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PA<ARO+10 ... R.\S:!R,Rhlr (()Nlrrluunc\ Ft)ti \ I t;\ 1.!it'itrlc:l) P ,\ I ) R.o ! I NSR Ic li\.\ i( \ P.\ t'LIi. i iti ll,,:t'. ,,1 ilt< P,r,iii- sr. m..$J..$.0.,I J..]rJ9.L.ta.. O"t ..'.t r:-..n3"t'llP-l'1 V1^N nme.....!.k.".0-fi' ...1............---.'-.- venue...A/....qh.i#k* / / '\;i.i i,.. 1.()l l l,.\ir.ilr)ii:,\iiillBL.l_()\\ \\,lll( l.llrvF.lt !s Ni)'l .\l,i,t_t(..\ll1 i: t'.\ Ii't l , i .' 1... Lrsctl br crrniii.lulc 5it Ltlt b), rccoqnised poljticill p:trl\ l I 'r.r:rii,:,.iJ its .t ;lin(lill:ite lix' slcction to thc HoLrst- t-,I tltc pcoplr: iior:t rlr". fu6.J, pA(AS*0UAAfl I'.rrli:irrru:tur-\ rr)ns!irLrcrlc\.1 '...rr,li,r.r:,.,.-,,'.*ArtXl-4-P(V.B/4*Rkf IrLrlrc...r*.'th.*.. Ired'.,,.,,,'..k.,..RA6.H.U {A f-P KRIJ {t ll4 rtfi R',,, L,t, : r ;, - - 5o/ dcr.x p BHD.Ijg4/, q&q1 v m,X na/ip^ U0 J ry = 4 r / lA 47 tli. r,.r rr, : ..:rr.r\.il ;:r S.No 711 u, I,rrrr N,,. .r-fq .... ,)i- rj)(l_,,1..,-1,.1;,1,,,..,,1.1 i(.\sscr,i,iv ii,: U NDL.. .... eorrrrrrucrrer (.,ir:i)r.rlid rr(i,in,rJO-9NAEd"+tflli.${S{ (',,t.rr1ri.re,.. ' I \tr n.rnr,- ,.QAnrg* PR&S,/UD.DE@IA"ud it is enrcred ar S\,rJ82-in parr ).,, 6l ',t.lr.: -leir,,ial r,,ll !i,r PA<ARO+10 ... r.\s:!r,rhlr (()nlrrluunc\ Parliamentary constituencl r,,,,.3.t.3.2 ol1 S rrrt"rt e of Prop.roscr 1,.\ll't II , ir, 1r.' rLscrl I.r e.rnciirlrrte \()-l :..r irp [r\ ri!()Ji]isc(l polirical plrt,, ) Ir ulc l-:r' nr''ntinittc as .rndr dirtc tbr- election to the FIouse the People fiorl illc. Parliar.ncntarr, (,oirstit,-rerrcv (:lit(lril.ll!'\ n't c lrat he r's nrolhcr'sr'lt usband's liiti.t.... I lis poslal udrlrcss I llis rtartte is cnteted lt S.\o in Pan o o1 Ihc le, toraI r.rll iil' ......Y(Ass constltuencv col]l s ,.'r.l n rllrrl r Parlia entilrv coltsttluencv. Wc rl.'clart that we arc electors of th bove Parliamentarv Constttllenc i'itld ollr ilirllle: tl'! Constituency as indi lttctl lrciLrl rurLi cntur!'d rn tirc electoral roll 1'or that rlrtrmentary ",. llirl)aIl(i \,Lir \i!il.titlrcs belrr\\ ill il)kin f subscrib ins to th is notrrination: Particullr () I thc proposers and thcir sigrt:tttr Si.nu Nanre of lcctor l{oll \o. ot' Fuil Nunrc :lrni.lirLi! L)., . !r0lrpo!lent I) ro poscr Assertbly Part No. of S.No. in Constituenc F: lectola l lhat part Roll l 4 l (t L l 4 5 () ll l0 N.B-th slrould be ten electors of the constituency as p PAII'T ]I I I. rlte crndrdatc nrentionr'(l in Palt l,'Part Il (Strikc out u'hich is not applicrblc) ass.nt 1,.) Ihrr nonrirlirlrr)n irntl hcrcbl declnrc (rri lh:rr I rrrl l r.:itizor of lndia and Irarc not acclttired thc citizcrrship ol lri-r' li,t'cisrt State,'country. ( lr) 11',", , have cornplcred......... a years of age: ISI RIKE OU1.c(i) oT c(ii) BELOW WHICHEVER IS NOT APPLICAtsLEI (\'r r/ r rlrur I urn scr rrp at rhi) elccrion by ntpULf,ANTSf1*qiXl l.WO COfV6"PFIJ plrtv. u,hich is a recognised tktmal-Prtty, Srtrte Parry in this Srare and that rhe svmbol rcservcd tbr the ahove party be ailotted to me. OR 2 (.)U i)tlllt Irr'n:r'l at this election by the ....... prlrt\,. \l ) ls a registered-unrecognised litical 'partv'thrt I lm co estinI this elec I io ir: rrn intlcpcndent candidatc. (S ike out u hich is not applic lc ) antl that the s bols I har,'e chosen, in order of laference. are:- (li ) tiii) {(i) th.)t my nlnre lntl nrv t'ather's/mothcr's/husband's name have beon correctly spelt out .lro".- i,,...@ $LLJ l:l ( nanre of thc ianguage): (c) that to thc bcst of'r.ny knorvlcdge and beliel, I am qualified an(l not also disqualilied lbr being choscn lo flll the seat in the House ofthe People. **Castc'tribc '' l lr-rr thu- tle rc lllirt I irrl a rnenrber uf thc *+caste r.t hrch is hedu['d tribe ol'the S 01' .....in rclalion Irl t.rrca)in thar I also declare thlt I have not been. d slrall not be nominated as a candidate at the present gcn.:rirl election/thc byc-elections being held srnr u ltaneously, to the House of the People lront nlore Lhan tuo Parlianrcrltarl Constitucncics. IU i),rr..r.f :3.:2otl Si gnature i1 didare rSc'ore rrut the words "assembly constituency comprised within" in the case of Jammu and Kashnrir. Andauran and Nicobar Islands, Chandigarh. Dadra and Nagar Haveli, Daman and Diu arrd Lakshadrveep. *Score out this paragraph, if not applicable. **Sctrre out the words not applicable. N.il.-A "recognised political party" neans a political party recognised by the Election Cornmission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State concemed. PART III,\ (1o be tilled h1 th.. crrnilidlie) r i r \\ itetlre: Lhc c.rndidrrtc t i) IxLs l,ccn c()r.r\ rclarl (rr r rrt rnr ,ltienea(s) trniiel srrb-seetion ( 1.1. or (hI lirr crrntr'.rrerli()n of iur\ llNr spccilictl in sut)-5aclio:r (l). o[ :ce ti,)n li ol'lhL' l{ci)rescn ta lion ot'thc l)coplc ,\ct. 195 ] (+ j trl 195 I ): or \s-\i, { /r ) hils bc.n conr ictcd lirr artr otht'r ollencc( s ) lirr ,,r ltich lre hus brcn .!rlrncc(l tcr irtrpr isonrtrenl 1t)r l\\(r \'ailr5 ul rD()rc. J l1'thc rnsrler.is "\ es". tlrc c:rndidate shall ftrrni the tirllowing intbrnration: '(r) t xsc lllst iniirr;lrrliott rcpoll No. \o r;r; l)rrlt. - )1..1i1,l ()r. I)istliel(.t. St (s) for w'hrch he ( ri1 ) sccli(r!)( s i 0l' lr rc e();.icerned \Ia:n(1 orici elcscription ol thc,'rt-lcll s) lrl. l'<. tt !,,11\ . l-(l . (;\ ll)Jlc(\ I ul \'ulr, r\:liJIil s l ( i ) Courl(s ) ri lt ich tortv icte e ca:rllrt1ate.... s ) quanturr of i |r )[)rr:r i:hntelt t( . ) i;,1 Iinilcatr' period ol implisonnretrt( arrd/or tine(s)1.... ( t ll) Datc(s ) ,.ri'rcl.irsc olll pnson rctloTr(! ). I \ i/l i\\ lrr \\ ir a ll't\ 1rpcal(s)'rcvision(s1 tiled against abov. a{lr,\ \',"'s \rr (i.r) I)ate antl parti lars ofappeal{s), application(s) for revisio letl (.r) \anlc ol th courtls) bcfcrc u'lriclr thc appcal(s)iapP licati n{s) fbr rc\,ision filcd.. (r'i ) Whcth the slid appeal(s)r'app licatron( s) fbr revisi haslhave heer.r ciisposed of or is :t cnding.. (vl) If l c sairl appcal{s )i app Iieai ion(s 1 lbr revt ston ave been disposed o1-'- \tt tc(s)ot'(lisposal.. ) Nature ul' order(s) passed............ (l) wherher rhe candidare rs holding an),ollice of prolit under the covernment of lndia or State ctn ernrncnl.)...NI ( itrs No) ffi (l) whether.thc candidlrc has heen declared insolvent by any Court?..aJO, (ifts-No) t.1t \\ hctltcr tltc clrr;tliclltc is ttttclct' aJlcgiarlcc or adhctcnce t() il:lv li'1.'isn eo Lrnt rr 1..N0-(J:cs-\,, ) [l+=:=lrcffis...... ...... ()r(lcr ()l' lt)\\ hctlrcr llre eirr.r(lr(llla 1-,rrs beer disrlLirrlilrcLl tttttlcr:,i;litttl 3A tlt tlre sltti A.:t b\ iLn thc President.'... NrO. .. Oig\ot W i(rI\\ ltcther thc..rrrilrtl.lc ,\.ts (lisntlss!d 11-t; (jor'111pliotr or lor tlisloraltf ir'lrile llolditls ot'fl( t Ltrtler tire ai()\t1.llll.l(!ll i,t'ltttlia ol llle (;()\.1-lllllcl.lt ol'anv Stalc'l "Nh t\3.\t'1 M (jtir in r ,'t \\ ittfhcl thr: ciinrlrrl;i1r ltil: itn\ >uDr,irling .olririlrti5) riith thc crnttt-'rr1 citlrcl ttltiirttlLlill eirllilelt\ !)i b1 llLt:t trt ptlrlllil:lLli) in rihiclr tllc eitnLlitlate Ilas it shille tpr-stipplr 4 ot ar'rv goo(ls to that Goven'rrnent or fbr execution ol rvorks undertaken by that ( irrr cr nnr.:nr'.'....4)0... tlt, xu) u \','-. ',r ith .' hielr Gevernrnent rnd cletails of -tib-;stin+ eon'r'aet(s), rr t \\ irr'1it:; 'l;e t:rrt,lirliric- is a tnatag;;rg a!Jl'r1. ()r ntilt:lgar L)l Sccrctiir\ ol'any corupAllv (rr ( ()m,,lrii;, r rr,llrcl thrrn a crrcrper-riirr. societr') in lir.' cirpilll t,l- \\,hich thc Ccntral (rirr r:r,ir:r.r1 i r Stilla (loVc'rnltti:Il ltl:. not iess tlter) l\\ Jnlv-il\'.- l.rercent sltirre 'l . NO. { )5, ilLr 1 i'./) \\ li(ilr.i ii. ,..irttlr,.l.tlc ltas bteti rir-.qtriiii.'d b.,,th,: Cr.,rrtrtrrssiolr rrrttit.r scctiorl l0/\ ol tfic .,,,r.1 ,\et. NO. (\blNor -il r.., ri, ,lr:. ,'t ,l -,rrr;rlitl, 'r" n \ u\. I'I...,.MR&J4 PUruFI \ rgrit Candidarc i)rrr-': &^!l- 3 U\1 P.\R I I\ tTt, i,q Illl.,t-l.r tlre llit,,rrlr:rc (, .r ( 1 , \(,. p.,1,.' n^O \.r.,r \,r,.,rr1il.,ri,,1r .t.lf th[[ zott I I-lri-< I\)rrrinittion \\.rs rle l5irctl lr, l c ltt r'n\ tltfice at.l?.
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