Rs,.100 ''' ONE 1.00 r-rtJNonEoRUPrrs
*o6*Fd6'.yr*r styr ANDHRArRADESH x 961383 a6/--- $or' 10 ,q, $.T"KftTESILVARA fiilAO I"lcencedSlomp troR Vendof wHoM$ K. Ffr\VE{"f,KF{AMMA'M
$ Affidavit to be furnished by candidate along with nomination paper Before the Returning Officer
for election to
from lL2 - Khammam ConstituencY
I, JALAGAM VENKAT RAO, S/o Late Shri JALAGAM VENGALA RAO { Aged 4lYears, resident of H.No. 6-l-3411, VDO's Colony, Khanapuram Haveli Panchayath,Khammam Urban Mandal, Khammam., candidateat the H aboveelection, do herebysolemnly affrrm and stateon oath as under:- H 1ul"Ls: ,Rs.100 ONE s. 100 HUNDREDRUPEES:.
*odd-Sd8 err*rytvr ANDHRArRADESH x 961384 51.ftc,c&*].q *[rl - kA-"- -, [T.KOTESWARA RAO soLDo !".^x^fr)y.,*>l"ois^**--"-Rn..*lel Au d+9-l^ffg-€^b. LrcencedStomp Vendof sOR WHOfVH.-^.","rW.q..o-..*E gtp d^--'-;^-- K. I"{AVELI,KHAMMATS
hasbeen taken by the court:-
(D Section of the Act and description of the offence for which cognizance taken : - Not Applicable-
(iD The Court which has taken cognizance: -
(iii) CaseNo. ; -
(iv) Date of order of the Court taking cognizance:
(v) Details of appeal(s)/ application(s)for revision, etc.oif any, filed againstabove order taking cognizance: _
(2) That I give herein below the detailsof the assets(immovable, movableo bank balance,etc.) of myself my spouseand dependents*: ./' il, / It )YC'cr.=- lvl
*"H.^t'.Y,:ii:rlfi5tqKrSHnfir ' A. Details of movable assets.
(Assetsin joint name indicating the extent of joint ownershipwill also have fo he ven Dependent-2 Dependent-3 Sno Description Self Spouse(s) Dependent-1 Name(s) Name Name Name Smt. J. Vnni J. Vengala Rao (1) Cash 8.75.500.00 1,76,500.00 (iD Depositsin 91,966.55 1,26,211.08 Banks,Financial (See At SBH, Institutions and attachment- Panjagutta, Non-Banking 2-S.no(ii) Branch,Hyd- Financial Alc Number Companies 52086597656 (iii) Bonds, 64,52,760.00 33,30,300 Debenturesand (See (See Shares in attachment- attachment-l- companies 2-S.no(iii) S no.(iii) (iv) OtherFinancial 4,69,923.51 3,48,740 Instruments (See (See NSS, Postal attachment- affachment-l- Savings, LIC, 3-S.no(iv) S no.(iv) Policies.etc. (v) Motor Vehicles 27,50,000.00 (details of (See makeoetc.) attachment- 3-S.no.(v) (vD Jewellery (give details of 4.35.000.005,65,000.00 weight and value) (viD Otherassets, 49,48,000.00 such as values (See of claims/ attachment- interests 3.S.no.(vii)
Note : Value of Bonds / Shares / Debmtures as per the latest market value in Stock Exchangein respect of listei companiesand asper boola in the case of non listed companiesshould be given.
*Dependenthere meansa personsubstantially dependents on the income of the candidate. tulb'= B. Details of Immovable assets
[Note : Properties in joint ownership indicating the efrent of joint ownership will ako have to be indicatedJ
Spousc(s ) Name(s) Smt J Vani AgriculturalLand - Location(s) - Surveynumbe(s) -Exten(Totalmeasurement) - currentmarket
- Location(s) - Surveynumbe(s) -Extent(Total measurement) - currentmar{ - Survey/ doornumbe(s) 6-3-347122 -Extent(Total measurement) 16,000sft - currentmarket value 5,60,00,000/- 1 (3) I give herein below the detailsof my liabilities / over duesto public linanoial institutionsand governmentdues :- [Note: Pleasegive separate detailsfor each itemJ Name and addressof Sno Description Bank Financial Amount Outstandingas on Institution(s) / 28.02.2009 Department(s) (a)(D Loans from Banks Syndicate Bank. Rk Mutt Rs.11,73,391.02 Branch, Hyderabad HSBC Bank, Banjara Rs.85,54,845.64 Hills Branch,Hyderabad HDFCBank, Lakdikapul Rs.3,29,381.53 Branch,Hyderabad Loans from financial VJ Financial ServicesRs.73,69,338.00 Institutions Private Ltd, Alexender road,Secunderabad (iD Govemment dues (other than income tax and wealth tax) Nil Nil (No Due Certificate to be enclosedin case holding or having held any public office) (b)(D IncomeTax including surcharge[Also indicatethe 3t .03.2008 assessmentyear up to which Nil Income Tax Retum filed. ACFPJ7033D Give alsoPermanent Account Number(PANI (iD Wealth Tax [Also indicate N/A Nil the assessmentyear up to which Wealth Tax retum filed.l (iii) SalesTax [Only in caseof Not applicable Nil proprietarybusinessl (iv) PropertyTax Newly consfucted Nil Buildine tuLr"> * 23AA482384 - ithz' IT.KOTESWANA RAC'" UcencedSfomp Vendo K. HAVELI,KHAMMAI$ (4) My educationalqualifications axe as under :- (GIVE DETAILS OF SCHOOLAND UNIVERSITY EDUCATION) (Nameof School/ Universityand the year in which the coursewas completedshould alsobe given.) School:Hyderabad Public School,Begumpet, Little FlowerHigh School,St.AndrewsHigh school,St.peter High school,Hyderabad. College:Intermediate at LayolaAcademy,Alwal University:Studied towards B.S.Computers at Universityof Maryland, Maryland-USA tu DEPONENT VERIFICATION I, the deponentabove named, do herebyverif and declarethat the contentsofthis affidavit are conect to the best of my knowledge and belief; no part of it is false and nothi l;"+.",t! has beenconcealed there from. l-'\. , thisthe 3",*q dayofrncvc\2O$. lvV^- DEPONENT Attachment-L (i) a) Agricultural Land: Location(s) Turkayamjal Surveynumber(s) 49012,493 12, 494 12, 5 l0 12,5ll 12,51212 -Extent (Total Measurement) 5.14Acrs CurrentMarket Value 2,14,00,000/- b) Agricultural land: Location(s) Penuballi Surveynumber(s) 2l513,2l4ll, Extent (Total Measurement) 3.30Acrs CurrentMarket Value 2.10,000/- luW*- Attachment-2 Detailsof MovableAssets of Sri. JalasamVenkat Rao as on28.02.2009 Detailsof S No (ii) I S B A/c no 104482 Statebankof Hyderabad, Rs. 55.89 Paniagutta Branch, Hyderabad- 8 2 2 S B A/c no 081159915 Rs.8.157.42 HSBC Bank Ltd, BanjaraHills Branch,Hyderabad-82 J S B A/c no 02020100254 Rs.70.005.24 ICICI Bank Ltd, Panjagutta Branch,Hyderabad-82 4 S B A/c no 52088488023 StateBank of Hyderabad, Rs.13,748.00 SecrekriatBranch. Hvderabad Total Rs.91.966.55 Detailsof S No (iii) I Sharesin VJIL Consulting.l-8- 165,Usha Kiran, S D Road, Rs.63,02,760.00 Secunderabad-3 No of Shares6,30,276 @l0l each 2 Sharesin Dyna Lampsand Glass WorksLtd, 35, Nungambakkam Rs. 1.00.000.00 High Road,Chennai-600034 No of Shares10,000 @l0l each J Sharesin GlobalTrust Bank Ltd, S P Road,Secunderabad-3 Rs. 2,000.00 No of Shares200 @l0l each 4 Sharesin VJ FinancialServices PrivateLtd, AlexanderRoad, Rs. 48,000.00 Secunderabad-3 No of Shares4800 @10/ each Total Rs. 64.52.760.00 luW* "ftJM Attachment-3 Detailsof MovableAssets of Sri. JalagamVenkat Rao as on28.02.2009 Detailsof S No (iv) I LIC PolicvNo: 60681333 Rs.3,00,000.00 2 PPFA/c no 30 at StateBank of Hyderabad-Panj agutta Branch, Rs.1,69,923.51 Hvderabad-40OO82 Total Rs.4.69.923.51 Detailsof S No (v) I Innova Car Rs. 8,00,000.00 2 Civic Car Rs.11.50.000.00 J SkodaFabio Rs. 8,00,000.00 Total Rs.27.50.000.00 Detailsof S No (vii) I ShareApplication Money Invested Rs. 2,23,000.00 in V J FinancialServices P\4 Ltd. AlexenderRoad. Secunderabad-3 2 Amountinvested in Jayashree Rs.28,50,000.00 Gardens,Jullapally Village, TalakondapallyMandel, Mahaboobnasar a J AmountInvested In SansadVihar Rs.11,75,000.00 Co-OperativeGroup Housing SocietyLtd, JH-22,Havz Khas, NewDelhi-l10016 4 Amountinvested in Pragathi Rs. 2,00,000.00 Resorts,Near Ramoji Film City,Kheda,Hyd 5 AmountInvested in openplot-in Rs. 5,00,000.00 MLA,S Colony Total Rs.49.48.000.00 lvWy: Attachment-1 'Detailsof MovableAssets of Smt.Jalagam Vani as on28.02.2009 Detailsof S No (iii) I Sharesin VJIL Consulting.l-8- 165,Usha Kiran, S D Road, Rs.29,39,000.00 Secunderabad-3 No of Shares2,93,900 @l0l each 2 GrasimIndustries 100 a J MontariIndustries 200 4 Ranbaxy ll4 5 TataSteel l0l2 6 L&T 40 7 RECLTD IOO 8 SAIL 50 9 UnionBank 100 10 VGUARD IOO MARKETVAVUE AS ABOVE Rs. 3.91.300.00 Total Rs.33.30.300 .00 Detailsof S No (iv) I LIC PolicvNo: 644429496 Rs.2.00.000.00 2 PPFA/c no 238 at PostOffice Kachigua,Hyderabad Rs.1,48,740.00 Total Rs.3,48,740.00 lv[L.o t I 1 100 I'IUNDREDRUPEES INDIA ANDHRAPRADESH x 951385 eroQFdF Tostvr kA.t-' K. KOTESIrARARAg sL.rto tt&S" LtcencedStomp venooc) '10 c--\" \uW>- pu."#u*u'n Signatureofdeponent 1[P.g*:9:: Form Of Oath Affirmation [Article 173(a)of the constitutionof India] (To be madeby a candidatefor electionto the legislatureof a state) t -Irfaqo'n 1/anraF +aD havingbeen nominated as a candidateto fill a IIY'kA*wiu',* seatin-iiJ'Andhr.. P*ausb StoFelegislative assemblydo swear in the name of the God solemnly affirm that will bear true faith and allegianceto the constitution of India as by law establishedand that I will uphold the sovereigntyand integrity of India. 7rW,y (Signatureand name in block Letters Of the candidate) Swornin the nameof god solemnlyaffirmed by Shti \a^Q_oq** lor^Coftt o ar p$6f9*v^e* A, U, o{--(;e-r. at..Il;ls Atllhour) this q{o*v_cA^ . The R o \.t dayof AaoJbeforeme. (Certificatefor receiptof oath) (To be handedover to candiedby the authorizedperson) Certifiedthat (name) a Candidatefor election to the Legislative Assembly has made and subscribedthe oath of Affirmationas required by the constitutionof India beforeme at my office at (Hour) On (Date). (Signatureof authorizedperson) Name,Designation and seaL Date.. *Scor" out whichis not applicable. N.B: This form shouldbe suppliedto the candidatesboth in Englishand in the official Languageof the state. 1*FORM-zB , (sEE RULE4) ruOMINATIONPAPER Election to the Legislative Assembly of ....Andhw ^ SIRiKE OFF PARTI lxn OR PARTII BELOWWHICHEVER IS NOTAPPLICABLE pARrl t\lv/ I h/ V ffo be usedby candidatesefup by recognizedporiticar party) I I nominate as a candidate for Electionto the LegislativeAssembly v/,$n-- \ r ^ .."...'...... -; from the "--'r4il3'tstsl!"'i""""."' Assembly constituency. candidate,s ffi": [Father'srmoirilr'rd;;;;;;,sname] \1"4flffwq His name is entered at S.No in Part No.... .Assembly co-nstituency.My nur.' ;; and it is enteredat S. No...... in partNo.... electoralroll for the,...... :...... ofthe ,t.,...,.... Assemblyconstituenoy. Date.. Signatureof theproposer from the '|J.'...vr4Alh(\r....Ttso. -hu€bafid:s r-ather's/ ftr€4k#- / name address-6..r',e4,vooji.&,rony.,. . &L^ - ^- HiS n^or-l r$"rop*nnr..{h'alrilthffafig.Bentered at sr. ....,..i....4.t...... of No.....,...1.o.o. ::::n' f0r...... Lr.r.....:...l"?n r,.No )zr the electoral rollrntl .Kk,*nma...... !!.r.!..i...... nssemory'Eonstituence.rectoral we declarethat we areelectors of thisAssembly constitu.ency and our names are the electoralroll fo1 Assemblydon"titu"nfv enteredin signatures ihis uerow'"ii'*" appendour berowin token of sqbscribing to this nomination:- "r-i.oi"atljo /* Subsfifu tedby NotificationNo.SO SEil(E),dt. g.g.1996. PARTICULARSOF THE PROPOSERSAND THEIRSIG/VATURES N.B.:There should be ten electors of constituency as proposers. , PART III l, thecandidate mentionedin Partl/Part ll (Strikeout which is notapplicable) assent to thisnomination . . and herebydeclare- , ,( (a)that l havecompleted.. . .. ,.*.1...... yearsof age; ( /srR/KE OUr b0) oR b(ii)BELOiW WHrcryEVER tS NOTAppLtcA:BLEI (b)(i)Ktnat|amsetupatthiselectionbythe...... recognized NationalParty/State Party in thisState and that the sym[olieserveO for tho aboveparty be allottedto me. (ii) ...... :;;;;=E::;:-;.....,.@ @/thatlamcontestingthiselectionasanindependent i candidate (Strlkeout whichis notapplicable) andthat the symbolsil have in order of preference, are:- (c) (d) thatto the bestof my knowledgeand belief, I am qualifiedand not alsodisquatified for being chosento fillthe seatin the LegislativeAssembly of this state. *i q fuitherdeclai'e ni'fha **r^^^r^/r-:L^ .--r-! that I am a membervr (,s...,...... **Caste/tribewhich is a schecluled """caste/tribeof the Stateof .inrelation to.*=- (area)in thatstate. I alsodeclare that I have not been,and shallnot be, "***nominatedas a candidateat the preisent generalelection lthe bye-electionsbeing held simultaneou.sly,to the LegislativeAssemblyof AoAhr+...Rodcsh.qstate; from morethan two Assembly constituencies. '/- lin I I )W-1" Dite...l\Acqah.... 90.,.. go.o.g. sisnatuJotiJi5"*"," *Scoreout paragraph, **Score this if notapplicable. out the Wordsnot applicable. N'B': A "recognizedpolitical party"means a politicalparty recognized by the ElectionCommission underthe ElectionSymbols (Reservation and Allotment) Order, 1g68 in the Stateconcerned. PARTIII A (Tobe fiiledby the candidate) Whetherthe Candidate * : (i) hasbeen convicted * l3l of anyoffence(s) under sub-section (1); or (b) For contr:aventionof any law specifiedin Sub-Section(2), of Section B of the ffi/Noy' Representationof the peopleAct, 19S1(49 of 1951):or (ii) has beenconvicted for any otheroffence(s) for which1 he has beensentenced to:imprisonment ior tryoye"rsi or more lf the answeris "yes" , the candidateshall furnish the followinginformation: (i) Case/Fir:stinformation report No./Nos (ii) Policestation (s) .....,...... District(s) State(s) .....1,.. Section(s)of the concernedAct(s) and brief descriptionof the offence(s)for which he has beenconvicted Date(s)of conviction(s) Court(s)which convicled the candidate Punishment(s)imposed [indicate period of imprisonment(s)and{or quantum of find(s)l Date(s)of releasefrom prison Was/wereany appeal(s)irevision(s)filed asainst -%7N6;Z- aboveconviction(s) Dateand particularsof appeal(s)iapplicqiion(s) for revisionfiled ,)anr.eof.the court(s) before which the appeal(s) /app!ication(s'\ for revision fiieci Whetherthe said appeai(s)I application(s) for revisionhas/have been clisposedof or" is/are pending lf the said appeal(s)iapplication(s)for. revisiori has/havebeen disp ---*7*-r;- *--- Place -----l{br;cnr..,am.---. 'J Date .----Momh-----Bo-*....go-o.9_ ul[9- $ignatureof Candiclate PARTIV (Tctbe filled by the:ReturningOfficer) SerialNo. of nominationpaper....,. .. lc, Thisnomination was drty*to me atmv office at.....:..Ll. .r.Ir.a s$ftou4 on..3-o f.:.).ei..trrur*t byrhe candidate/ PAR.TV . Decistbnof ReturningO:fficer Accepting or Rejectingthe Nominationpaper I have examinedthis nomination paper in accordancewith section 36 of theRepresentation of thePeople Act, 1g51 and decide as follows: Date ReturningOfflcer Pertoration)