' A'b E Form 26 R Ryffh Trcr,.-, (See Rule 4A) 196G

.-' a'b e Form 26 _r ryffh trcr,.-, (See rule 4A) 196g. t

Adv.)CS li; ,AR VIT TO BE FILE,D BY THE CANDIDATE ALONGWITH NOM INATION n?cd. tll. l'i: BEFORE THE RETURNING OFI'ICER FOR EI-ECTION TO ABHA FROM 4.HISAR CONSTITUENCY t" r61: \ PART A

I BHAVYA BISHNOI +tson/daughter/wife of KULDEEP BISHNOI Agcd 2-6 years, resident of 80. NEW ANAJ MANDI. ADAMPUR (mention full postal o s ), a candidate at the abovel election, do hereby solemnly affirm and state on + * under:- 35( ACvccate HiSAR (l a candidate set up byINDIAN NATIONAL CONGRESS RegC. Uc. r E,ip. Dt 1;!rl :FN the political party) / **am contesting as an Independent candidate. ra of .'t t V is not applicable) O,E \ trike out whichever (2) My name is enrolled in 47-ADAMPUR (Name of the Constituency and the state ). at Serial No 917 in Part No: 54

(3) My contact telephone number(s) islare 01662-244595 and my e-mail id (if any) is bbhavr' abishnoi @smail.com and my social media account(s) (if any) is/are

(i) Bhavya Bishnoi (Facebook page) (ii) Bhavya Bishnoi @bbhavyabishnoi (Twitter account)

( iii) Bhavya Bishnoi (lnstagram)

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(4) Details of Permanent Account Number (PAN) and status of filing of Income tax f return: Sl. No. Names PAN The otal income year for own in Income Tax Return(in which the upees) for the last five last Income- inancial Years completed (as tax return has 3l" March) been filed

Self -18 (i) 20t7 r 3.52.930.00 (ii) 201.6-t7 r I,r2,600.00 BDI ]PB55 2015- l6 (iii) C 28A 9,98,030.00 s) (iv) V: 2014-15 59,32,120.00

A4 cel.e I _l- #r, ;{ :. (v) NA n.^.! l.l l 2013-14 (i) Spouse NA 7!.'yt (ii) !,, 1, (] NA 'a })'^1, (iii) NA (iv) NA (v) NA (lf r- i) 3 H Lt F Candidate is NA K artrCoparcener) (ii) NA (iii) NA (iv) l NA I

(v) NA i) l 4 Dependent I NA .t rrl NA (r A NA ) NA iv) NA

(v) NA

2 , \

.5 Dependent 2 (i) NA NA

NA NA -l NA

NA (v) NA

. . (i) 6. Dependent 3. NA

NA NA NA

NA + /- NA Ad./o (v) b>Ll.IsAR * NA

Lip. EL 1"9? i for PAN holder to mention PAN and in case of no PAN. it should be \q 6ioa' ed "No PAN allotted"

(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) N' A OR

(ii) The following criminal cases are pending against me: N , pt

(If there 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

(a) FIR No. with name and address of

Police Station NA NA NA concerned

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(b) Case No. with Name of the Court NA NA NA

(C) Section(s) of concerned Acts/Codes involved (give no. of the NA NA NA Section, e.g. Section.,.....of IPC, etc.). 0 rl j- A. *1 (d) Brief description of 1- tii.r4,? ' offence NA N A ;rj : N&l * v-+-i (e) Whether charges have been framed a",i- i (mention YES or NA NA NA NO)

(f) If answer against (e) above is YES, then give the date on NA which charges were NA NA framed

l (g) W hether any A ppeaVA pplication for revision has been filed against the proceedings NA NA NA (Mention YES or NO)

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(6) Cases of conviction

(i) 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) .1.] . I

(ii) I have been convicted for the offences mentioned below: N . A

(Ifthe candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the Table below) J\l ' N

Table

(a) Case No. NA NA ./* (b) of the Name Court NA NA L N&:" I b (c) Sections of d. l.Jc. | 1a.r89 0i ililz I Acts/Codes involved (give no. of the riF NA NA Section, e.g. Section...... of IPC, etc.).

(d) Brief description of offence for which NA NA NA convicted

(e) Dates of orders of conviction NA NA NA.

(f) imposed Punishment NA NA NA

v1 5 I or No) t.r'p I r'r.* N,A (h) lIf answer to (g) above is YES, give details and present NA NA status of appeal I

a.p. i,L ie.L:l party about all p (6A) I have given full and uP-to-date information to my political given in paragraphs (5)' cases against me and about all cases of conviction as should clearly write NOT [candidates to whom this Item is not applicable ippl-rc,c,slB rN VIEW OF ENTRIES IN 5(i) and 6(i)' abovel

Note: 1. Details should be entered clearly and legibly in BOLD letters' columns against each 2, Details to be given separately for each case under different item. the latest case to be 3. Details should be given in reverse chronological order' i'e'' cases' mentioned first and backwards in the order of dates for the other 4. Additional sheet may be added if required' in compliance of Hon'ble 5. Candidate is responsible for supplying all information Supreme Court'i judgment in W' P (C) No' 536 of 2011'

and immovable etc') of myself' my (7) That I give herein below the details of the assets (movable spouse and all dePendents: A. Details of movable assets : will also have to be Note: l. Assets in joint name indicating the extent ofjoint ownership given.

Note:2.Incaseofdeposit/Investment,thedetailsincludingSerialNumber'Amount'dateof are to be given' deposit, the icheme, Name of Bank/Institution and Branch Note:3.ValueofBonds/ShareDebenturesasperthecurrentmarketvalueinStockExchange companics in respect of listed companies and as per books in case of nonlisted should be given. candidate or spouse and any N ote: 4. 'Dependent' means parents, son(s), daughter(s) of the marriage' who have no other person related to the candidate whether by blood or ."p**" a"un, of income and who are dependent on the candidate for their livelihood.

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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.

Iixplanation,- 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 ofall assets and liabilities in foreign countries'1

S. \o. Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3

(i) Cash hand in 1076181.15 NA NA NA NA NA

( ii) Details of deposit in Bank accounts (FDRs, Term Deposits and all other types of deposits including saving accounts), Deposits with Financial Institutions. Non-Banking Financial NA NA NA NA NA Companies and Cooperativesocieties and T 1-r the amount in each such deposit L . Advccaii, .$- Hi;/iR egd. ijo * C: ie-ai (iii ) Details of investment in i Bonds. Debentures/Shares in and units 1574810.00 NA NA NA (.i NAr NA companies/Mutual Funds and others and the amount.

_-+ + l (iv) Details of investment in NSS, Postal Saving, 600000.00 Insurance Policies and (HDFC investment in any Financial Life N,\ NA NA NA NA instruments in Post office lnsuranc or Insurance Company and e Policy) the amount

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(v) Personal loans/advance given to any person or entity including firm, company, Trust etc. and 76,115,18, NA NA NA 99 NA NA other receivables from dehtors and the amount.

( vi) Motor Vehicles/Aircrafts/ Yachts/Ships (Details of M ake, registration number. NA NA NA NA NA NA etc. year of purchase and amount ) (r ii) Jewelleiy, bullion and (give valuable thing(s) NA NA NA A AI caiu NA details of weight and value) ,.t ,qeSC lnj (viii) Any other assets such as 19r8.0 NA NA A NA value of claims/interest u + 1299020 '\{Li (ix) Gross Total value NA NA NA NA 9.73 ___l_,1

B. Details of Immovable assets:

Note: 1. Properties in joint ownership indicating the extent ofjoint 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 Dependent-1 Dependent-2 Dependent-3

(i)

L,ocation(s) NA NA NA NA NA NA Survey number(s) +- A rea (total measurement NA NA in acres) NA NA NA NA

(a) 8 I

Whether inherited property NA NA NA NA NA NA (Yes or No)

Date of purchase in case of self - acquired property NA NA NA NA NA NA

Cost of Land (in case of purchase) at the time of NA NA NA NA NA NA purchase Any Investment on the r of land by way NA NA NA NA NA NA development, construction etc. l A pproximate Current NA NA NA market value NA NA NA

Location(s) NA NA NA NA NA NA Survey number(s)

(total A rea measurement NA NA NA NA NA NA in sq. ft.) Whether inherited property NA NA NA NA (Yes or No) Date of purchase in case AR NA of self - acquired property NA NA NA .l c. l1i i c,c-i i I Cost of Land (in case of purchase) at the time of NA NA NA ( NA purchase

Any Investment on the land by way of NA NA NA NA NA NA development, construction A pproximate current NA NA NA NA NA NA market value

Shop (including apartments) and iDdustri NA NA NA NA NA -Location(s) al plot -Survey number(s) IL I

9 t/) A rea (total measurement in sq. ft.) 2500 NA NA NA NA NA

Built-up Area (total 24 1 3 NA NA NA NA NA measurement in sq.fi.) Whether inherited property Yes NA NA NA NA NA (Yes or No) Date of purchase in case of self - acquired property NA NA NA NA NA NA L Cost of property (in case of purchase) at the time of NA NA NA NA NA NA urchase Any Investment on the property by way of NA NA NA NA NA NA development, construction

A pproximate current NA NA NA NA NA market value (iv) (including apartments) -Location (s) NA NA NA NA -Survey number(s) ,.)rffi l$,."t1 .l Area (Total measurement * NA NA NA t\ dvcc .M \ NA in sq. ft) {*# tii I\R i .t (Total Built up Area NA NA NA NA so. ft.) \^\ry;; i,ll:lov, Whether inherited l measurement in sq. ft.) NA NA NA NA property

Date of purchase in case NA NA NA NA NA NA of self - acquired property Cost of property (in case l of purchase) at the time of NA NA NA NA NA NA purchase l Any Investment on the land by way of NA NA NA NA NA NA development, construction etc. I A pproximate current market value NA NA NA NA NA NA

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(v) (such as in Others interest NA NA NA NA NA NA property) Total of current market Lv,) value of (i) to (v) above 2t0!!1000 NA NA NA NA NA

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

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

Description pouse HUF Dependent-1 ependent-2 pendent- No. (D Loan or dues to Bank/F in an cia I

Name of Bank or NA NA NA NA NA Financial Institution, \s Amount outstanding, Advocats Nature of loan HISAR l,oan or dues to any 11.'' AL 1i-!:z,t other individuals/ ?" entity other than '). mentioned above. B6hnoi NA NA iNi \ NA NA

Name(s), Amount t'l8623t2. outstanding, nature of 50 loan Any other liability 58r02/- NA NA NA NA NA

Grand total of liabilities 792[1 NA NA NA NA NA

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lt ii) (A) Has the Deponent been C) Government Dues: in occupation of accommodation provided by the . tick the Government at any time during the last ate Dues to depaltments ten years before the date of notification ]ltemative ) NO dealing with of the current election ? Government (B) If answer to (A) above is YES the Na accom m odati on following declaration may be fumished namely : (i) The address of the Govemment accommodal ion : NA (ii) There is no dues payable in respect of above Govemmenl accommodation, towards : (a) Rent; N,A (b) Electricity charages; Jrl .p (c) Telephone charges as on J\1,6...1aate) 61,ft [the date should be the last date of the third month prior to the month in which the election is notified or any c date thereafterl. -\ Note - 'No Dues Certificate' from the agencies concerned 6 in respect of rent. electricity li :?::l'l * charges, water charges and No telephone charges for the L'ip. DL i above Government accommodation should be (rr submitted. N,n

iii) to department dealing r ith Govemment transport including aircrafts and NA NA NA NA NA NA icopters)

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Self pouse HUF ependent- I pendent-2 Dependent-3

iv) Income Tax dues NA NA NA NA NA NA

v) GST dues 5810 NA NA NA NA NA .32

(vi) M unicipal/Property tax dues NA NA NA NA NA NA

(vii) Any other dues NA NA NA NA NA NA l (viii) Grand total of all 58102 NA NA NA NA NA Govemment dues .32 l Whether any other l ix) liabilities are in dispute, if so. mention the amount NA NA NA NA NA involved and the authority before which it /- is nendins. '!:- Hl6AR ngd. )'f (9) Details of profession or occupation: ND. ,l:,83 D.1s.s.21./ (a) Self Businesman OF\ (b) Spouse NA

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

(a) Self Rentals and Interest

(b) Spouse: NA

(9B) Contracts with appropriate Govemment and any public company or companies

(a) details of contracts entered by the candidate NA

(b) details of contracts entered into by spouse NA

(d) details of contracts entered into by Hindu Undivided Family or trust in which thc

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candidate or spouse or dependents have interest NA

(e) details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners NA

(f) details of contracts, entered into by private companies in which candidate or spouse or dependents have share NA

(10) My educational qualification is as under:

M.Sc. Contemporary India in year 2015-16 from St' Antony

College, UniversitY of Oxford.

(Give details of highest School / university education mentioning the full form of the certificate/ diploma/ degree course, name of the School /Collegel University and the year in which the course was comPleted.)

o /Y j- L ACvomie ,,f I-IJgAR ?eqd. N.r. t1?89 k Ur 1ag! I

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PART - B

(r 1). ABSTRACT OF THE DETAILS GIVEN IN (T) TO (10) OF PART. A:

Name of the candidate Sh. Bhavya Bishnoi

2 Full postal address 80, New Anaj Mandi Adampur 3 Number and name of the (Haryana) constituency and State 4-Hisar

4 Name of the political party which set up lhe candidate (otherwise Indian National Congress 'Independent') wJite ,/a L 5. Total number of pending criminal \ CASES NA I ACvocaie which 6 Total Number of cascs in t lo. 11'j-89 NA 1 i ;,-..i. convicted PL 1$9? PAN of Year for which last Total Inco Income Tax Retum filed OF

(a) Candidate RDUPB5528A 2017-18 1352930.00 (b) Spouse NA NA NA (c)IluF NA NA NA (d) Dependent NA NA NA 8 etails of Assets and Liabilities (including offshore assets) in rupees

l) tion Self S SE H L,IF' dent- 1 endent-2 De t-3 Moveable Assets 13222'775 NA NA NA NA NA (Total value) 88 1- Immovable Assets B. 000000 NA NA NA NA NA

T Purchase Price of self -acqui red NA NA NA NA NA immovable property ll ['r Development/const ruction cost of immovable A NA NA NA NA NA property alter purchase (if I a licable) l5 t t

I It I Approximate Current M arket Price NA NA NA NA NA NA

(a) Self-acquired (Total assets NA NA NA NA NA NA Value)

(b) Inherited assets (Total Value) 5000000 NA NA NA NA NA 9 I-iabilities N.A N.A N,I N.A 'd (i) Government dues (Total) s8102.25 NA NA NA NA NA

(ii) Loans from Bank, Financial Institutions 17920414 NA NA NA NA NA and othe rs (Total ) .50 t0. Libilities that are under dispute N'A N.F N.A N'A N.A N A (i) I Govemment dues (Total) NA NA NA NA NA NA

(ii) Loans from Bank. Financial Institutions a n d NA NA NA N NA othe rs ( Total) NA *

I ighest educational qualification : Give details of highest School/University education mentioning the full rnt p Pdvo,-.ri', .H certificate/di plomir,/degree course, name of School/Collegefu niversity an ifie ear'tqc. ln Itl'e 6h c as completed.) M, ln India in I mS An lll rd. :..] r' o!: \\"

l6 VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents ofthis 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 ofconviction 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 lnl Part A and items 8. 9 and 10 of Part B above. c + )- rified at HISAR this the 22ND day of April 2019

HIS(R .& * Regd. No. ! 13189 !,:xp. Dt 1++21 D NI.]N1'

N uld be filed latest by 3.00 PM on the last day of filing nominations.

Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public. Note: 3. All columns should be filled up and no column to be left blank. If there is no information to 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 of the Affidavit should be signed by the deponent and the Affidavit should bear on each page the stamp of the Notary or Oath Commissioner or M agistrate before whom the Affidavit is sworn.

C,.:i:f,..| iitat ihe abcve rvas declare c:fh befcre va me on t!:j.;22.n1.. day of :,J 1 ,3r h,lJAil in i ir? !-ii:::ii:)ic c{lofr\I Airrotci lVho _c (_ 't, lnno N iSAR t 1i1; 1y;,o makeinE thereof 0\ I 1,7

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