1.16 Approximate Lakhs NIL Crores NOT NOI Current market NOT APPLICABLE APPLICABLE value APPLICAALE (ii) Non-Agricultural Madhuruvada- NIL NOT NIL NOT NOT Land S.No.330/2 APPUCABLE APPI.ICABLE Location(s) Plot Survey number 5 No.9,12,51,52 Area (Total 1009.58 Sq fts NIL NIL NOT NOT measurement in sq. NOT APPLICABLE APPLICAELE APPLICAELE fr NIL NIL Whether inherited NIL NOT NOT NOt property APPLICABLE APPLICABLE es or No 10 07 Date of purchase in Dt / /'1998 NIL NOT NIL jrOI q N.S. v f"'4" t'ct"',-t'^^., Regd ,617/2009 K 3/2018 Renewed NF'391 val id t -03-2 024 ^Y?Es'ED LAM TOWN 11 case of self - A?PLICAOLE APPLICABLE acquired property Rs 2,66 - NIL Cost of Land(in ,000 / NIL NOT NOI NOI case of purchase) at APPLICABLE the time of purchase Any Investment on NIL NIL NOI NIL NCn NOT the land by way of APPLICABLE development, construction etc. Approximate Rs 35,00,000/- NIL NIL NOT NOT NOI Current market APPUCABLE APPLTCABLE AlPLICABLE value (iii) Commercial NIL NIL NOT NIL NOT NOT Buildings APPLICABLE APPLICABLE APPLICABLE (including apartments) -t.ocation(s) -Survey Number(s) Area (total NIL NIL NOT NIL NOT NOT measurement in sq A?PLICABLE APPLICABLf, APPLICABLE ft.) (total NOT NOT Bulit-up Area NIL NIL NOT NIL APPLICABLE APPI,ICABI,E measurement in sq. A?PLICAELE ft.) Whether inherited NIL NIL NIL NOI NOT NOT property APPLICABL! APPUCABLE (Yes or No) Date purchase of in NIL NIL NOI NIL NOT NOT case of self - APPLICABLE APPLICAOLT acquired property ( Cost of property NIL NIL NOT NIL NOT NOT in case of purchase APPLICABLE APPLICABLE APPLICABL! ) at the time of purchase NIL Any investment on NIL NIL NOT NoI NOT the property by AIPLICABLE APPLICABLE way of development, I N.S. o IV.rJLL,JJ..4.-, Reod. No N /617/2009 \(vr.7- NR 3913/2018 A'TES'ED Valid uPto 1-03-2024 SRIKAKU LAM TOWN 72 construction etc. NIL Approximate NIL NIL NOI NOT NOT Current market APPLICADLE APPLICADLE APPLICABLE value. Residential NIL House, (ir) 1.Plot No.5, NOT Location: NOT NOT Buildings Pasagada APPLICAELE 80 Feet Road, APPLICAELE APPLICABLE (including Layout + Near Arasavalli Jn., apartrnents): Building Near Srikakulam. -Location(s) KR Survey No: -Survey number(s) Stadium,Sklm R. S. No: 509, Twon 5.No.708,710,772 S. No: ,141 & 713 2.Plot-C-135 +Building IndiraNagar Narasannapeta S.No.34 3.Flat No.403,503 S.No.5/1 Sampath Pradhan Residency, KRM Colony Maddili em Area (Total 1= 3,037 Sq fts NIL 26920 .75 Sq. f ts NOT N('I NoI measurement in sq. 2=3,600Sq fs APPLICABLE APPLICABLE APPLICABLE ft.) 3=2,000 Sq fts 1=2860 sq 11131.28 Sq. Built up area (Total fts NOT fts NOT NOT measurement in sq. 2=1500sq fts AIPLICAtsLE APPLICABLE ft.) 3=1,300Sq fts Whether inlrerited NIL NOT NIL N!/r NOT property (Yes or NIL APPLICABLE APPLICASLE No purchase 't.Dr.'t2/ 03/-1999 NIL Date: 07.03.2015 Date of in NOT NOT NOI case of self - 2.Dt.30 10 1984 APPLICABLE APPLICAELE APPLICABLE $ N.S. o,"^."-.' lr-,-, " t"; "; RE No R/617/2009 KurFYf NR/3913/2018 A7?ESTED Valid upt 1-03-2024 SRIKAKU LAM TOWN 13 acquired property 3 .Dt. 06 / 03 / 2007 Cost of 1.Rs 20,000/- NIL \"O'l Rs.59,83,000/- NOI NOI property ( in case of 2.Rs 4,000/ - APPLICABLE APPUCABLE purchase ) at the 3.Rs 23,50,000/- time of purchase -1,67,44,'1,50 Any lnvestment on 1.Rs 30,00,000/- Rs. - NIL NOT / NoI NOT the land by way of 2.Rs 12,00,000/- APPLICABLE APPLICABLE developmen! NIL corl'struction etc. Approximate 1.Rs 1.10 Crore NIL Rs.2,73,21,076/- NOT NOT NOT Current market 2. Rs 30.00lakhs A!PUCABLE APPLICABLE APPLICABLE value 3. Rs 74.00lakhs (") Others (such as NIL NIL AIPUCABLE NIL NOT NOT interest in APPLICABL! APPLICABLE property) ("i) Total of current Rs 2,92,95,A00/- NIL Rs.3,89,21,016/- NOT NOT NOT market value of (i) APPLICABLE to (v) above (8) I given herein 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) S. Description Self Spou HUF Dependent-1 Depen Depen No se(s) dent-2 dent-3 (i) to the NOI NOT Loan or dues NIL NIL NOT APPLICABLE 1)Name of Banly'Financial Bank: SBI, Main LE LE Institution(s) Branch, Sklm Name of Banl< or A/c No: Financial lnstitution, 36726037802 Amount outstanding, Amounl 90 Nahrre of loan Lakhs Nature of Loan: Home Loan 0oint with Mother) rl N.S. o,",".... Regd. No R/617/2009 p.rr@ Renar€d Vide s.NRBS13/2018 \ Loan or Dues to any NIL \O'IAII'LICABLE NIL NOT NO"r other individualy'entity NIL other than mentioned LE L! above Name(s), Amount outstanding, Nature of loan Any other liability NIL NIL NIL APPI-iCABLE NOT NOT ^_OT LE LE Grand total of NIL NIL NOT APPLICABLE NIL NOI NOT liabilities LE LE (ii) Government Dues: (A)Has the Deponent been in occupation of accomrnodation provided by NO Dues to departments the Government at any time during the last ten years before the date of dealing with notification of the current election? Government accommodation (B) lf answer to (A) above is YES, the following declaration may be furnished namelyi (i) The address of the Government accommodation; NOT APPLICABLE (ii) There is no dues payable in respect of above Government accommodatiory towards- (a) Rent; (b) Electricitycharges; (c) Water charges; and d T ch as on date \4 N.S. R69d 161712009 \34.p'tr""-" Rencs/ed Vide NR/3913/2018 Valid uDt 1-03-20?4 l77E6IEO SRIKAKU LAM TOWN 15 [the date should be the last date of the third month prior to the month in which the election is notified or any date thereafter]. Note-'No Dues Certificate' from the agencies concerned in respect of rent electricity charges, water charges and telephone charges for the above Government accommodarion should be submitted. (iii) Dues to department NIL NIL dealing with Government transport (including aircrafts and helicopters) S. Description Self Spou HUF Dependent-1 Depen Depen No se(s) dent-2 dent-3 (i") Income Tax dues NII NIL NOTAPPLICABLE NIL NCTI NOT APPLICAB LE LE NIL NOT (") GST dues NIL NOT AI]I'LICABLI NIL NoI LE NOT ("i) Municipal/Property tax NIL NIL NOTA?PLICABLE NIL NOI dues APPLICAD LE LE dues NIL (vii) Anv other NIL NIL N'/I'A?PLICASLE NOT NOI LE Lf NOT (viii) Grand total of all NIL NIL NIL NOT Government dues LE LE other NIL (ir) Whether any NIL NIL NOT AIIJLICASLE NOT NOT Iiabilities are in dispute, APPLICAB LE I,E if so, mention the amount involved and the authority before which it is pending. N.S. C}.-!tl-J4,^J Reg No Ri617/2009 Kv6')l'l Ntu3913/2018 Val -2024 ^VYE8I*D SRI TOWN 1b (9) Details of profession or occupation: (a) Self : House Wife (b) Spouse NOT APPLICABLE (9A) Details of source(s) of income (a) Self: Political Pension (b) Spouse: NOT APPLICABLE (c) Source of income, if any, of dependents, - NIL - (9B) Contracts with appropriate Government and any public company or companies (a) details of contracts entered by the candidate - NIL - (b) details of contracts entered into by spouse - NIL - (c) details of contracts entered into by dependents - NIL - (d) details of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest - NO - (e) details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners - NO - (f) details of contracts entered into by pdvate companies in which candidate or spouse or dependents have share - NO - (10) My educational qualification is as under: (1) Intermediate (Women's College.Srikakulam) Year 198G82 (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.) \1 r-) N.S. o,"^ "",. (vegpY.r-.r-u R.gd.flo R/6 't7t2009 A1ItEufED Renct|€d Vlde N Ry391 3/20.t 8 Valid u o 1 -03-2024 SRI LAM TOWN t7 PART.B (11). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A; 1 Name of the candidate Shri. Vijayakumari Kinjarapu 2 Full postal address Nimrnada village and Post, Priyagraharam via, Kotabommali Mandal, Srikakulam Distdct. PtN -532430 3 Number and name of the constituency No.02,HOP Srikalulam Parliamentary and State Constituency, Andhra Pradesh 4. Name of the political party which set up the candidate (otherwise write TELUGU DESAM PARTY 'Independent') 5. (l) Total number of pending criminal NIL cases 6 Total Number of cases in which NOT APPLICABLE convicted 7 PAN of Year for which last income tax Total lncome Shown Return filed -t7 (a)Cancliclate AT'IPK6179.A 2017-2018 15 , ,555 / - (b)Spouse NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (c)HUF NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (d)Dependent ALAPR9645-P 201,7-2018 15,15,742/- 8. Details of Assets and Liabilities (including offshore assets) in rupees Description Setf Spouse HUF Dependent -1 Depe De nden Pen den t-3 Rs 68,45,913/- Rs 4,26,04;134 - NIL Moveable Asset NIL NOT / NIL (lotal Value) APPLICABLE B Immovable Asset NOI I Purchase Price Rs 29 ,79 ,000 / - NIL Rs.59,83,000 NIL \IL of self-acquired immovable property Rs 7,14,65,218 - II Development,/c Rs 42,00,000/- NIL NOt / Ntt. Nlt. r\,'t N.s. Regd o /617/2009 KV, NFv3913/2016 A'TE 1 -03-2024 SRI LAM TOWN 18 onstruction cost APIILI(:ABLE of immovable property after purchase(iI applicable) III Approximate a)Rs Nil (a)Rs. NIL NOT Nn. Current market 2,92,95,m,0/- APPLICABLE 2,73,27,0'16/- price b)NIL (b)Rs. (a)self-acquired 7,t6,O0,OOO/- assets(Total Value) (b)Inherited assets(fotal Value) 9 Liabilities (i) Government NIL NIL NII- NIL NOT NN dues (Total ) APPLICABLE (ii) Loans from NIL NIL Rs. 1.20 Crores NOT NIL :VIL Banl, Financial A?PLICABLE lnstitutions and other (Total) 10 Liabilities that are under te. (i) (ii) Government NIL NIL NIL NIL NOT NIL dues(Total) APPLICAALE (iii) (i, Loans from NIL NIL NOT NIL NIL Bark, Financial APPLICASLE Institutions and other(Total) 11 Highest Educational qualification: 1. Intermediate (Women's College-Srikakulam) Year 198G82. (Cive 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. ) \1 ,1b I N.S. o kv,r.,+^o^tc'"^'-''-" Regd-No 17t2009 Remnad Vrde NRv3913/2018 Valid upt 1-O3-2024 ^nEs+*, SRIKAKU LAM TOWN 19 VERIFICATION I, the deponent, above named, do herby verify declare tlat the contents of this affidavit are true and correct to the best of my knowtedge and belief and no part of it is false and nothing material has been concealed there from. I further declare thati (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, or my dependents do not have any asset or liability, other than those mentioned in items 7 and 8 of Part A and items 8, 9 and 10 of Part B above. Verified at Srikakulam this the 25th day of March, 2019 Kv'J? luY''Lt'J DEPONENT TTTBtTIO Note: 1. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations. Note: 2. Affidavit should sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public. Note: 3. All columns should be filled up and no column to be left blank. If there is no inlormation to furnish in respect of any item, either "Nil" or "Not applicable", as t}te 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. \q o,",.-.'. Solemnlv aff irmed and SigneN'S' Cz beforc mL this the ..?'(J[1daY ol Regd.No R/617/2009 yl*rt4/,20 19.,..... at Srikakulam Ren6a/ed Vrd6 NFr3913/2018 Valid u 1 -03-2024 LAM TOWN I 20 Ortglnal/ duplicate (Original to be kept with nomination paper and Duplicate to be handed over to candidate) Check List of documents ln connectlon with filinq of nomination Name of constituency, Snl KDLtlLfl.l Name of the candidate: V13llyALUHA[J kJhliBAAPU Date and time of filing nomination paper : f-S.3. )Ol1 a\t lr'.o zAo-1. 31. No. of nomination paper: O tl/+tOP/?611/pD SNo 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 \r- (a) Whether all columns are fi1led up H- (b)If not, which are blank column(s) (please specify). (c)Whether the alfidavit is sworn before al oath Commissioner or Magistrate of First Class or before a H% notary Public. 2 Certified extract of electoral ro11 (when candidate is an elector of a different constituency) 3 Forms A and B (applicable in the case of candidates set up by political parties) 4 Copy of caste certificate from competent authority (if the candidate claims to belong to SC/ST) 5 Security deposit (whether made) w 6 Oath/ affirmation (whether taken) ) (k) Above mentioned columns in the rlfhdavit in Porm 26 t:ave been left blank. You must submit a fresh affrdavit with columns duiy filled up before the commencement of scrutiny of nominations, failing which the nomination paper will be liable to be rejected. (t) should be filed latest by Received uut'ttt^: 1( vr.-'E It, zJ\rlrnlS (srgnature oI candidate) Signature of RO/ARO Date & time: Place: N.B: 1. The Aflidavit in Form 26, Forms A & B have to be filed latest by 3'OO P.M. on the last date of filing nominations. 2. If columns have been left blank ln the alfidavit in Form 26, this should be specified against item 1, and candldate should be asked to submit an aflidavit complete in all respect, latest by the time fixed for commencement of scrutiny of nominations. Failure to submit revised affidavit complete in all respects, even after reminder by RO will be a ground for rejection ofthe nomination paper. 3. Oath has to be taken after flling nomination paper and before the date fixed for scrutiny. 4. Certified extract of electoral roll can bc llled up to the time of scrutiny. 1("r.ril wt@