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Rm 26 (Seerule4a) C 654096 Form 26 (SeeRule4A) tP~ ~~ '~~y . ,'!r;b.\..\.-.~, 0F: A S~ ff)'''' U~~FFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINATION PAPER NoC'~::'(~" BEFORE THE RETURNING OFFICER FOR ELECTION TO HOUSE OF PEOPLE FROM 4- p..O I DHUBRI H,P, CONSTITUENCY. I PART-A I I, ZABED ISLAM, Son of Late Zahirullslam aged 51 years, resident of Village :INo. Beparipara, P.O. a P.S. Mankachar, District - South Salmara Mankachar, (Assam) PIN • 783131 , a candidate at the above election, do hereby solemnly affirm and • ~ J~te on oath as under ;- A r B~i'~' OTARY Gftubrf OJ "ct, t)hubr' ( Page1 of 13) ~,'ndja , d. N -DBf-4 .Il. (1) I am a Candidate set up by Asom Gana Parishad. (2) My name is enrolled in 21 Mankachar Legislative Assembly Constituency in the state of Assam at serial No. 198 in part No.250. (3) My contact telephone number(s) is/are 9957057577 and my email id (if any) is islamzabed32Cfgmail.com and my social media account(s) (if any) is/are - Nil (4) Details of Permanent Account (PAN)and status of filing of Income tax return : SI. Names PAN The financial Total income shown in No. year for which Income Tax return (in the last Rupees)for the last Income -tax five financial years return has completed (ason 31st been filed March) 1 Self- Zabed Islam AAKPI4224Q 2017-18 (i) 2013-14 ~ Rs.8,51,858/- O~ - '" (ii) 2014-15 / ~~ Rs.9,58,072/- ( :i.mer (/; ~ '" (iii) 2015-16 ~\\nn~ ,0' 3,;. iragl * - "", Rs.12,89,240/- .:1 rl~\II'-' , ) \ "'-recri_t ,1'111 " ~ (iv) 2016-17 \ ) :~(J"l ..... \ Rp.go. t~.4/JJ Rs.4,79,063/- (v) 2017-18 " ~-~ -.---~~~/ .,,~ b Rs.6,75,917/- 2 Spouse- Hashina AAKPI4132R 2017-18 (i) 2013-14 Islam Rs.3,68,164/- ~f.) (ii) 2014-15 Rs.3,59,676/- (iii) 2015-16 'lEI" Rs.3,62,439/- ....c~ I..' ,~ e>'? ~d.£l. '.a:,-= (iv) 2016-17 tt.£l.lt "...\...\ e· 0 1\ B~\' Rs.6,70,922/- .V' if}""""'~' (v) 2017-18 - Rs.3,87,881/- 3 HUF(If the Candidate Not Not (i) Not Applicable is Karta or Coparcener) Applicable Applicable (ii) (iii) (iv) (v) 4 Dependent -1. Hashmi AFHPI9190P Not (i) Not Applicable RobshanIslam Applicable (ii) (iii) (iv) (v) ~.\, (Page2 of 13) Am . I ~I NOT~-RY Dhubri District, Dhubr' (A~$-am).India ~egd. ~Jn.-D8!-4 5 Dependent -2. Zubair No PAN Not Applicable (i) Not Applicable Islam allotted (ii) (iii) (iv) (v) 6 Dependent-3.Zannat No PAN Not Applicable (i) Not Applicable Islam allotted (ii) (iii) (iv) (v) Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly stated "No PANallotted". (5) Pending Criminal Cases \,/'(i) I declare that there is no pending Criminal Caseagainst me. /0 ...~ (Tick this alternative if there is no criminal case pending against the candidate ~ :;:::: I .~ and write NOTAPPLICABLE against alternative (ii) below) *"/1\ ~"'1e' ~(~::-Z,;';~f!1r1' ~e following criminal casesare pendin~:gainst me. ~ \ - ,JO. !~o.'DB/.;'CI $(If there are pending criminal casesagainst the candidate, the tick this alternative \.0 ;", /\~ ~ and score off alternative (I) above, and give details of all pending cases in the ,AJ - N\;/ Table Beklw) • Table ~~.J (a) FIR No. with name and address of Police Not Not Not .,.').8'~ station concerned Applicable Applicable Applicable A) ~CaseNo. with Name of the Court Not Not ~ ~. Not a;ttda. i~. Applicable Applicable Applicable art p.. \ - S~ e· jop'RSection(s) of concerned Acts/Codes Not Not Not ""c,u -.-, C···rr-,·.'· \". involved (give no. of the section e.g. Applicable Applicable Applicable section ..... of IPCetc.) (d) Brief description of offence Not Not Not Applicable Applicable Applicable (e) Whether charges have been framed Not Not Not (mention YES or NO) Applicable Applicable Applicable (f) If answer against (e) above is YES, then Not Not Not give the date on which charges were Applicable Applicable Applicable framed (g) Whether any Appeal/Application for Not Not Not revision has been filed against the Applicable Applicable Applicable k,?roceedings(Mention YES or NO) ~\'1 Am 't al I (Page3 of 13) N T)l RY Chubri District, Dhubrt (Assam). India ~e-G(1. No.-OB~ (6) Ca~ of Conviction vM' I declare that I have not been convicted or any criminal offence. (Tick this alternative, if the Candidate has not been convicted and write NOT APPLICABLEagainst alternative (ii) below) OR I have been convicted for the offences mentioned below: (If the Candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the table below) ~3\fag\ ~ ..rl\C.\fiC\ {, U'''' ;:::: Table o"~~ffo, Not Not Not Applicable Applicable Applicable - -11)) ~me of the Court Not Not Not Applicable Applicable Applicable (c) Section{s) of Acts/Codes involved (give Not Not Not no. of the section e.g. section ..... of IPC Applicable Applicable Applicable etc.) (d) Brief description of offence for which Not Not Not convicted Applicable Applicable Applicable (e) Dates of orders of conviction Not Not Not Applicable Applicable Applicable ~? y (f) Punishment imposed Not Not Not Applicable Applicable Applicable L...t1 ,~(g) Whether any Appeal has been filed Not Not Not ~z.t"''_~ tJ (y against conviction order (Mention YESor Applicable Applicable Applicable &n;, j"£l'~~~ NO) a;rtCl-1 f-,-.e!-.--!--------------f-----f-----f------! Sa-ei"t'tt e.po..·~\Jf answer to (g) above is YES,give details Not Not Not I"' ~~y..•O'r and present status of Appeal Applicable Applicable Applicable ,t[':'· . ,. 1;\,0"'-- (6A) I have given full and up-to-date information to my political party about all pending criminal casesagainst me and about all casesof conviction asgiven in paragraphs (5) and (6). [ Candidates to whom this Item is not applicable should clearly write NOT APPLICABLEIN VIEW OF ENTRIESIN 5(i), above] Note: 1. Details should be entered clearly and legibly in BOLDletters. 2. Details to be given separately for each caseunder 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 • ~preme Court's judgement in W.P. (C) No. 536 of 2011. ~mr\ a au \ NOTA y (Page4of13) ghubri Oistrtct.~hubr (f...ssam).InciIO Regd. No.-OBI-4 ar 1""" ~~~ ~ ~me;-'.(_ "* Amiit Lai Bairagf * ~, 4rea-D\uor; DIStrict ~ ~' Rl?od. No.·D84·4 if (7) That I give herein below the details of the assets (movable and i ~11).0 able etc.) of ~ myself, my spouse and all dependents. ' Or- ~\ ." A. Details of movable assets: ..6 Note :1. Assets in joint name indicating the extend of joint ownership will also have to be given. Note: 2. In caseof deposit / Investments, the details including Serial Number, Amount, date of deposit, the Scheme,Name of the Bank/Institution and Branch are to be given. Note: 3. Value of Bonds/Share Debentures as per current market value in stock exchange in respect of listed companies and 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 any other person related to be 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 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 other body or institution abroad, and details of all assetsand liabilities in foreign countries. SI. Description Self Spouse HUF Dependent-l Dependent-2 Dependent-3 No. Zabed Islam Hashina Islam Hashmi Zubair Islam Zannat Islam Robshan Islam (i) Cashin hand Rs.24,85,151/- Rs.3,54,648/- Rs.5,100/- NIL NIL (ii) Details of 1.U.Co. Bank, 1.5BI, Dispur Branch, 5B N 1.5BI, Dispur I () '" deposit in Bank Mankachar Branch, 5B A/C NO.l0821745254 0 Branch, 5B tll.d~,.w accounts A/C No.03880100005941Rs.18,358.54 T A/C ~ ," (FDRs, Term Rs.5,554/- 2. U.Co. Bank, No. P"4 ' Deposits and 2. U.Co. Bank, Mankachar Branch, 5B A 2034628302 ~W. "all other types Mankachar Branch, SB A/C No. P 1 ~~~'l-O .I of deposits A/C No. 03880100007488 P Rs.5,432.26 q) ,~, l,qc{~~ 03880110057117 Rs.l,75,652.20 L _ A a. ~art Sav~ -\3. Rs.559.40 3.SBI, I Cl-"" e~~\. 3.5BI, MankacharBranch,5B C ...-.r ,....=:-c, ~posits with MankacharBranch,SB AlC No.32636442338 A ,C\J . Financial A!C No. 32636427433 Rs.1,004/- B Institutions, Rs.976.50 4. Sahara India Pariwar, L Non-banking 4. 581, Assam Guwahati 58 A/C No. E companies and Secretariat Branch, 58 138601022293 NIL NIL co-operative A/C NO.20084030798 Rs.46,600/- socities and Rs.9,545.99 the amount in 5. SBI, Mankachar each such 8ranch, CA A!C deposit No.38350245305 Rs.9,469/ 6.5ahara India Pariwar, Guwahati Pass book No. 24300 Rs.10,000/- \~ ( PageSof 13) Amr~~{ 8airaQl NOTARY Dhubri District, Dhubr' (Assam), India RAnd. NO.-DBf--4 (iii) Details of investment in Bonds, Nil NIL NIL NIL debentures/shares and units in companies/mutual funds and others and the amount (iv) Details of 1.LlC Policy No.
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