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

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' A'b E Form 26 R Ryffh Trcr,.-, (See Rule 4A) 196G a" .-' 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) h 1 9)lq\\ '! 2931 KYtl^v'i D "Aw,*,i "-itc.....,,$ l"-.uv sh @t* h. ffi.-1...6)dt-.- ;el- - \ lrar fnf tdrap !'snrJorL D.ffcrf6, H'SAR , (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 ., , t l, (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) 4 \ (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 OR (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 (c) W hether any Appeal has been filed against conviction NA NA NA order (Mention YES 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. 6 t I ! 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 t/) 7 , (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 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.
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