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TAMIL NAPU 1 290 (if • ccTAMIL NADU AFF1DAV E FttilR4014F DIDATE ALONG WITH NOMINATION PAPER BEFORE THE RETURN! ieRTAFA TO FROM 08.VELLORE CONSTITUENCY PART A AC

S.SHANII UGAM son of SATHIYAKUMAR and aged 47 years, resident of No.07, 3rd street, Sriram nagar, Phase-Ill, Vallalar, Sathuvachari Vellore-632009, a candidate at the above election, do hereby solemnly affirm and state on oath as under:-

I am a candidate set up by INDEPENDENT

(- - • . • / **am contesting as an Independent candidate. My name is enrolled in 08. Vellore , Parliamentary Constituency, Tamilnadu State at Sella! Number 1055 in Part Number 203 of No.43, Vellore Assembly Constituency.

(3) My corfact tele hone number is 9787275259 and my e-mail id---- NIL. And my social media account is (i).....NIL... (ii).....NIII.. r- (iii).. ..NIL...

(3\r.,‘ V. NATANASIGAMANI, B.Com., rAtk-'' c,,o.•‘•,,,„,r1. ADVOCATE NOTARY PUBLIC - Govt. of India I-4( itVO‘tildiA.10 FORMER ADDL. PUBLIC PROSECUTO 5 No. 31/118A, Anna! Theresa 2nd Stre 02.-ZZ Phase - Ill, TNHB, Sathuvachari, r VB-02" 0:1$ VELLORE - 632 009, Veliore District. f o 4) Details of Permanent Account Number (PAN) and status of filing of Income tax return:

SI. No. Names PAN The Total income financial shown in Income Tax year for Return(in which the Rupees) for the last five last Financial Years Income- completed (as on tax return march) has been filed 2016-17 Rs.102720/-

2017-18 Rs.220840/- 1. ...NIL... S.SHANMUGAM DTVPS09 I ON 2018-19 Rs.305060/- ...NIL...

...NIL... Not applicable 2. No Not applicable S.MANJULA pan alloted Not Not applicable applicable Not applicable Not applicable Not applicable

Not Not Not applicable 3. HUF (If Candidate is applicable applicable Karta/Coparcener) Not applicable Not applicable

Not applicable

Not applicable

Dependent 1 Not Not applicable applicable Not 4. S.Pradesh (son) applicable Not applicable Not applicable

Not applicable (i) Not applicable n

2

h t AR 14

V. NATANASIGAMANI, B.Com., ADVOCATE NOTARY PUBLIC - Govt. of India FORMER ADDL. PUBLIC PROSECUTOR No. 31/118A, Annai Theresa 2nd Street, Phase - III, TNHB, Sathuvachari, VELLORE - 632 009, Vellore District. -411-

Not applicable 5. Dependent 2 Not Not applicable applicable Not S.Devanand (son) applicable Not applicable Not applicable

Not applicable

Not applicable Not 6. Dependent 3... applicable Not Not applicable applicable Not applicable

Not applicable

Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly stated No PAN allotte (5) Pending criminal cases

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 The following criminal cases are pending against me:

(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

FIR No. with name Not Not Not applicable applicable applicable and address of Police Station concerned

Case No. with Name Not Not Not applicable applicable applicable of the Court

v,1;7 3 NC)-1Mt3

V. NATANASIGAMANI, B.Com.,B.L, ADVOCATE NOTARY PUBLIC - G.syt. of India 4/41,41,, FORMER ADDL. PUBLIC PROSECUTOR Yti 104. No. 31/118A, Anna i Theresa 2nd Street, r—ito04,0,0. Phase - III, TNHB, Sarhuvachari, VELLORE - 632 009, Vellore District- N 441/44Pstleit.' \O Etoof 4°- to 47; x to.. in19-0,,Po e .-08.204-0015. Section(s) of concerned Acts/Codes involved (give noofthe Not applicable Not applicable Not applicable Section,e.g.Section of IPC, etc.). Brief description of offence Not applicable Not applicable Not applicable

Whether charges have been framed (mention YES or NO) Not applicable Not applicable Not applicable

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

(g) Whether any Appeal/Application for revision has been filed against the proceedings Not applicable Not applicable Not applicable (Mention YES or NO)

(6) Cases of conviction 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

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)

TABLE

Case No. Not applicable Not applicable Not applicable

Not applicable Not applicable Not applicable Name of the Court

Sections of Acts/Codes involved (give no. of the Not applicable Not applicable Not applicable Section, e.g. Section of IPC, etc.).

4

elf)11

V. NATANASIGAMANI, B.Com.,}31.9 ADVOCATE NOTARY PUBLIC - Govt. of India FORMER ADDL. PUBLIC PROSECUTOR No. 31/118A, Annai Theresa 2nd Street, Phase -10, TM-1B, Sathu-vachari, VELLORE - 632 009, Vellore District.

Brief description of offence for which Not applicable Not applicable Not applicable convicted

Dates of orders of conviction Not applicable Not applicable Not applicable

Punishment imposed Not applicable Not applicable Not applicable Whether any Appeal has been filed against conviction order (Mention Not applicable Not applicable Not applicable YES or No)

If answer to (g) above is YES, give details and present status of appeal Not applicable Not applicable Not applicable

(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). [candidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), above]

Note: Details should be entered clearly and legibly in BOLD letters. Details to be given separately for each case under different columns against each item. 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. Additional sheet may be added if required. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court's judgment in W. P (C) No. 536 of 2011.

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

A. Details of movable assets:

Note: I. 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 Bank/Institution and Branch are to be given.

V. NATANASIGAMANI, B.Com.,13.1.1 ADVOCATE NOTARY PUBLIC - Govt. of Inella FORMER ADDL. PUBLIC PROSECUTOR No. 311118A, Annai Theresa 2nd Street Phase - III, TNHB, Sathilvachari, VELLORE - 632 009, %Wore District.

•

Note: 3.Value of Bonds/Share Debentures as 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.

Explanation,- 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 of all assets and liabilities in foreign countries';

S. No. Description Self Spouse HUF Dependent- Dependen Dependent-3 1 t-2

Cash in hand 30,000.00 15,000.00 Not -NIL-- -NIL-- Not applicable applicable Details of deposit in Bank accounts (FDRs, Term Deposits and all other types of deposit including saving -NIL-- accounts), Deposits with -NIL-- Not -NIL-- -NIL-- Not Financial Institutions, applicable applicable Non-Banking Financial Companies and Cooperative societies and the amount in each such deposit

Details of investment in Bonds, Debentures/Shares andunits in companies/Mutual Funds --L--NI -NIL-- Not -NIL-- -NIL— app licaebl Not and others and the amount. applicable

6

\r)i T.44 4. V. NATANASIGAMANI, B.Com., ELL, ,A\ ADVOCATE NOTARY PUBLIC - Govt. of India 1* V NATANASIGAMANI FORMER ADDL. PUBLIC PROSECUTOR B.Corn., B.L., 1 No. 31/118A, Annai Theresa 2nd Street, VELLORE,VELLORE DISTRIO, Phase - III, TNI-1B, Sathuvacnari, TAMIL NADU Reg. No. VELLORE - 632 009, Veliore District. 10970 From: 19-02-2015 7 )• ,ovv 0 F I" •

Details of investment in NSS, Postal Saving, LIC POLICY Insurance Policies and NO.736729708, 736729709, -NIL-- Not -NIL-- -NIL-- Investment in any Not Financial instruments in 736729710, applicable 737336257, applicable Post office or Insurance 737336258, Company and 737336259, the amount 737336260, 737336261, RS.2,76,264.00 Personal loans/advance given to any person or entity including firm, Not company, Trust etc. ancl-NIL-- -NIL-- Not -NIL-- -NIL-- applicable other receivables from applicable debtors and the amount.

Motor Vehicles/Aircrafts/ TN23AM6654 TVS Yachts/Ships (Details ofscoury 201! . Make, registration number. R S 38,000/- --NIL-- - Not -NIL-- Not applicable etc. year of purchase and applicable --NIL-- amount ) Jewellery, bullion and Valuable thing(s)(give Not applicable details of weight and value) N -NIL-- IL-- --NIL-- Not --NIL-- applicable

Any other assets such as value of claims/interest --NIL-- Not -NIL-- Not applicable --NIL-- --NIL-- applicable

Not --NIL-- applicable Not applicable Gross Total value -NIL-- 3,44,264.00 15,000.00

B. Details of Immovable assets:

Note: I. 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-.isc-tee) LA" ti":1 411- 7 V 1r) I 14) 00 r V. NATANASIGAMANI, B.Com., ADVOCATE if. ,A- NOTARY PUBLIC - Govt. of India filfs4S113011111 FORMER ADDL. PUBLIC PROSECUTOR VEItORE 13-Corl . .46 No. 31/118A, Annai Theresa 2nd Street, r' lftliORE 13.4 Phase - III, ThHB, Sathuvachari, fi 4140/787R16; VELLORE - 632 009, Veilore District. Froni..1°. 10970 TO: /8.n9,,"°2-2015 OF S. No Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3

(I) Agricultural Land Location(s) --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable Survey number(s) Area (total measurement in acres) --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Whether inherited property --NIL-- Not applicable --NIL-- Not applicable (Yes or No) --NIL- --NIL--

Date of purchase in case of self- acquired property --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Cost of Land (in case of purchase) at the time of --NIL- --NIL-- Not applicable --NIL-- Not applicable purchase --NIL-- Any Investment on the land by way of --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable development, construction etc. Approximate Current market value --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Whether inherited property --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable (Yes or No)

Date of purchase in case of self - acquired property --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Cost of Land (in case of purchase) at the time of --NIL- --NIL-- Not applicable --NIL-- --NIL-- Not applicable purchase Any Investment on the land by way of --NIL- --NIL-- Not applicable --NIL-- NIL-- Not applicable development, construction etc. Approximate Current market value --NIL- --NIL-- Not applicable --NIL-- NIL-- Not applicable

8 5 -s ih‘ts14-1/"--

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V. NATANASIGAMANII 8.com., ADVOCATE NOTARY PUBLIC Govt. of India FORME ADDL. PUBLIC PROSECUTOR No. 311118A, Annal Theresa 2nd Street, Phase - III, TNHB, Sathuvacharin VELLORE - 632 009, Vellore District. --411,

Non-Agricultural Land

Location(s) --NIL- --NIL-- Not applicable --NIL-- NIL-- Not applicable Survey number(s) Area (total measurement in sq. ft.) --NIL- --NIL__ Not applicable NIL-- NIL-- Not applicable

Whether inherited property --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable (Yes or No)

Date of purchase in case of self- acquired property __ NIL____NIL-- Not applicable --NIL-- --NIL-- Not applicable

Cost of Land (in case of purchase) at the time of --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable purchase

Any Investment on the land by way of --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable development, construction etc. Approximate current market value --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Commercial Buildings

(including apartments) --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable -Location(s) -Survey number(s)

Area (total measurement in sq. ft.) --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Built-up Area (total measurement in sq.ft.) --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Whether inherited property --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable (Yes or No)

Date of purchase in case of self- acquired property __ NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

9

vc\ rv,9

0 0 V. NATANASIGAVIANI, ADVOCATE 41474114siGo NOTARY PUBLIC Govt. oi India PELlokt aco irf4Ati FORMER ADDL. PUBLIC PROSECUTOR ' VELLOR 41*. 8•L , 311118A, AnnW Theresa 2nd Street, T14444;DIST Rkl; 940. U • No. Phase - til,Sathotachad,DiSifiCi. tom: /9 1o970 - 632 009, Vellore To • VELLORE ' 18-o2.Roz 2°o1 5 OF 10 •

Cost of property (in case of purchase) at the time of Not applicable --NIL-- Not applicable purchase --NIL-- --NIL-- --NIL-- Any Investment on the property by way of Not applicable --NIL-- Not applicable development, construction --NIL-- --NIL-- --NIL-- etc. Approximate current market value --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable (iv) Residential Buildings (including apartments): --NIL-- Not applicable --NIL-- Not applicable -Location (s) --NIL-- --NIL-- -Survey number(s) Area (Total measurement in sq. ft) --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Built up Area (Total measurement in sq. ft.) --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Whether inherited property --NIL-- --NIL-- Not applicable --NIL-- Not applicable (Yes or No) --NIL-- Date of purchase in case of self— acquired property --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Cost of property (in case of purchase) at the time of --NIL-- Not applicable --NIL-- Not applicable purchase --NIL-- --NIL-- Any Investment on the land by way of --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable development, construction etc. Approximate current market value --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

s

10

V. NATANASIGAMANII B.Com., B.L., ADVOCATE NOTARY PUBLIC • Govt. of India '4o *7-1 FORMER ADDL. PUBLIC PROSECUTOR 16, No. 31/118A, AfInai Theresa 2nd Street, Phase - III, TNHB. Sathuvacnari, VELLORE - 632 009, Veilore District. 410RE,1,- gZG cito, ,411,a/1z 41/ ivo 097 )k 015 vRO I IS Others (such as interest in property) --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Total of current market value of (i) to (v) above --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

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

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

S. Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3 No. (i) Loan or dues to Bank/Financial --NIL-- --NIL-- Not applicable --NIL-- Not applicable Institution(s) --NIL-- Name of Bank or Financial Institution, Amount outstanding, Nature of loan

Loan or dues to any Other individuals/ --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable Entity other than mentioned above. Name(s), Amount outstanding, nature of loan

Any other liability --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

Grand total of liabilities --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable

\to-A NN) 11

NATANASIGAMANI , B.Com.,B.L, ADVOCATE NOTARY PUBLIC- Govt. of India TIMMER ADDL. PUBLIC PROSECUTOR Nr, 31/118A, Annai Theresa 2nd Street, Phase - III, TNIHB, Sathuvachari, VILLORE - 632 009, Vellore District. (ii) Government Dues: (A)Has the Deponent been in occupation of YES/NOV accommodation provided by the Government at (P1. tick the Dues to departments any time during the last ten years before the appropriate dealing with date of notification of the current election ? alternative) Government accommodation (B) If answer to (A) above is YES, the following declaration may be furnished namely:-

(i) The address of the Government accommodation:

NO NO NO

(ii) There is no dues payable in respect of above Government accommodation, towards-

rent;

electricity charges; water charges; and telephone charges as on (date)

[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) Dues to department dealing with Government transport __ NIL----NIL-- Not applicable __NIL__ --NIL-- Not applicable (including aircrafis and helicopters)

12 c\rrAit,

acorn.,B.L. V. NATANASIGAMANI, ADVOCATE - Govt. ol India NOTARY PUBLIC PORMER ADDL. PUBLIC PROSECUTOR No. 31/118A, Annai Theresa 2nd Street, Phase - Ill, TNHB, Sathuvachari, VELLORE - 632 009, Veliore District Self Spouse HUF Dependent-1 Dependent-2 Dependent-3

Income Tax dues

--NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable applicable GST dues

--NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable applicable

Municipal/Property tax dues --NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable applicable Any other dues

--NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable applicable Grand total of all Government dues --NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable applicable

Whether anyother liabilities are in --NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable dispute, if so, mention applicable the amount involved and the authority before which it is pending.

(9) Details of profession or occupation:

Self— Insurance agent

Spouse-NIL

(9A) Details of source(s) of income: Self-3,05,060.00 Spouse - NIL Source of income, if any, of dependents NIL

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

(a) details of contracts entered by the candidate NIL

13 SN'

G1.N1 k-S

V. NATANASIGAMANI, ADVOCATE 44,f„ NOTARY PUBLIC - Govt. of India "4gCA 1/47 49. FORMER ADDL. PUBLIC PROSECUTOR Co`Wittitt No. 31/118A, Annai Theresa 2nd Street, A- 9. Iv it 4/40 b/st0 ti •c •,. Phase - DL TNHB, Sathuvachari, /go 0,9,>0 • VELLORE - 632 009, Vellore District.

0P 101) details of contracts entered into by spouse NIL

details of contracts entered into by dependents NIL

details of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest NIL

details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners NIL

details of contracts, entered into by private companies in which candidate or spouse or dependents have share NIL

(10) My educational qualification is as under:

SSLC-1987 Govt.Hr.Sec School, Sathuvachari .

(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.)

PART — B

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

I. Name of the candidate S.SHANMUGAM

Full postal address No.07, 3' street, Sriram nagar, Phase-III, Vallalar, Sathuvachari Vellore-632009 Number and name of the Vellore , Parliamentary Constituency, Tamilnadu constituency and State Name of the political party INDEPENDENT which set up the candidate (otherwise Total number of pending ---- NIL--- criminal cases

Total Number of cases in ---- NIL--- which convicted NAME PAN of Year for which last Total Income Shown Income Tax Return filed

(a) Candidate 2018-19 3,050,60.00 DTVPS0910N 14

& (4 tsi 0 V. NATANASIGAMANI, B.Com., Big ADVOCATE NOTARY PUBLIC - Govt, of India FORMER ADDL. PUBLIC PROSECUTOR No. 31/118A, Annai Theresa 2nd Street, Phase - HI, TNHB, Sathuvachari, WLLORE - 632 009, Vellore District. (b) Spouse --NIL-- --NIL-- --NIL-- (C) HUF --NIL-- --NIL-- --NIL-- (d) Dependent --NIL-- --NIL-- --NIL-- 8. Details of Assets and Liabilities (including offshore assets) in rupees

Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3 Moveable Assets (Total value) 38000/- --NIL-- Not applicable --NIL-- --NIL-- Not applicable Immovable Assets

--NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable I Purchase Price of self-acquired --NIL-- --NIL-- Not applicable --NIL-- Not applicable immovable --NIL-- property II Development/const Ruction costof Not applicable --NIL-- Not applicable immovable --NIL-- --NIL-- --NIL-- property after purchase (if applicable)

III Approximate Current Market --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable Price

(a)Self acquired assets (Total Value)

9. Liabilities --NIL-- --NIL-- Not applicable --NIL-- --NIL-- Not applicable Government dues (Total) --NIL-- __NIL__ Not applicable __NIL__ --NIL-- Not applicable Loans from Bank, Financial --NIL-- __NIL__ Not applicable __NIL__ --NIL-- Not applicable Institutions and others (Total)

10. Liabilities that are under dispute —1\A I-- —

1(C;I-Liv•-kr1)1 h \Ai 0 TA ‘V V. NATANASIGAMANI, ADVOCATE NATA NOTARY PUBLIC - Govt. ot India RASIGAMANI\ B.Corn. POKER ADDL. PUBLIC PROSECUTOR VELLORE, *CLO No. 311118A, Annai Theresa 2nd Street, RE DISTRICT, TAMIL NADU Phase - Ill, TNHB, Sathuvachari, Reg. / No. 1097a VELLORE - 032 009, Vellore District. From:19-0 4. 2-20-15 To: 18-02-2020 )1 0 Government dues (Total) --NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable applicable Loans from Bank Financial --NIL-- --NIL-- Not --NIL-- --NIL-- Not applicable Institutions and applicable others (Total) 11. Highest educational qualification: SSLC-1987 Govt.Hr.Sec School, Sathuvachari.

(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.) VERIFICATION

I, 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:-

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;

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 Vellore this the 18th day of July-2019 - DEPONE

B Com B Note: I. Affidavit should be filed latest by 3.00 PM on the last daYonbilliggigleNI / ' " .L" AD TtlAIRAtjYri;sU. BoLdiin -cc GwoytsiosfEIcnduiTaoR Note: 2. Affidavit should be sworn before an Oath Commissioner osLOt Class or before a Notary Public. No. 31/118A, Annai Theresa 2nd Street, Phase - III, TNHB, Sathuvachari, Note: 3. All columns should be filled up and no column to be NEtLIAiik.- Mg-1We, Neli8re District. 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 Magistrate before whom the Affidavit is sworn.

16 o T.44,

'V MAT

V. NATANASIGAMANI, VELLORE, VELLORE DISTRICT, ADVOCATE TAMIL NADU NOTARY PUBLIC - Govt. of India Reg. No. 10970 FORMER ADDL. PUBLIC PROSECUTOR C')\ From:19-02-2015 No. 31/118A, Annai Theresa 2nd Street, Ze Phase - Ill, TNHB, Sathuvachari, VELLORE - 632 009, Vellore District. , • ; • NOTARY CERTIFICATE

Be it known and made manifest (Unto all people) that on I R. °D• W1 at

Vellore, Vellore District, V.NATANASIGAMANI, B.Com., B.L., Advaocate, NOTARY

PUBLIC, Registration No.10970, dated 19-02-2015, appointed by the GOVERNMENT

OF INDIA, under NOTARIES ACT 1952 (53 OF 1952) to practice in Vellore, Vellore

District, State of Tamil Nadu; duly authorized admitted and sworn subject to the provisions under Rule 8(4) of the NOTARIES RULE 1956.

I DO HEREBY CERTIFY THAT; Deponent personally appeared before me, described in the affidavit as Mr/Mils S • .S irloktAveiv C4A 51,0 S ATA-4 y A kli 0041..

Deponent and he/she deponed in my presence and signed his/hefitheic after knowing the contents of this affidavit having been read over the explained to the deponent who seemed perfectly to understand it or acknowledged that he/she/their signed the same a free-will.

This instrument is intended to take effect within Vellore, Vellore District, Tamil

Nadu.

NOTARIAL REGISTER BOOK In Volume No.I , Page No: 3 , Serial No: 13

According to Central Act for Centra / State Government Notary Adhesive Stamp Value for

Rs.10/- is sufficient complied, and Notaries stamp duty on the instruments. IN

TESTIMONY WHEREOF I have hereunto set my hand and seal of the office at Vellore,

Vellore, Vellore District on k i? • • ?-A

i\ctirml

a.corn.,131., V. NATANASIGAMANI, ADVOCATE Govt. of India NCTARY Pueue . FORME; ADDL. PLISLIC PROSECUTOR o !-nerssa 2nd Street, No. 311116A, Satrittvachari, Phase - VELLORE - 632 009, Veilore District