J
F0lt\{ 2A (See RLl,E 4) NOMINATION PAPER f(. rJ o Election to the House of the PeoPlc
?- '. q.r 0 FVn n .L!-13 Itl
RO
S IRIKE OFF PART I OR PART II BELO W WIIICHEVER IS NOT APPI I('AI]I I PART I (To be used by candidate set up by recognized political party)
I nominate as a candidate for election to the House of the People ftom the Not Applicahlc ['arl iamentary ConstituencY.
Candidate's name ...... NA...... , Father's name ...... Not Applicable...... His postal address ...... Not Applicable
His ,rame is entered at S.No ...NA... in Part No ...NA... of the electoral roll fbr ...NA ...... NA..... (Assembly constituency comprised within) ...NA... Parliamentary Constitucrrcr'. NIvNameis ...... NA.....' anditisenteredatS.No....NA"' inPartNo""NA"' ofthe' clectoral roll for ...NA... *(Assembly Constituency comprised within) ...NA... Parliantt'tl i.r i' Constitr rency.
Y R. KJ,. (* Proposer Date: 25-03-2019 Signature of
-l- t ARl-it
(To be used by candidate NOT set up by recognized political party)
we hereby nominate as candidate for election to the House of the people from the I l-Machilipatnam Parliamentary Constituency
candidate's name Yarlagadda Rama Mohana Rao Father's Name (Late)yarlagadda Neelachalam. His postal address 191289-8., Chilakalapudi, Machilipatnam-521002 Krishna District, Andhra Pradesh.
I {rs name is entered at S.No 747 inpartNo 42 of the electoral Roll for ?5 -Machilipatnam (Assembly constituerrcy corrprised within) I l-Machilipatnam l'ari i arnentary constituency.
\\ e declare that we are electors of the above Parliamentary Constituency and our names arc .'ntered in the electoral roll for that Parliamentary Constituency as indicated below and w.e trppcnd r)ur signatures below in token of subscribing to this nomination. PARTICULARS OF THE PROPOSER AND THEIR SIGNATURE ; S.No Narne of Elector Roll Full Name I Signature Date , Component No.of Proposcr r Assembly
I :Constituen I Part No.of S.N,r in Electoral rh i-I I Roll lt:r t
I 2 J 4 5 6 7 75 N4achilipalnam D, 373 Y Krisluta l\lohan l.>c+ropn 7-i Machilipatnam .12 i7?. Y Charrdra Kumar Y-el"4L-lr^-- 75 Machilipatnam 12 520 R Raina Ra (6(w -2- Y PART-III I. thJCandidate mentioned in PART l/Part II (Strike out which is not applicable assent) to this nomination and hereby declare : - (a) That I am a citizen of India and have not acquired the citizenship of any foreign State / Country. (b) That I have completed 56 years ofage: ISTRIKE OUT c (i) OR c (ii) BELOW WHICH EVER IS NOT APPLICABLEI (c) (i) That I am set up at this election by the ...NA.., which is a recognized National Party ,/State Party in this state and that the symbol reserved for the above party be allotted to rne. OR (ii) That I am set up at this election by the Bahujan Maha Party, which is a registered unrecognized political party that I am contesting this election as an independent candidate (Strike our which is not applicable) and that the symbols I have chosen, in order preferencc are: RubbersfronP ghiP i1 Whistle ii) f+histle- Iii) :Alhisth d) That my name and my father's/mother's/husband's name have been correctly spelt out above in English; e) That to be best of my knowledge and belief, I am qualified and not also disqualified tbr being chosen to fill the seat in the House of the People. * *Caste/tribe + I turther declare that I am a member of the NA Which is a scheduled ** caste / tribe of the state of NA in Relation to NA ...... (area) in that state I also declare that I have not been, and shall not be nominated as a candidate at the present general election / by - election being held simultaneously, to the House of the People fi'om more than two Parliamentary Constituencies. t 0.*\^Q* (Yarlagadda Rama Mohana Rao) l)ate 25-03-2019 Signature of Clandidate "Score out lhe vords" assembly constituency comprised within" in the case oJ'Jammu arul Kashmir Andaman and Nicobar Islands, Chandigarh , Dadra and Nagar Haveli , Daman and Diu and LakshadeeP. -j- * Score out this paragraph, if not applicable. ** Score out the words not applicable N.B.A"recognized political party" means a political party recognized by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the state concemed PART_IIIA (To be filled by the candidate) I ) Whether the candidate i) Has been convicted NO a) Ofany offence (s) under sub-section ( l) or NA b) For contravention ofany law spe,:ified in sub -.sections (2) ofsection 8 of the Representation of the People Act, l9-sl (43 of 1951) ; NA or ii) Has been convicted for any other off'ence (s) for which he has been sentenced to imprisonment fbr two ),ears or more. ------NO If the answer is "Yes", the candidate shall fumish the following information. ii) Case / first information report No. / Nos NA ii) Potice Station NA District (s) NA State (s) NA iii) Section of the concemed Act(s) and brief description of the offence '(s) which he has been convicted NA iv)Date (s) of conviction (s) ...... NA r ) Clourl(s) which conr,icited the candidate...... NA ...... vi) Punishment(s) imposed {Indicate period of imprisonment and / or quantum of fine(s) ...... NA ...... vii) Date(s) ofrelease from prison NA 'iii) Was were any appeal (s) revision (s) field against above conviction(s) ... NA ,l -4- fto-no ixl iiate and particulars ofappeal(s) application(s) for revision field ...... NA x) Name of the court(s) before which the appeal (s) application(s) for revision filed:.... NA xi) Whether the said appeal(s) application(s) for revision has have been disposed ofor is are pending NA xii) ll'the appeal(s) application(s) for revision has/have disposed of ... NA ...... a) Date(s) of disposal NA b) Nature of order's passed ...... NA 2) Whether the candidate is holding any office of profit under the Govemment of India or State Govemment ? No If Yes. details of the office held NA 3) Whether the candidate has been declared insolvent by any Court? No IfYes. has he been discharged from insolvency...... NA 4) Whether the candidate is under allegiance or adherence to any foreign country? NA.. 5) Whether the candidate has been disqualified under section 8A ofthe said Act by an order Of the President No lf Yes, the period for which disqualified NA 6) Whether the candidate was dismissed for comrption or for disloyalty while holding offlce under the Govemment of India or the Govemment of any State? No If Yes, the date of such dismissal NA (7) Whether the candidate has any subsisting contract (s) with the Government either in supply ofany good to that Government or for execution of works undertaken by that Govemment ? No If Yes. with which Government and details of subsisting contract (s) NA Y tu,yprvo l*^t- -5- (8) Whether the candidate is a managing agent, or marlager or Secretary of any companyi. Corporation (other than a cooperative society) in the capital of which the Central Govemment or State Government has not less than twenty -five percent share? ..... \g If yes, rvith which Govemment and the details thereof NA 9) Whether the candidate has been disqualified by the Commission under section l0A of the said Act No Ifyes, the date ofdisqualification NA 1 r,\A ( Yarlaga da Rama Mohana Rao) Place : Machilipatnam Signature of Candidate Date :25-03-2019 -6- 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/propose (name ofproposer Date Retuming Officer PART-V Decision of Returning Officer Accepting or Rejecting the Nomination papcr I have examined this nomination paper in accordance with section 36 of the Representation of the People Act, 195 I (43 of I 95 I ) of and decide as follows. Date Returning Of ficer Perforation PART - YI Receipt for Nomination Paper and Notice of Scrutiny (To be handled over to the process presenting the Nomination Paper ) Serial No. of nomination paper...... The nomination paper of Shri Yarlagadda Rama Mohana Rao, a candidate for electiorr liorr the I I - Machilipatnam 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 -7- I ,{- l= lffiq]sso Rs,. 10 \ oNE'"- a EI ht. f. :l 00 IiI I R E v EIoil Ef,-1 1 oo -I OU oo' oo -1 o<) 1 oo 1 oo oo I N I o 1 o c)r1 o o 1 oo -o(f o -t q t 1 1 o o -1 o rOO a 1 o c) 1 o roo ( -t o o 1 o :ootoo o o eeord d 5' e{r*r xfu 6Npt{RA pRADE'H 1 gffi6r tP gnr2 t ,3.e-rl? CH.VV.RAMANA RA r. tffiL LICENSEO STAMP VENNOR Sold tc o.L.No.06-1 2-O04l!Ol tl tilrDf,66 E"drtsr..S's 5Do5 .S{bm}q-:o RL No.06- 12-025/2017 t"'u"{;fuL[ IQBM 26 Valid up to 31- 12-2019 (See Rule 4A) .No.2(l-260, BrahmaPUrrm, iAgflfi.li:lATNt r - 521 002. I Cell:929o73i557 I .ltHttxvtr 'rllll ro BE FILED BY THE CANDIDATE ALONG wtrH NOMINAiloN pApER BEI:oRI RFTURNING oFFICER FoR ELECTION To LoK SABHA I.'ROM tr - MACHTLtpA-r'N,\Ir n.,r$t.t,tnteNla,Ry coNSt'truENCy. E( PART-A I YARLAGADDA RAMA M0HANA RAo Son of (LATE) YARLAGADDA NEELACHALANT. Agetl 56 years. resident ol D.No:- 191289-8, Chilakalapudi, Machilipatnam-S21002, Krishna District, ,\nf hra Pradesh, a candidate at the above eleclion, do hereby solemnly:affirm and state on oat6 as lnLicr : 1 I am a candidate set trp by Bahujan Maha Party which is registercd and un-recognisecl part1. 1 l\{v name is enrolled 75 ) in - Machilipatnam Assembly Constituency, Andhra piatlesh , at Scr.ill No 7{7 in l)art No 42. . l\4y conlact ) telephone number is (Moobile number) 9966221s22 and my e-mail id is .. NIL antl nrl, social Media account (s) (ifany ) is / are : - i) No ii) No iii) No 1.fu**h- P-' 1 I + ,,/ir:fi *.,/ tli rtrl\ ir ,t ;g$ ?a: .-..,J.r'ar: ,(4) Details of Permanent Account - Number (PAN) and status of filing of lncome Tax return The Financial Total income shorrn in year for which Income Tax Return (in the last Rupees) for the last fivc S.N o Names PAN Tax Income financial years comPleted has return (as on 3lst March) I been filed (i) NII, ( ii) Nil. Yarlagadda Rama Mohana (ii Nil. Rao AHZPY 6753A NII,, i) (Self) (iv) Nll. ( ) NII, (i) NII, (ii ) NII, Yarlagadda I-akshmi NIL NIL (iii) NII, l (Spouse) (iv) NII- ( ) NII, (i) ( ii) ( Karta / HUF lf Candidate is NA NA (iii) NA Coparcener) @ ( ) (i) (li ) 4 [)cpendcnt I NA NA ( iii) NA (iv) ( ) (i) l (ii) I)ependr:nt 2 NA NA (iii) NN (iv) ( ) l (i) ( ii) 6 Dependent 2 NA NA (iii) NA (iv) ( ) Note : [t is mandatory for PAN holder to mention PAN and in case of no PAN it should be clearly stated "No PAN allotted". (5) lending criminal cases y'(it I declare that there is no pending criminal case against me. oT4 f ick this alternative if there is no criminal case pending against the Candidate and N t: write NOT APPLICABLE against alternative (ii) belon') 4, t , 2 1 p--* L^ OR (ii) The following criminal cases are pending against me : NOT APPLICABLE ( Ifthere are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give details ofall pending Cases in the Table below) Table FIR No. with name and address of Police (a) NA NA NA Station concerned (b) Case No. with Name of the Court NA NA NA Section(s) of concerned Acts/Codes involved (give no. ofthe Section, e.g. Section ...... of NA NA NA I PC, ctc.). d Bricf description of offence NA NA NA I Whether charges have been framed (mention (c) NA NA NA YES or NO) I I I If answcr against (e) above is YES, then give (l) NA NA NA the date on which charges were framed I ----f---- Whcther any Appeal / Application for revision has been filed against the proceedings NA NA (Mention YES or NO) l'^l I (6) Cases of conviction VGI 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) OR (ii) I have been convicted for offences mentioned below : NOT APPLICABLE (If the candidate has been convicted, then tick this alternative and score off alternative (i) above m and givc details in the Table below. $ o7 3 Y a^tYw,,Nl0 t^' I 'fable (a) Case No, NA NA NA (b) Name of thc Court NA NA NA Sections of Acts/Codes involved (give no. of the re) NA NA NA Section, e.g. Section...... of IPC' etc.). I (d) Ilrief description of offence for which convicted NA NA NA (e) l)ates of orders of conviction NA NA NA (t) Punishment imPosed NA NA NA Whether any Appeal has been filed against conviction (g) NA NA NA order (Mention YES or No) answer to (g) above is YES, give details and present (h) If NA NA NA status of appeal (64) I have given full and up-to-date information to my political party about all pending Criminal cases against me and about all cases of conviction as given in paragraphs (5) and (6)' IN Icandidates to whom this ltem is not applicabte should clearly write NOT APPLICABLE vtEw oF ENTRIES IN 5(I) AND 6(I), ABOVEI Note : 1. I)etails should be entered clearly and legibly in BOLD letters 2. Details to be given separately for each case under different columns against liach item 3. l)ctails should be given in reverse chronological order, i.e., the latest case to be Mcntioned first and backwards in the order ofdates for the other cases ,1. Additional sheet may be added if required. 5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court's Judement in W.P O No.536 of 2011. (7) That I give herein below the details of the assets (movable and immovable etc) Myself, my spouse and all dependents. OTA \r il s z 2 Y Q*-*h^Q- o ,7 4 r,F t A. Details of movable assets : v Note : 'l Assets in joint name indicating the extent ofjornt ownership will also have to be Given. Note : 2 In case of deposit/investment, the details including Serial Number, Amount date of deposit. the scheme, Name of the Bank / Institution and Branch are to be given Ncrte : 3 Value of Bonds / Share Debentures as Der current market value is Stock exchange in respect of listed companies and as per books in case ofnon-listed companies should be given Note : 4 'f)ependent means parents, son(s), daughter(s) olthe 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' : Yarlagadda Yarlagadda I I Rama Dependent Dependent Dependent S,No l)cscription Lakshmi HIIF Mohana Rao 1 2 3 (Spouse) (Self) (i) Cash in hand 250000 70000 NA NA NA NA Details of deposit in Bank accounts (FDRs. Term Deposits and all other types of deposits including saving accounts), Deposits with ( ii) 3,70,000 I I 0 000 NA NA NA N.\ Financial I Institutions, Non- Banking Financial Companies and Cooperative societies and the anrount in each such deposit Details of investment in Bonds. Debentures/Shares NA NA ( iii) and units in No NO NA NA companies / !\&{ual Funds and tl ffio'n' , 5 6] t1 (; L*^*rIr^?-" Details of I inve stment in I NSS. Postal I aving. Insurance Policies and investment in any No NA NA NA NA ( ir') NO l--inancial I instruments in Post ofllce or Insurance Company and the atnount. Personal loans / advance given to any person or I entity including NA NA NA (v) limr. company. NIL Nll. NA Trust etc. and I other rcceivables liom debtors and i the amount. Motor Vehicles / I Aircrafis / Yachts I Honda shine lShips (Details of Motor Cycle I I NA NA NA (vi) Make. registration I Make 2014 NIL NA number. etc. Year lnprocNtsas n..go,ooo ol purchase and I I ilrrount I 150 Gms Gold Worth 300 Gms Gold .leweller-v. bullion Rs 4.50.000 Worth and valuable Approx Rs 9,00.000 NA NA (vii) thing(s) give & Approx NA NA details ol weight 900 Gms of & 3 100 Gms of and value) Silver Silver worth Rs worth Rs 90.000 30,000 Any other assets NA NA NA NA li iii) such as value of NA NA claimsiinterest NA (ir) (iross Total value I I,86,000 1t,70,000 NA NA NA li. l)ttails of lmmovablc Assets ownership will also have to bc Note : I properties in joint ownership indicating the extent oljoint indicated. in this format Note : 2 Each land or buitding or apartment should be mentioned separately assets' Note : 3 Details should include the interest in or ownership of offshore o '1.k**\^% 6 I Yarlagadda I Yarlagadda Rama Dependent Dependent Depcndcnt S.No Description Lakshmi HUF Mohana Rao I 2 (Spouse) (Self) ,\gricultu ral Land NII- NIL l,A NIL NA NA I-ocation(s) Survel' number(s) Area (total NIT- NA Nil. NA NA measurement in I NIL acres) Whether inherited property (Yes or NIL NIL NA NIL NA NA I No) Date of purchase I in case of self - NIL NIL NA NIL NA NA (j) acquired property C'ost of Land (in case of purchase) I NIT, NIL NA NI]- NA NA at the time of purchase Any Investment on the land by way of NIL NIL NA NII, NA NA development. construction etc. I Approximate Cunent Market Ntt. NIL NA NIL NA NA value N on-Agricultural Land Machavaram. NIL NA NIL NA NA Machilipatnam I [-ocation(s) l6ltgt A Survey number(s) l Area (total I measurement in 6957 NIL NA NIL NA NA sq.ft.) Whether inherited property (Yes or NO NIL NA NIL NA NA No) ( ii) Date of purchase - I NIL NA NIL NA NN in case of sell 9.10.2009 I acquired property l Cost of Land (in case of purchase) Rs.14.14.000 NIL NA NIL NA Nz\ at the time of purchase Any Investment the land by NII, NIL NA NII- NA NA \.r o mcr11. c! 7 :> :: ,a Y t*r"tr,, 14 constructron etc I N} NA N+ N+ l', + NA Approximate I current market 77.30.000 NII- NA NIL NA NA value Commercial lluildinss I (including NIL NIL NA NII, NA NA apaflrments) - Location(s) - Survcy number(s) Area (total measurement in NIL NII- NA NII- NA NA s .fi Built-up Area (total NIL NIL NA NII- NA NA nteasurement in S .ft.) Whether inherited property (Yes or NII, NlI- NA NII, NA NA (lll ) L\O f)ate of purchase I in case of self - NIL NII, NA NIL NA NA acquired property Cost of property I (in case of NIL NIL NA NIL NA NA purchase) at the time of hase Any Investment on the property by n'ay of NIL NII, NA NIL NA NA development. oonstruction etc. Approximate current market NII, NII- NA NIL NA NA value Rcsidential Iluildinss I (includine NIL NIL NIL NA NA :rDartments "ol Location (s) - Sun number(s) (iv) Area (l-otal I measurement in NII, NIL NA NIL NA NA . li) Built up Area 'Iixal NII, NII, NA NIL NA NA rement rn 6 : 8 1 maMo)un1 r Whether inherited property (Yes or NIL NIL NA NIL NA NA No) Date of purchase I in case of self NII, NII- NA NIL NA NA acquired property Cost of property (in case of NIL NII, NA NIL NA NA purchase) at the I time of purchase I Any lnvestment on the land by way of NIl- NIL NA NIL NA N.A development, construction etc Approximate I current market NIL NIL NA I NIL NA NA value Others (such as interest in NIL NIL NA NIL NA NA property) Total of current market value of NII- NIL NA NII- NA NA (i) to (v) above I (8) I give herein below the details of liabilities / dues to public financial institutions and Government:- (),lote Please give separate details ofname ofbank, institution, entity or individual and amount before each item) Yarlagadda Rama Yarlagadda l)ependent Dependent Dependent S.No Description Mohana Lakshmi Htr t' I ) -t Rao (Spouse) t (Self) [,oan or dues to I Banki Financial I I lnstitution(s) Name of Bank or Irinancial NII, NIL NII, NIL NII- NIL Institution. Amount outstanding, (i) Nature of loan Loan or dues to any other entity I mentioned above. NIL NIL NII- NIL NII- NII- Name(s), outstandin . loan Anv other Ntt. Ntt. *ftut" NIL NIL NII, NIL :, :,! 9 Y M, :', ij 1 Crand total of NIL NIL NIL NII, I NII- NIL liabilities (A) Has the Deponent been in occupation of accommodation provided by the Government at any time during the last ten years before the date of notification ofthe cunent election ? (B) If answer to (A) above is YES. the following declaration may be furnished namely:- (i) The address of the Govemment accommodation: Government (ii) There is no dues payable in respect ofabove Govemment l)ut's: accommodation. towards- (a) rent; Dues to (ii) (b) electricity charges; NO departments (c) water charges; and dealing with (d) telephone charges as on24.03.2019 (iovernment [The date should be the last date of the third month prior to the accommodation month in which the election is notified or any date thereafter]. Note- 'No Dues Certificate' from the agencies concemed in respect ofrent, electricity charges, water charges and telephone charges for the above Govemment accommodation tt should be submitted. Yarlagadda Yarlagadda Rama Dependent Dependent Dependent Lakshmi HI.]F Description Mohana I 't 3 Rao (Spouse) Se Dues to department dealing ra'ith Govemment ( iii) NIL NIL NA NIL NA NA transport (including aircrafts and helico ters (iv) Income Tax dues NIL NIL NA NII, NA NA ( ) GST dues NIL NII, NA NIL NA NA (ri) Municipal/Property NiL NIL NA NIL NA NA tax dues ( r'ii) Anv other dues NIL NIL NA NIL NA NA Grand total of all 1r iii) NIL NIL NA NII- NA NA Govemment dues Whether any other liabilities are in dispute. if so, mention the (ix1 NIL NIL NA NIL NA NA amount involved and the authority I before which it is I endin t\o AN c 1 p^,-*r., 10 Z F I (9) Details of profession or occupation : (a) Self : Cultivation (b) Spouse : House Wife (9A) Details of source(s) of income : (a) Self : Agriculture Income (b) Spouse : NIL (c) Source ofincome, if any, of dependents : Not Applicable (9B) Contracts with appropriate Government and any public company or companies a) Details ofcontracts entered by the candidates : No b) Details ofcontracts entered into by spouse : No c) Details of contracts entered into by dependents : Not Applicable d) Details of contracts entered into by Hindu Undivided Family of trust in which the carrdidalcs or spouse or dependents have interest.: Not Applicable e) Details ofcontracts entered into by Partnership Firms in which candidate or Spouse or dependent are partners : Not Applicable 0 Details of contracts entered into by private companies in which candidates or spouse or dependents have share : Not Applicable (10) My educational qualification in as under: Passed Intermediate at Hindu College, Machilipatnam in the year f 985-86. (Give details ol' highest Schoolfuniversity education mentioning the full form of the certificate diploma / degree course. name ofthe School/College / University and the Year in which the course was completed) ..j rn4fno tl o a FI 11 PART-B (r l) ABSTRACT OF THE DETAILS GIVEN IN (I) TO (X) OF PART-A : Nan.re of the I Shri Yarlagadda Rama Mohana Rao Candidate Door No. l9-289-8, Chilakalapudi. Machilipatnam - 521002. Full Postal Address Krishna District. Andhra Pradesh. Number and name of 1 1 - Machilipatnam, Lok Sabha Parliamentary Constituency. Andhra I the constituency and -) Pradesh. State Name of the political party which set up Bahujan Maha Party .1 the candidate ( which is registered and recognised party) (othcrwise write 'lndependent') -l'olal numbcr of l 5 pending criminal NIL CASCS I Total Number of (r cases in which NIL convicted Year for which the last Income Total PAN of Tax return has income shown been filed I I Yarlagdda Rama Mohana Rao AHZPY 67.53A NII- NIL 7 Self) Yarlagadda Lakshmi NII- NIL NIL (Spouse) uup i. I I rtrcunaiaur. NA NA NA Karta / Coparcener) | Dependent NA NA NA 8 Details of Assets and Liabilities (including offshore assets) in rupees Yarlagadda Yarlagadd Rama a Dependent Dependent S. l)escription HT]F Mohana Rao Lakshmi I 2 '*'t'*'I (Selfl (Spouse) I J t2 Y b*\^ Moveable Assets ('l'otal value) L 11,86.000 I 1.70,.000 NA NIL NII- NII, u Imnrovable Asscts Pruchase Price of I self-acquired 14,14,000 NIL I NA NIL NII- NII, immovable property Development/ construction cost of II immovable property NIL NIL NA NIL I NIL NII- after purchase (if applicable) Approximate I Current Nlarket NIL NII- NA NIL NIL Nil_ lnrl Price (a) Self-acquircd I 77.30,000 \IL NA NII- NIL NIt, assets (Total Value) (b) Inherited assets I NII- NIL NA NIL NII- NII, (Total Value) 9 Liabilities Government dues (i) NIL NIL NA NIL NIL NII, (Total) (ii Loans lrom Bank, I Financial Institutions i,trII- NIL NA NII- NIL NII, L ) and others (Total) I l0 Liabilities that are under disputc Governnrent dues (i) NIL NII- NA NIL NIL NIL ] (Total) I Bank, (ii Loans from Financial Institutions NIL NIL NA NIL NII- Nlt ) and others (Total) Hichest educational qualification : - Passed Intermediate at Hindu College' at Machilipatnam , in the year 1985-86. ll (Give deiails of highest School funiversity education rnentioning the full form of the certificate/ diploma/ degree nu*" ofthe school /college/ university and the year in which the course "ourr", was completed.) OT ,1 $ 4 na-tto (, ., ti,r I) t-' VERIFICATION I. the deponent, above named, do hereby verify and declare that the contents ol this alfidavit are true and sorrect to the best of my knowledge and belief and no pafr of it is false and nothing materials has been concealed there from. I further declare that : - (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 of my dependents do not have any asset or liability, other than those mentio;ed in items 7 and 8 of Part A and items 8,9 and 10 ofPart B above' Verilletl at Machilipatnam. this the 25th day of March, 2019 1 il^**$,- ?-,. DEPONENT last day of filing nominations. Note : 1 Affidavit should be filed latest by 3.00 PM on the of the First Class or Note : 2 Affrdavit should be sworn before an Oath Commissioner or Magistrate befbre a Notary Public. there is no inlormation to Note : 3 All column should be filled up and no column to be left blank. If 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 ofthe Aflidavit should be signed by the deponent and thc af{idavit should Bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavit is sworn. My Commisslcn cixpires on 28-1 1-2(D>- (Ministry ol Law & Justice Notification No. H 1 1019(4) 201 8-Leg II, dated lOth S.L, No, lsfr?t".-2O I 8 and Notification No . H - I 1 0l 9/l 3/20 I 6 - Leg II, dated 26th February. 2019 ) t.rtGE Nor 5 $o AN .Ls 3.\1 1- &,,-*)',-,?- o : ,9 , . 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