NOMINATION PAPER Election to the House of the People

FORM2A (See rule 4) NOMINATION PAPER Election to the House of the People

R.,:::ent stan p size

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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

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!. ;.-:,,-, * ~ -~i....Tp"\.. . r;, CURr .~ O)'IlI!.Il\1.0M ~ '. ··('10485 3-' '1 I Exp~Comm;$SIUI1" ell' ~ Ires 01130'''.2022 s 2 ~~ . ~oflnd;a . EVINENI SIRISHA KUSUMA KUMARl ~ ~s. 1If·.A.P ~~~ ADVOCATE & NOTARY ;VA ~~ 5th ~ine, Devapuram, GUNTUR Cell..9603911172 (i) INotApplicable (ii) 1N0tApplicable 6. Dependent - 3 Not Applicable Not Applicable (iii) 1N0tApplicable (iv) 1N0tApplicable (v) ~ot Applicable

(5) Pending criminal 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: NOT APPLICABLE

(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

(a) FIR No. with name and ot Applicable ot Applicable ot Applicable address of Police Station concerned (b) Case No. with Name of the ot Applicable Court (c) Section(s) of concerned Acts/ ot Applicable Codes involved (give no of the Section, e.g. Section of IPC, etc.).

(d) Brief description of offence Not Applicable ot Applicable ot Applicable

(e) Whether charges have been ot Applicable ot Applicable ot Applicable framed (mention YES or NO)

(t) If answer against (e) above is Not Applicable ot Applicable ot Applicable YES, then give the date on which charges were framed

VINENI SIRISHA KLISUMA KUMAEij ADVOCATE c. l~OTARY 5th Line, Devapurarn, GUNTUR Cell: 9603911112- (g) Whether any Appeal lNot Applicable lNot Applicable lNot Applicable / Application for revision has been filed against The proceedings (Mention YES or NO)

(6) Cases of conviction A 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 (0) I have been convicted for the offences mentioned below: NOT APPLICABLE

(If the candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the Table below)

Table

(a) Case No. lNot Applicable lNot Applicable lNot Applicable (b) Name of the Court lNot Applicable lNot Applicable lNot Applicable (c) Sections of iNot Applicable lNot Applicable iNot Applicable Acts/Codes involved (give no. of the Section, e.g. Section ...... ofIPC, etc.). (d) Brief description of offence for Not Applicable Not Applicable Not Applicable which convicted (e) Dates of orders of conviction iNot Applicable lNot Applicable iNot Applicable

(f) Punishment imposed iNot Applicable lNot Applicable iNot Applicable

(g) Whether any Appeal has been iNot Applicable INot Applicable lNot Applicable filed against conviction order (Mention YES or NO

Q)~,.3·'~

tHENI SIRISHA KUSUMA KUMARI ADVOCATE & NOTARY 4 5th Line, Devapuram, GUNTUR Cell: 96039111"72. (b) If answer to (g) above is YES, lNotApplicable lNotApplicable Not Applicable give details and present status of appeal

(6A) 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). - NOT APPLICABLE

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 for the other cases. 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying all information in compliance ofHon'ble Supreme Court's judgment in W. P (C) No. 536 of2011.

(7) That I give herein below the details of the assets (movable and immovable etc.) of myself, my spouse and all dependents:

4& Details of moyable assets i

Note: 1. Assets in joint name indicating the extent of joint 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 Bankilns titution and Branch are to be given.

Note: 3.Value of Bonds/Share Debenturesas per the 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 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 investment

Note: 6. Details should include the interest in or ownership of offshore assets.

institution abroad, and details of all assets and liabilities in foreign countries'; CS)'\l0,g uutCl 4.: q 2J-1" ,

DEVINENI SIR1SHAKIJSUMA KUMAR' ~ ADVOCATE fA :~OTARY 5th Line, De\,apuram, GUNTUR Cell: 9603911172 S. Description Self Spouse HUF Depend Depende Dependent No. ent - 1 nt - 2 - 3 (i) Cash in hand 1Rs·6,93,2511- Not Not Not Not Not Applicable Applicable Applicab Applicabl Applicable Ie e (ii) Details of deposit in Bank Not Not Not Not Not accounts (FDRs, Term Applicable Applicable Applicab Applicabl Applicable Deposits and all other types of ~NNEXURE - I Ie e deposits including saving ~.63,42,469/• accounts), Deposits with Financial Institutions, Non- Banking Financial Companies and Cooperative societies and the amount in each such deposit (iii) Details of investment in Bonds, Not Not Not Not Not Debentures/Shares and units k\NNEXURE - II Applicable Applicable Applicab Applicabl Applicable ill Ie e companieslMutual Funds and Rs.36,85,18,460/• others and the amount.

(iv) Details of investment in NSS, Not Not Not Not Not Postal Saving, Insurance ANNEXURE- Applicable Applicable Applicab Applicabl Applicable Policies and investment in any III Ie e Financial instruments in Post office or Insurance Company 11>".16521 000/- and the amount ~'" , , ,

(v) Personal loans/advance given Not Not Not Not Not to any person or entity INIL Applicable Applicable Applicab Applicabl Applicable including firm, company, Trust Ie e etc. and other receivables from debtors and the amount. (vi) Motor Vehicles/ Aircrafts/ iMARUTI CIAZ Not Not Not Not Not Yachts/Ships (Details of Make, IDL2CAU 4646 Applicable Applicable Applicab Applicabl Applicable registration number. etc. year IYEAR 2014 Ie e of purchase and amount) 1Rs·5,25,000 (vii) Jewellery, bullion and valuable 166 Grams Not Not Not Not Not thing(s) (give details of weight iD" Applicable Applicable Applicab Applicabl Applicable and value) 1-"-",.19,00,000 Ie e (viii) Any other assets such as value INIL Not Not Not Not Not of claims/interest Applicable Applicable Applicab Applicabl Applicable Ie e (ix) Gross Total value iRs·39,45,00,180/- Not Not Not Not Not Applicable Applicable Applicab Applicabl Applicable Ie e ~{{oiA~ ~' /(s/ G.O.R.T. .vo~ *~ ~1·~,,9 !Jj My Commission i- 1;2 Expires on 30·7·2022 'it 6 ~ Govt. of India I~ DEVINENI SIRISHA KUSUMA KUMAR! ~~ Guntur. A.P. ~~). ADVOCATE & NOTARY ?$,If~~ 5th Line, Devapuram, GUNTUR - Cell: 9603911172 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 apartment should be mentioned separately in this format

Note: 3. Details should include the interest in or ownership of offshore assets.

S.No Description Self Spouse HUF Depende Dependen Dependen nt -1 t -2 t-3 (i) Aa:;ri£ul!ural Lund Not Not Not Not Not Applicable Location(s) Survey JANNEXURE - IV Applicable Applicabl Applicable Applicable number(s) e Area (total measurement in ANNEXURE - IV Not Not Not acres) Not Not Applicable Applicable Applicabl Applicable Applicable e Whether inherited property JANNEXURE - IV Not Not Not Not Not (Yes or No) Applicable Applicable Applicabl Applicable Applicable e

Date of purchase in case of ~NEXURE-IV Not Not Not Not Not self - acquired property Applicable Applicable Applicabl Applicable Applicable e Cost of Land (in case of IANNEXURE - IV Not Not Not Not purchase) at the time of Not Applicable Applicable Applicabl purchase Applicable Applicable e Any Investment on the land IANNEXURE - IV Not Not Not Not Not by way of development, Applicable Applicable Applicabl Applicable Applicable construction etc. e

Approximate Current market IRs.1,96,40,000/- Not Not Not value Not Not Applicable Applicable Applicabl Applicable Applicable e (ii) ~!!D-Aa:;ricuI!U[illLuud Not Not Not Not Not Applicable Location(s) Survey Applicable Applicabl Applicable Applicable number(s) INIL e

Area (total measurement in Not Applicable Not Not Not Not Not sq. ft.) Applicable Applicable Applicabl Applicable Applicable e Whether inherited property lNotApplicable Not Not Not Not Not (Yes or No) Applicable Applicable Applicabl Applicable Applicable e Date of purchase in case of lNotApplicable Not Not Not Not Not ~~d property Applicable Applicable Applicabl Applicable Applicable l%\nT e '~Y~ r-';'- I if .r.')/ G,OX, tJo 486 * iO)'\~ ".l,a .._, I "n Me" ...., i!~::::( ,Y Oll1mlSSlOn it.: &) '1'1'1 I;;"';: Exp;res 011 30,7-2022 ~, (Ll2~~ ~ Govt.I)f IndIa ~ J 7 Guntur A f' ~ 1 '. " DEVINENi S:RISHA KUSUMA KUMARJ ~A K\f.>VJ~· ADVOCATE & NOTARY - 5th ~,line Deva puram, GUNTUR Cell: 9603911172. Cost of Land (in case of lNot Applicable Not Not Not Not Not purchase) at the time of Applicable Applicable Applicabl Applicable Applicable purchase e Any Investment on the land lNot Applicable Not Not Not Not Not by way of development, Applicable Applicable Applicabl Applicable Applicable construction e etc. Approximate current lNot Applicable Not Not Not Not Not market value Applicable Applicable Applicabl Applicable Applicable e (iii) ~!lmm~[£iill BuildiD21i Not Not Not Not Not JANNEXURE - IV Applicable Applicable (including apartments) Applicabl Applicable Applicable e -Location(s) -Survey numbe!1_s) Area (total measurement in !ANNEXURE - IV Not Not Not Not Not sq. ft.) Applicable Applicable Applicabl Applicable Applicable e Built-up Area (total !ANNEXURE - IV Not Not Not Not Not measurement in sq. ft.) Applicable Applicable Applicabl Applicable Applicable e Whether inherited property !ANNEXURE - IV Not Not Not Not (Yes or No) Not Applicable Applicable Applicabl Applicable Applicable e Date of purchase in case of JANNEXURE - IV Not Not Not Not Not self - acquired property Applicable Applicable Applicabl Applicable Applicable e Cost of property (in case of !ANNEXURE - IV Not Not Not Not Not purchase) at the time of Applicable Applicable Applicabl Applicable purchase Applicable e Any Investment on the !ANNEXURE - IV Not Not Not Not property by way of Not Applicable Applicable Applicabl Applicable development, construction Applicable etc. e Approximate current ~. 75,00,000/- Not Not Not market value Not Not Applicable Applicable Applicabl Applicable Applicable e (iv) Besid~ntiill Bl!ildin2~ Not Not Not Not Not (including apartments): ~NEXURE-IV Applicable Applicable Applicabl Applicable Applicable -Location(s) e -Surveynumber(s) Area (Total measurement ~NEXURE-IV Not Not Not in sq. ft) Not Not Applicable Applicable Applicabl Applicable Applicable e Built up Area (Total JANNEXURE - IV Not Not Not measurement in sq. ft.) Not Not Applicable Applicable Applicabl Applicable Applicable e Whether inherited property JANNEXURE - IV Not Not Not Not Not _eYesor No) Applicable d, Applicable Applicabl Applicable Applicable =nI..l\~ e V" ~#,!J..~ OR r No. 486 ... /~t:", : v */c., f:1t ~'~'Ij 'I'__.,1 "~':l(.i: "y. COIi1;!li~"iJn. (i I.>~ 'xfl;r9S 01/ 30.7 ' .". ~ 1 t'n G 'i.0LL DEVINENI SIRISHA KUSUMl KUMARI ~~ ,\~~ O~toflnd ~ '7G IJ, ADVOCATE & NOTARY \ u~ IJmlif..A.P. ~ ~';~.s/f.~ ~~~ 5th Line, Devapuram, GUNTUR ~,~KUS CeU: 960391117Z Date of purchase in case of ~NNEXURE - IV Not Not Not Not Not self - acquired property Applicable Applicable Applicabl Applicable Applicabk e Cost of property (in case of ~NNEXURE - IV Not Not Not Not Not purchase) at the time of Applicable Applicable Applicabl Applicable Applicable purchase e Any Investment on the land ~NNEXURE - IV Not Not Not Not Not by way of development, Applicable Applicable Applicabl Applicable Applicable construction e etc. Approximate current IRs.1,63,00,000/- Not Not Not Not Not market value Applicable Applicable Applicabl Applicable Applicable e (v) Others (such as interest in !NIL Not Not Not Not Not property) Applicable Applicable Applicabl Applicable Applicable e (vi) Total of current market 1Rs·4,34,40,OOO/- Not Not Not Not value of (i) to (v) above Not Applicable Applicable Applicabl Applicable Applicable e

(8) I give herein below the details of liabilities/dues to public financial institutions and govemment:-

(Note: Please give separate details of name of bank, institution, entity or individual and amount before each item)

S. Description Self Spouse HUF No. Depende Depende Depende nt-l nt-2 nt-3 (i) Loan or dues to 1) Andhra Bank Not Not Not Not Not BanklFinancial Institution(s) Car Loan Applicabl Applicabl Applicabl Applicabl Applicabl 1Rs.83,5311- e e e e e Name of Bank or Financial Institution, 12) District Co- Amount outstanding, Operative Central Nature ofloan Bank Agri Loan Rs.ll,49,640 Loan or dues to any other Not Not Not Not individuals/ entity Not other NIL Applicabl Applicabl Applicabl Applicabl than mentioned above Applicabl e e e e e

!Name(s), Amount [outstanding, nature ofloan Any other liability NIL Not Not Not Not Not Applicabl Applicabl Applicabl Applicabl Applicabl e e e e Grand total of liabilities e Rs.12,33,1711- Not Not Not Not Not Applicabl Applicabl Applicabl Applicabl Applicabl .0-rJO~& e e 1/....*;_- "~:,,:')'I'§. e e e Go,!,:" {rif''.:::: M),c, (fc 486"<,"'"~ , ~oW'l"~ <: Exp' Off/IT!. ' ,,, ;reso"':l ISS/O,., - 9 ~·~1r-C % go.,,:~20ll\~.,~ EVINENI SIRISHA KUSUMA KUMARI ~ ""'/Jr., 4.~ -!!) ADVOCATE & NOTARY ~I 3'/t..cf KIJS\)~c 5th Line, Oevapuram, GUNTUR ~.-:-- :-_ .' Cell: 9603911172 ------. - (ii) Goyerpment Dues; (A)Has the Deponent been in occupation of YES Dues to departments accommodationprovided by the Government at dealing with any time during the last ten years before the Government date of notificationof the current election? accommodation (B)If answer to (A) above is YES, the following declarationmay be furnishednamely:- Declaration (i) The address of the Government Enclosed accommodation: C-1I20, PANDARA PARK,NEW DELHI - 110003

(ii) There is no dues payable in respect of above Government accommodation, towards- (a) rent; (b) electricitycharges; (c) water charges; and (d) telephone charges as on 19-03-2019 [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 accommodation should be submitted.

(iii) lDuesto department dealing NIL ~ol ~ot lNot Applicable ~ot Applicable lwith Government transport IApplicable !Applicable (including aircrafts and helicopters)

DEVINENI SIRISHA KUSUMA KUMARI ADVOCATE ~ NOTARY 5th Line, Devapuram, GUNTUR Cell: 9603911172 .,.,

Self Spouse HUF Dependent Dependent Dependent - 1 -2 -3 (iv) Income Tax dues ~IL Not Not ~ot Not Not Applicable Applicable IApplicable Applicable ~pplicable

(v) GST dues ~IL Not Not lNot lNot lNot Applicable Applicable Applicable ~pplicable !Applicable

(vi) MunicipallProperty tax dues !NIL Not Not lNot lNot ~ot Applicable Applicable iApplicable !Applicable !Applicable

(vii) Any other dues INIL Not Not lNot lNot lNot Applicable Applicable Applicable Applicable iApplicable (viii) Grand total of all !NIL Not Not Not lNot lNot Government dues Applicable Applicable Applicable Applicable ~pplicable

Whether any other !NIL Not Not lNot lNot ~ot (ix) liabilities are in dispute, if Applicable Applicable iApplicable !Applicable Applicable so, mention the amount involved and the authority before which it is pending.

(9) Details of profession or occupation:

(a) Self: Business, Agriculture, Politics & Social Worker (b) Spouse: Not Applicable

(9A) Details ofsource(s) of income:

(a) Self: Remuneration as Parliament Member, Dividends & Interest

(b) Spouse: Not Applicable

Source of income, if any, of dependents,: Not Applicable

deta~ls of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependent have interest; Not Applicable t nJJ.-.lJ..-~.eJr--C ~c:!1'3"1 (~_C- DEVltJENI SIRISHA Kusu~l KUMARI ADVOCATE & NOTARY 5th line, Devapuram, GUNTUR Gel!: 9603911172 Cv (d)" details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners: Not Applicable

(t_)tt)- details of contracts, entered into by private companies in which candidate or _ .~ spouse or dependents have share : n \P}YMlS.TRANSTROY INDIA LIMITED (IN WHICH I AM HAVING SHARES) ~ / EXECUTING CIVIL WORKS IN POLAVARAM IRRIGATION PROJECT BY WAY OF JOINT VENTURE AND ON SUB CONTRACT BASIS.

(10) My educational qualification is as under:

COMPLETED B.Sc (Bachelor of Science) IN THE YEAR 1964 FROM NEW SCIENCE COLLEGE, OSMANIA UNIVERSITY, HYDERABAD.

(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.)

DEVINENI SIRISHA KUSUMA KUMARl ADVOCATE & NOTARY 5th Line, ~vapuram, GUNTUR Cell: 9603911172

12 PART-B

(11). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A:

1. Name of the candidate Shri. RA YAP AT I SAMBASIV A RAO

2. Full postal address IJ>.NO.5-91-26, 41.t1LANE, LAKSHMIPURAM, GUNTUR, ANDHRA PRADESH, PIN CODE - ~22007 3. Number and name of the 14 - NARASARAOPET PARLIAMENT constituency and State CONSTITUENCY

4. Name of the political party which set up the TELUGU DESAM PARTY candidate (otherwise write 'Independent')

5. Total number of pending criminal cases INIL

6. Total Number of cases in which convicted NIL

7. PAN of Year for which last Total Income Shown Income Tax Return filed (a) Candidate ~DEPR8003K 2017-18 Rs.7,19,272/- (b) Spouse Not Applicable Not Applicable Not Applicable (c) HUF Not Applicable Not Applicable Not Applicable (d) Dependent -1 Not Applicable Not Applicable Not Applicable (e) Dependent -2 Not Applicable Not Applicable Not Applicable (f) Dependent -3 Not Applicable Not Applicable Not Applicable 8. Details of Assets and Liabilities (including offshore assets) in rupees

Description Self Spouse HUF Dependent Dependent- Dependent- -1 2 3 Moveable Assets V\. 1Rs.39,45,OO,180/- Not Not Not Not Not (Total value) Applicable Applicable Applicable Applicable Applicable B. Immovable Assets

I Purchase Price of self- Not Not Not Not Not acquired immovable Not Applicable Applicable Applicable property Applicable Applicable Applicable

II Development/const Not Not Not Not Not ruction cost of Not Applicable Applicable Applicable immovable property Applicable Applicable Applicable after ..Qurchase (if ~ t\_( ~ble) ~*'--- J'~ ~ G.OR " ortMueuD .: 021,&"1 - Ex OlTJlTJlS . 2: Plro s a SiOIl C2 miM'c-. II'",'"J[J..7'lD22 · .e: -z; Govr.of I' i " G fir/I,] DEVlNENI SIRISHA KUSUMA KUMARl (fl until". -1 P ~ ~ '. ADVOCATE & NOTARY ~)f.r1 KUS\j~!, 5th Line, L)f!Vi::piJram, GUNTUR - 0- "I· N'~":1n~'i1n III Approximate Current Market Price - (a) Self-acquired ~ot Not Not assets (Total NIL ~pplicable Not Applicable Applicable Value) Applica Not ble Applicable (b) Inherited assets ~.4,34,40,0001 - (Total Value)

9. Liabilities (i) Government dues NIL lNot Not Not Not Not (Total) ~pplicable Applica Applicable Applicable Applicable ble (ii) Loans from Bank, Rs.12,33,171/- Not Not Not Not Not Financial Institutions [Applicable Applica Applicable Applicable Applicable and others (Total) ble

10. tLiabilities that are under dispute (i) Government dues NIL ~ot Not Not Not Not (Total) ~pplicable Applica Applicable Applicable Applicable ble (ii) Loans from Bank, NIL ~ot Not Not Not Not Financial Institutions ~pplicable Applica Applicable Applicable Applicable and ble others (Total)

11. Highest educational qualification:

Completed B.Sc (Bachelor of Science) in the year 1964 from New Science College, Osmania University, Hyderabad.

VERIFICATION

I, RAY APATI SAMBASIV A RAO, the deponent, above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief and no part of it is false and nothing material 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, 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 GUNTUR OR this 21st day of MARCH 2019

~. c:!r •.3·'~ OEVlNENI StRiSHA KUSUMAKUMAJif ADVOCATE &. NOTARY 5th Line, Devapuram, GUNTUF: Cell: 9603911172. , (

ANNEXURE-I

RAY APATI SAMBASIV A RAO (SELF)

DETAILS OF DEPOSITS IN BANK ACCOUNTS Sl. Name of the Bank & Branch Account Number Balance as on No 19.03.2019 1 INDIAN OVERSEAS BANK, SB A/c . 002801000000079 5,38,858 GUNTURBRANCH 2 ANDHRA BANK, SBAlc.108910100007143 48,825 AP BRA WAN BRANCH, NEW DELHI 3 ANDHRA BANK, SB Alc. 108910011100535 12,37,151 AP BRA WAN BRANCH, NEW DELHI 4 STATE BANK OF INDIA, SB A/c : 10023835804 PARLIAMENT HOUSE, NEW DELHI 5,53,307 5 INDIAN OVERSEAS BANK, SB Alc : 065701000012179 LEMALLE BRANCH, 10,145 GUNTUR DISTRICT 6 VIlA YA BANK, SB Alc : 414701011000003 NARASARAOPET BRANCH, 2,626 GUNTUR DISTRICT 7 BANK OF INDIA, SB A/c: 561510110000094 LAKSHMIPURAM BRANCH, 1,60,089 GUNTUR 8 ANDHRA BANK, SBA/c:307910100000399 36,12,247 VELAGAPUDI BRANCH, GUNTUR DISTRICT 9 BANK OF INDIA, SB AIC : 561510110006899 1,000 LAKSHMIPURAM BRANCH, GUNTUR 10 INDIAN OVERSEAS BANK, SB A/c : 29690200000077 2,000 NARASARAOPETBRANCH GUNTUR DISTRICT 11 UNION BANK OF INDIA, CD A/c : 409001010531586 1,70,669 LAKSHMIPURAM BRANCH, GUNTUR 12 INDIAN OVERSEAS BANK, CD A/c: 296902000000060 5,552 NARASARAOPETBRANCH GUNTUR DISTRICT TOTAL 63,42,469

Itft>'N~N 6.'0 -:1 ~~U'UQ~;'3'Jj

(!-~~(I) ~ 0" ,~, ~ OEVINENI SIRISHA KUSUMA KUMARj I~ ~ 6J. . -. ~~.6:do,,.,~· \'' ADVOCATE &. NOTAR-tS ~ '-f~~ ~ ~ ~ .1> ~ 5th Line, Devapuram, GUNTllR -+:lJsUiiA~~ Cell: 9603911172 ANNEXURE - II

RAYAPATI SAMBASIVA RAO (SELF)

DETAILS OF INVESTMENTS IN BONDS, DEBENTURES & SHARES Sl. Details Whether No. 0 Face Value in Rs. No. Listed or Shares Value Unlisted 1 Sri Jayalakshmi Tobacco Co Limited NO 2,43,360 10 24,33,600 2 Gogeneni Tobaccos Limited NO 17,25C 100 17,25,000 3 Green Leaf Tobacco Threshers Limited NO 32,00C 100 32,00,000 4 Sri Jayalakshmi Spinning Mills Limited YES 25,00,00C 1 25,00,000 5 BIT Corp Private Limited NO 11,05,000 10 1,10,50,000 6 Tobacco Bye Products Limited NO 220 100 22,000 7 Avanthi Leathers Limited YES 500 10 5000 8 Dr. Organic Chemicals Limited YES 200 10 2000 9 Shree Jayalakshmi Power Corp Limited NO 135500 10 13,55,000 10 Reliance Industries Limited YES 200 1378 2,75,600 11 Transstroy India Limited NO 3,45,04,886 10 34,50,48,860 12 ITC Limited YES 3000 299.70 8,99,100 13 Reliance Capital Limited YES 5 180.60 903 14 Reliance Infrastructure Limited YES 7 136.75 957 15 Reliance Communications Limited YES 100 4.40 440 TOTAL 36,85,18,460

ANNEXURE - III

RAY AP ATI SAMBASIV A RAO (SELF)

DETAILS OF INVESTMENT IN NSS, POSTAL SAVING, INSURANCE POLICIES & INVESTMENT IN ANY FINANCIAL INSTRUMENTS IN POST OFFICE OR INSURANCE COMPANY Sr.No. Policy Name & Number Sum Assured Current Value 1 LIC Policy No.678541885 1,65,21,000 1,65,21,000 TOTAL 1,65,21,000

DEVINENI SIRiSHA KI.ISUMA I{UMARl ADVOCA.TE & NOT.c.RY 5th Line, Devapurarn, GUNTUR Cell: 96039t1"172

--_ .. ANNEXURE - IV

RAY AP ATI SAMBASIV A RAO (SELF)

DETAILS OF IMMOVABLE ASSETS i) AGRICUTURE LAND Location Survey Area (In Whether Date of Cost of Any Approximate Number Acres) Inherited Purchase Land Investment Current Value Property 2741B 1.62 YES Not Not NIL 32,40,000 Applicable Applicable 1101B 0.58 YES NA NA NIL 11,60,000 Vungutur village, 115/A 0.48 YES NA NA NIL 9,60,000 Amaravati mandal, 911B 0.09 YES NA NA NIL 1,80,000 Guntur district 921B 0.25 YES NA NA NIL 5,00,000 Andhra Pradesh 90/2 0.47 YES NA NA NIL 9,40,000 103 1.27 YES NA NA NIL 25,40,000 2191B 1.13 YES NA NA NIL 22,60,000 119/113 1.06 YES NA NA NIL 21,20,000 111 2.06 YES NA NA NIL 41,20,000 115/C 0.19 YES NA NA NIL 3,80,000 108 0.62 YES NA NA NIL 12,40,000 TOTAL 9.82 196,40,000

ii) NON-AGRICUTURE LAND Location Survey Area (In Sq Whether Date of Cost of Land Any Approximate Number Yards) Inherited Purchase Investment Current Value Property NIL iii) COMMERCIAL BUILDINGS Location Survey Area & Whether Date 0 Cost of Land Any Approximate Number Built-up Inherited Purchase Investment Current Value Area Property In Rs. Main Road, 114 SHARE Lakshmipuram, D.No.7/C OUT OF YES NA NA NIL 75,00,000 Guntur, Andhr 196 Sq Pradesh Yards & 6344 Sft TOTAL 75,00,000

d)O)lta • It If 0.0.' ~, .3.,<>

OeVINENI SIRISHA i{USUM.t\ K01t1ARJ ADVOCATE & NOTi~RY 5th Line, Devapuram, GUNTUR Cell: 960391"1172 (iv) RESIDENTIAL BUILDINGS Location Survey Area & Built- Whether Date of Cost of Any Approximate Number or up Area Inherited Purchase Land Investment Current Door No. Property Value in Rs. Lakshmipuram, D.No. 5- 114 SHARE YES NA NA NA 85,00,000 Guntur, Andhra 91-26 OUT OF 6750 Pradesh Sft SVN Colony, D.No. 114 SHARE YES NA NA NA 15,00,000 Guntur City 258/Al OUT OF 1890 Andhra Pradesh SFT Sanath Nagar, D.No.7-2- 114 SHARE YES NA NA NA 21,00,000 Hyderabad 1791 OUT OF 1691 Sft Veeru Castle, D.No.6-3- 1/4 SHARE YES NA NA NA 42,00,000 Punjagutta, 900/6 OUT OF 2800 Hyderabad Flat No. Sft 402 & 403 TOTAl 1,63,00,000

, ~'l~'.OU ~"3'{'

E'J\NEN\SIRISHA\(USU~A KUMAR! o AO\JO"AiE 8,H01~.RY "V GUNiUR 5th Line, Devapuram, Ce\\: 9603911172

18 I .'

~Ol~I~Q~ . ~ ANDHRA PRADESH 66AA 724863 :)~No. sSVl' tJt.20~ '/1 Rs.U)L... . P. MAHESWARA RAO f) - ] / _ jJ. L Vc I. . LICENCED STAMP VENDOR Sold to Sri/Srnt. :/(OJ(bJ ~il· ~~8ft/aJ"-~/6 e4")/ccr;eu L.No.: 07-32-007/2013 / - ~ _.. LJ' A L) I R.L. No: 07-32-011/2019 For Whom&",«! ,f(aJ? "eJ ~04 cn~t""'" Koritepadu, GUNTUR. "(7 Cell: 7416750124 I AFFIDAVIT

Elect1n to The House of People (Lok Sabha) from 14-Narasaraopet Parliamentary Consrtuency.

I, RAf'APATI SAMBASIVA RAO, son of RAYAPATI VENKATA RANGA RAO, aged 75 Years;resident of D.No.5-91-26, 4th Lane, Lakshmipuram,Guntur, Andhra Pradesh, a candidate at thtbove election, do solemnly affirm and state on oath as under:-

l' I have been allotted Govt. accommodation at C-1I20, PANDARA PARK, NEW DELHI-ll0003 during the period of last 10 years prior to the date of notification of the , current election, and there are no arrears of any dues to be paid towards Rent for the accommodationor any arrears to the agenciesproviding Electricity, Water and Telephone a at the said accommodationas on 19-03-2019.

2, "No Dues Certificates" from the agenciesconcernedagencies are attached hereto.~

~~ ~. ~'l·[j OEVINENf SrR'SHA KUSUMA KUMARI ADVOCATE & NOTARY 5th lint, Dewapuram,GONTUR Cell:"03811172

------.1L_ _ VERIFICATION

I, Rayapati Sambasiva Rao, the deponent, do hereby verify and declare that the above statements are correct to the best of my knowledge, and no part of it is false.

Verified at GUNTUR on this the 21st day of March 2019.

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l-e. (i) ;rrl/( ti) ;V\. J·o o-.CU"r.",/"')-' PARTIn

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 National Party/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) of that tribe.

Date: SIgnatureo~· ~f~~ (./__,~. . ------•

PART IlIA (To be filled by the candidate) (1) Whether the candidate--• (i) has been convicted- (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2), of section 8 of the Representation of the People Act, 1951 (43 of 1951); or ¥es/ No (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more.

2 .