FORM2A (See rule 4) NOMINATION PAPER Election to the House of the People R.,:::ent stan p size J , be aaacnea; PART I (To be used by candidate set up by recognised Political Party) Inominate as a Candidate for Election to the House of the People from the 14-NARASARAOPET PARLIAMENTARY CONSTITUENCY. Candidate' name: RAYAPATI SAMBASIVA RAO, Father's name: RAYAPATI VENKATA RANGA RAO. His postal address: D.No.5-91-26, 4THLANE, LAKSHMIPURAM, GUNTUR, ANDHRA PRADESH, PIN:522007. His name is entered at S.No.216 in Part No.131 of the electoral roll for 94-GUNTUR WEST ASSEMBLY CONSTITUENCY comprised within 13- GUNTUR PARLIAMENTARY CONSTITUENCY. My name is AMARANADH KAMINENI and it is entered at S.No.470 in Part No.159 of the electoral roll for 97-NARASARAOPET Assembly Constituency comprised within 14- NARASARAOPET Parliamentary Constituency. 2_L~ Date: 22/03/2019 S1gnature of Proposer Place: Narasaraopet 1 ---------- -- - - PART II (NOT APPLICABLE) (To be used by candidate NOT set up by recognised political party) We hereby nominate as andidate for election to the House of the People from the. ... Parliamentary Constituency Candidate's nam Father's/mother's/husband's name His postal address . His name is entered at S.N .in Part No. of the electoral roll for .............................................................. 'Y(Assembly constituen y comprised within) .............................................................. Parliamentary constituency We declare that we are ele tors of the above Parliamentary Co stituency and our names are entered in the electoral roll for that Parliamentary Constituenc as indicated below and we append our signatures below token of subscribing to this nomi tion:- lars of the proposers and their signatures S1.no. Name of Elector Roll No. of Full Name Signature Date component Proposer Assembly Part No. of S.No. Constituency Electoral in that Roll part 1 2 3 4 5 6 7 1. 2. 3. 4. NOT APPLICABLE 5. 6. 7. 8. 9. 10. N.B.- There should be ten electors of the constituency as proposers. 2 PART III I, RAYAPATI SAMBASIVA RAO, the candidate mentioned in Part I 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 75 years of age; (c) (i) that I am set up at this election by the TELUGU DESAM PARTY, which is a recognised State Party in this State and that the symbol reserved for the above party be allotted to me. (d) that my name and my father's name have been correctly spelt out above in ENGLISH; (e) that 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 further declare that i am a member of the NOT APPLICABLE. ** caste / tribe which is a scheduled ** caste / tribe of the state of ... NOT APPLICABLE in relation to NOT APPLICABLE (area) in that state. I further declare that I am a member of the NOT APPLICABLE caste / tribe which is a scheduled ** caste / tribe of the state of NOT APPLICABLE in relation to NOT APPLICABLE (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 being held simultaneously, to the House of the People from more than two Parliamentary Constituencies. £/.) 'A ~§ - Date: 22/03/2019 Signat~r~jd~ Place: Narasaraopet (i) has been convicted- (1) Whether the candidate- 3 PART III I, RAYAPATI SAMBASIV A RAO, the candidate mentioned in Part I 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 75 years of age; (c) (i) that I am set up at this election by the TELUGU DESAM PARTY, which is a recognised State Party in this State and that the symbol reserved for the above party be allotted to me. (d) that my name and my father's name have been correctly spelt out above in ENGLISH; (e) that 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 further declare that i am a member of the NOT APPLICABLE. ** caste / tribe which is a scheduled ** caste 1tribe of the state of ... NOT APPLICABLE in relation to NOT APPLICABLE (area) in that state. I further declare that I am a member of the NOT APPLICABLE caste / tribe which is a scheduled ** caste / tribe of the state of NOT APPLICABLE in relation to NOT APPLICABLE (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 being held simultaneously, to the House of the People from more than two Parliamentary Constituencies. Date: 22/03/2019 Sign.~ Place : Narasaraopet (i) has been convicted- (1) Whether the candidate- 3 If the answer is "Yes", the candidate shall furnish the following information: (i) Case/first information report No.lNos: NOT APPLICABLE (ii) Police station(s) : NOT APPLICABLE District(s): NOT APPLICABLE State(s): NOT APPLICABLE (iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted: NOT APPLICABLE (iv) Date(s) of conviction(s) : NOT APPLICABLE (v) Court(s) which convicted the candidate: NOT APPLICABLE (vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of fine(s)] : NOT APPLICABLE (vii) Date(s) of release from prison: NOT APPLICABLE (viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) : Yes/No : NOT APPLICABLE (ix) Date and particulars of appeal(s)/application(s) for revision filed: NOT APPLICABLE (x) Name of the court(s) before which the appeal(s)/application(s) for revision filed: NOT APPLICABLE (xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending: NOT APPLICABLE (xii) If the said appeal(s)/application(s) for revision has/have been disposed of.• (a) Date(s) of disposal: NOT APPLICABLE (b) Nature of order(s) passed: NOT APPLICABLE (2) Whether the candidate is holding any office of profit under the Government of India or State Government?: NO -If Yes, details of the office held: NOT APPLICABLE (3) Whether the candidate has been declared insolvent by any Court?: NO -If Yes, has he been discharged from insolvency: NOT APPLICABLE (4) Whether the candidate is under allegiance or adherence to any foreign country? NO -If Yes, give details: NOT APPLICABLE (5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the President?: NO -If Yes, the period for which disqualified: NOT APPLICABLE (6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? : NO -If Yes, the date of such dismissal: NOT APPLICABLE (7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply 4 of any goods to that Government or for execution of works undertaken by that Government?: NO -If Yes, with which Governmentand details of subsistingcontract(s): NOT APPLICABLE (8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central Governmentor State Government has not less than twenty-five percent share?: NO -If Yes, with which Governmentand the details thereof: NOT APPLICABLE (9) Whether the candidate has been disqualified by the Commission under section lOA of the said Act: NO -If yes, the date of disqualification:NOT APPLICABLE Place: NARASARAOPET Date: 22/03/2019 5 , Form 26 (See rule 4A) I I I j\FFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINA N 'PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO THE HOUSE flF PEOPLE (LOK SABHA) FROM 14-NARASARAOPET PARLIAMENTARY ecONSTITUENCY PART A I am a candidate set'up by TELUGU DESAM PARTY. 2) My name is enrolled in 94-GUN!V..R WEST,ASSEMBLY CONSTITUENCY, at Serial No. 216 in Part No.131 ~ .2-' .,l' lq, ~ OEVINENt SIRISHA KUSUMA KUMARI ~7. ADVOcATE & NOTARY ./ 5th Line, Oevapuram, GUNTUR Cell: 9603911172 - _. - - -------------- (3) My contact telephone numbers are 0863-2350400, 2350500, 9849061777, 9441061777, and my e-mail id is [email protected] and my social media account is (i) www.facebook.comlRayapatLTDP (4) Details of Permanent Account Number (PAN) and status of filing of Income tax return: Sl. Names PAN The financia Total income shown in Income 1N0. lYearfor Tax Return (in Rupees) for the lwhich the last last five Financial Years Income- tax completed (as on 31st March) return has been filed (i) 1 Self Rs. 7,19,272/- (2018) (ii) Rs.19,47,592/- (2017) RAYAPATI W>EPR8003K FY 2017-18 (iii) SAMBASIV A RAO 1Rs.18,27,226/- (2016) (iv) 1Rs·30,15,520/- (2015) (v) 1Rs.29,97,500/- (2014) (i) !NotApplicable 2. Spouse Not ApplicablelNotApplicable If·i)11 !NotApplicable (iii) lNotApplicable ifiv) lNotApplicable (v) lNotApplicable (i) Not Applicable 3. HUF (If Candidate is KartalCoparcener) Not Applicable Not Applicable (ii) Not Applicable (iii) Not Applicable (iv) !NotApplicable (v) lNotApplicable (i) lNotApplicable 4. Dependent - 1 (ii) !NotApplicable Not Applicable lNotApplicable (iii) lNotApplicable (iv) !NotApplicable (v) lNotApplicable (i) !NotApplicable 5. Dependent _ 2 (ii) lNotApplicable Not Applicable Not Applicable (iii) lNotApplicable (iv) lNotApplicable :::::::--., (v) lNotApplicable h~-i 1!.