FORM 2A (See rule 4) NOMINATION PAPER 0003 Election to ihe House of the PeoPle
I
STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PART I (To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the House of the People fiom rhe..',.;.AAfi.&.t'l ....&..y-jV..CQ.f.l)..... Parliam9nt3;v constituen( ;i.?i 6 E'?*q.r=,,**L*' Frl, candidate' nur" Pf.1.E-1. f t 4! | l! ryy:, fi ! Onyi1.ryit ....Hispostar"Ja,.,rtt.nto,:3.r-t...14!b.Q.B.t.].tu.tl.ry..u.N.i1&!f.nulr.t- n"," s-!rPl[el? S of Proposer PART II (To be used bY candidate NOT set y recognised political PartY) We hereby nominate as candidate election to the House of the People from the...... P tary Constituency .Father's./mother's,4rusband's Candidate's n atllc. name...... -.. His postal address...... 1 His name is entered at S.No...... in Part No ofthe ele I roll for ...1(Assembly constituency compfl within) ...... Parliamentary constituency We declare that we are electors of the above Parliamentary Consti and our names are entered in the electoral roll for that Parliamentary Constituency as dicated below and we append our sigaatures below in token ofsubscribing to this nominati Particulars of the proposers and their atures Sl.no. Name of Elector Roll No. of F Name Signature Date component Proposer Assembly Part No. of S.No. in Constituency Electoral (hat Roll I 2 3 I 5 6 7 l. ) J. 4. 5. 6. 7. 8. 9. l0 N.B,- There shoul ten electors of the constituency as proposers. PART TII I, the candidate mentioned in Part I/Pa*-H (Strike out which is not applicable) assent to this nomination and hereby declare- (4) that I am a citizcn of India and have not acquired the citizenship of any foreign State/country. (b) that I have ...... years of age; "ompl.ted...... -4.2...... ISTRIKE OUT c(i) or c(ii) BELOW WHICHEVER IS NOT APPLICABLEI. (c) (r) thar I am set up at this electron uy tt.. l)!l hRl-IlYl. JA^{4IA Pf.BT/ parry, which is a rccognised National PartyiEtate-Ilarty in this State and that the symbol resen'ed for the abovc party bc allotted to rne' OR 2 0003 (c) (ii) that I am set up at this election by the party, which is a registered- ised political party/that I am contesting this election as an independent c te. (Strike out which is not applicable) and that the sr.rnbols I have chosen order ofpreferen ce, are'.- (0...... (i,)...... (,,,). (d) rhat my name and my father's/mother's/husband's name have been correctly spelt out in...Ed i.!--V.(1...... (name of the lansuase); "uou" (e) that to ihe best of my knowledge and Lelief, I am qualified and not also disqualified for being chosen to fill the seat in the House ofthe People. +l further declare that I arn a mem of the...... **Caste/tribe which is a scheduled t*caste/trib f the State o in relation to...... ( IN that State. I also declare that I have not been, and shall not be nominated as a candidate at the present general electiontthe bye-elections being held simultaneously, to the House of the People from more than wo Parliamentary Constituencies. -I{ffs\ o"," p.iLl.g-!.l1ol1 Signature of Candidate 'Score out the words "assembly constituency comprised within" in the case of Jammu and Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep. *Score out this paragraph, ifnot applicable. +tScore out the words not applicable. N.B.-A "recognised political party" means a political party recognised by rhe Election Commission under the Election Symbols (Resewation and Allotment) Order, l968 in the State concemed. PART IIIA (To be filled bythe candidate) (r) whether the candidate- (i) has been convicted- (a) of any offence(s) under sub-section ( I ); or (b) for contravcntion of any lerv specified in sub-section 12), ofsection 8 of the Represcntation ofthe People Act, l95l (43 of l95l); or Y"^" (ii) has been convicted for any other ofl'ence(s) for which he has been sentenced to imprisonment fbr rwo years or more. 3 Ifthe answer is "Yes", the candidate shall furnish the following information: (i) Case/first informarion report No.AJos. . . .NqT. . A,0p!lS.&R LE- .. police (ir) sration(s).... f{.01.. AP PllS-tel9.. ... D istrict(s). N 2I. A p I ll.Sn B!.€. p. statels;.?.:t I 7.. A. ? !r! Cfr.q1€...... (iii) section(s) of lhe concemed Acr(s) and brief description orthe offence(s) for which he has been convicrcd.. qI.. ... N .4.P?.Lt.gft h le-.. . (iv)Date(s) or t-E conviction(s) . t{d i.. ; P.i.l{ i;iB (u) Court(s) wh ich conv icted the cand idate. .l(f.T. .4.P.?.ll.9t!!*. . . . (vi)Punishment(s) imposed Iindicate period of imprisonment(s) and/or qr"r*. fine(s)]... N0f..AP.P Lle "f (vri) Date(s) of release from prison.., .frt0.T. . hP.?.!.!S.lp.*. (vrii)wavwere any appeat(s)/revision(s) fired against above conviction( N0 lefA.Jo "r (,,r) Date and parriculars of appeal(s/application(s) for revision fifea...N0i A PLKABLC (.r) Name ofthe-cguJt(s) before which the appeal(s/application(s) for revision fi|ed...... '.N0.T....4.?lH9aB.LE....'...... ,.... (;ri) whether the said appear(slappri_carion(s) for revision has/have been disposed of or iVare pending. Nl/L h P PL t eABtE (ril) Ifthe said appeal(s/application(s) &r revision-has/have been disposed of_ (a) Date(s) of disposat... N0 L.6?. gnble I -L (D) Nature of order(s) passe d..?t0.T..fr.?!4. (8) Whether the candidate is a managing agent, or manager or Secretary ofany company or Corporation (other than a cooperative sociery) in the capital of which the Central Government or State Govemment has not less than rwenty-five percent share?..N.D.. ('/ Yz(/no ) -IrYes, with which Govemmenr and rhe details thereof .. NdL.4.?.1:!..1.9-P.*...... (9) Whether the candidate has been disqualified by the Commission under section l0A of the said ecr....N0...... tldnol -rf yes, the date of disqualifrcatio"..NPZ..A P.?.f .!.5.+.ry.1E -|-GSJ:A- puc",2-Al?4{... Signarure of Candidate o.t", E.Q.la.V.l.4?19 PART IV (To be filled by the Re.tu-$ing Ofllcer) Serial No. of nominarion ,u*, .12.1...n.?1..'017..1..ko lut; 1yt - This nomination was delivered to me at my office at...... (hour) on..il!.:.fl..'.?9!l.(date)bytheroenffite/proposer.(nameofpropose...... H6.tt*s-..X+n-+ar' ) ont.... fl-{.: ?il :. ?ul ) -",JrkJ# PART V Decision of Returning Officer Accepting or Rejecting the Nomination Paper I have examined this nomination paper in accordance with section 36 of the Representation ofthe People Act, l95l(43 of I95l) and decide as follows:- Date...... Returning Officer (Perforation)...... 5 2!J?..: | 4: P : H.: P!!l:.oa !-?: -. - - - -) AFFIDAVIT of PATEL LALUBHAI BABUBHAI H. No. 206-G, Sabri Kutir, Dungri Fa1ia, Kachigam, Nani Daman, Dist-Daman, I J l> U i fr Ifi a ^44.,-gsle=;-" I "',|,iIUNDRED:RUPEES r:II! ABry -*r oor odiffi ) 1 001 001flr.--;i INDIAi 1 OO1 OO jrh I C)O 1 OCa*r\::*4 o -to10 c)tlOr I J I o -1 0 oi\ s4qr fia 6[q. qcur sfR t{ DAMAN AND Dru 187 993 t 1 T Serial No 2q\ Daman Dt.9..-r'1.. I? I w, Particular Attestation AN & DIIJ I FORM 26 1 E (See Rule 4Af iAFFIDAVIT To BE FILED BY THE CANDIDATI ALoNGWITH NoMINATIoN -PAPER BEFORE THE RETURNING OFFICER F'OR ELECTION TO THE HOUSE OF E-THE PEOPLE (LOK SABTIAI FROM 1 - DAMAN & DIU PARTTAMENTARY Econsrrruprcy PART A tl, patpr, LALUBHAI BABITBHAI, son/da*ghre+/vd{e of pATEL BABITBHAI IG/INDABI{AI Aged 63 years, resident of H. No. 206-G, Sabri Kutir, Dungri Falia, Kachigam, Nani Daman, Dist-Daman (UT) (mention fuIl postal address), a candidate lat the above election, do hereby solemnly affirm and state on oath as und.er:- I I ATTESTED BY W I RAJNIKANT B. - TANDEL Advocate & Notarv Mrfii Daman (U.T.) tNDth I Reg. Nd. ohiN-oos i Serial No. 73285 Daman Treasury, dated 25-Mar-2019 Value of Stamps Papers Rupees]oNEEIINDEEL Name of the Purchaser !\LLIEIIALEEAIE-L Residing at KACHIGAM. NANI DAMAN Son/Wife of Agent MAYUR D HALPAT|Purpose Affidavits Name of Parties to the Transaction Sought- - A"' N. A"^J Signature of Treasurer Signature of Purchaser * t- l{reJ"t ATTESTED BY ) oor*,*k.ro*o.o ,.dvocrte & Notary ?lrfti:,'i'.ll&i cddLd'.. .,' lJ'r'l"T-'"'."*"den' i -,;:,.iIJiJ"#r'"* . "-- .. Ilff ] I;{ilt}=1.*;** r*r';' 'Iifl:';lljJ*J.JJ::;;' ac.o6tlsr lirdvlc/d' M;'t,'#lx"**r*m*;1d*lil:'1"';;" s"der Med," - - Td rne srarus ot filins ol hc6e tccounl Nlmber (PANI dd (41 Debns ol P'@dent Yed6 comPleted (as on (rr 2016 r7 11,08,382 2o1s 16 51,09,444 2014-1s 13,97 853 1"1 2Al7 1a ,or7 18 83,28.082 (nl 2ot.l 15 a,07 303 t,l ,o13-14 19.51,a15 2017-14 l 2017-18 9,15,260 (i 11.) (.) (il 2017 13 13,11,466 2016,17 15.25,105 l Li If-6r+ts ro,zr,ses 2017-18 3,50127 LUI 2at6,17 2,52,651 li,u|zo r-. ro ry.e. li') (, 6 lil ATTESTEO BY w RAJNIXAI]I B, TANDEL fr!iti!ol),lXi{ "rd ;,' e Xs€i4 2014-I5 lr should be cl€dlY staied Pentting crtbhar {5) 'ee' thts crt6ln.l *e agaitlt 6e lTtck dcclare that tlere ts !o {'it' t,l r 3gainst the candiilat€ ald iI th.re te ro crtoinar @e lending 'neBatt* a ror aPPLICAELE 4nt'3t alte Tlre fouoEtng cttoinar @e' s P'id'!c:s':!1:e:ddidate. trrls tor ae'lnst tLe! ti.k ;,; .t * !G!dr!a crimtn'r cs's "* gte detaus orar P€ndrns'a'es :1'#;";":":;;t.re.'tiw ttr above a!'t -, NOT APPIICABLE -' FIR No. {ith nde Police Station concemed T o asse No niih Nam. intulred (elve No. of th€ s..rion-...,., oflPC, etc l N,A. q Bneld€s!npt on of oft€n.e T Whether chdses have been If dsuer is YES. th.n sit lhc date o \ T whr.h.hrecs r"re frmed Whether ey APp€al/ApPli.ation reYision has been fted againsr prceedings (M€ltion YEs or Nol 161 Cases or colvictton Itl I declate that I have aot bcen cdvlct.d fo,.!v .ttEitral ofie!.. l?i'k this altenattve, tf t!. c.ndtdat. ta6 not bcet conatcted ud wttte ttoT AIPLIoaBIJ aeal4t .n Eatlve (n) berow) OR lli) I h.v6 bee! coavtcte.l fot thc of.tr.es eenttotr.d b.loP. ATTESTED AY +{/r5, W!#;lW' 1{#,1^ llt tb. car.ltdrt. ha. b€.! colltct .l, tL€n tlct tlr&.rtehstlv. &nd.cor. oft .lt.@tty. lt) .bov.,.!d glw€ d.talb tn th. t bl. t.r.wl .., IOT A}PIICAALE ,' sections of Acts/codes in@lved (aive NA. do. of the Section, e.g. Sedion...... ot Bn f desdiption oa ofi.nc. Ior which t,\ t Dat--s of orders ol.onwi.ri.n \\ NA whelher dy Appeal/Appli€tjon revision has bcen iiled against Proceedinss {M.nrion YEs o. No) (h) to (sl ab.ve is YES, NA, N,A, I NA (6,4) I hawe siven fuU and up-to date inJomatioa 10 my politiczt aErtv about att lrndins ..iminal oss asai"it (e ad abour .ll cases ot convicrion as giwn in pa.agEphs len.ltrLt.. to ehoD iht. n6h t. @t strElcaDl€, .horrld cl.dly Elte noT APPLICABLE ltr fEE VIEI, OF EI{TRIF,S llt S0l ud qr, .Dorcl I. Detdr. 3hould b. ent.r.d cl.sty ud ,.g.!y ln aOLD lett€E. 2. D.t ll. to be gtE &p.nt ly fo, e.ch case urd€! dttlelent cotuhns .gah.t e.ch tt E. Deteil! .t.ulit gtveD bc tr rGv.E6 cluonologtc.l odcr, t.e.r tiG t t..t d,. o be Dentlo!.d fEt md b..t-u.b t! th. od.r or &t.. ao, tie o Er AddltloD.r shect my b. add.d lfr.qutred. , cardldrt. i6 r€.postblc to,.upplyrDg dr irro,o.troa h coepli&c. oa tte Ilor'ble supr€De cos,r'. JudgE.nt r! w.p lc) !ao. sO6 or2ot1- (7) ttat I srrc hcrein b.low the dct ls oI tlle a.*rs (!mabl6 ert hy*l[ my spous ad aI dep..derts: Note: 1. As&tlj! j@t ne. idietiog th. joint .xt nt of leGhip wiU al@ hav. to ** " ;I"1a:fff il J p" ffi :ti#.?1*ff :,"m.f H3T #iJ t l4t?"8' ArrEsrEo BY R} , 4sR[4 AfiESlEO BY **t**"'*B* {:r:#lutl -"';':"[;l=Jj;: *'""x-*L*?i:+Ti;,::5"]f""J;fi T:;:'lff :',Tfl iomPJrcs st'outa t' els' """"#It##s**:o-*+*i-H{-{'il*irff**} then ivehhood i. to be eiven seP ately Note: 5. D€tai1s including dount ol offsho'e asseis include the inr€rest l! or o@ership Note: 6 Derails should Eipra@uour For the Pu'Po* of tLis.Fod-'::i::.":i::;T":T*1.fl b'tudhg, deta s of dcpo'itt 'll 'r dd detals Pf a1l *ets otd" o' t"tituttd 'b@d! ""U -r;tn* ,nd llahllittes i! ,oleigr couatn€'; E ET -d itr.-"*,. *d -r d.pdr deh. urcrshc! od uoB r C@0@n, Mutud tuids od od4e W. *r;r*L\ I I 3dFl&r&qrdr!,E.lfith Aryfu!'4t,e6afu.d :l -l""1 I @ @ @ w @EEr Nob l. Propetu.s in jmt M..stup rndr.arin8 lhe.rr.nr or Jornt oher.hip sU ste hak to b. rdi.ar.d Not : 2. E ch tsd or bundidg or apartmar .houl.t be Dddoned sep&rety in this Note 3. D.rrjls shoqrd incrude thc i.rcr in or omcFhjp of ofishd. as*t6. A]TBSIED BY h. I 144J' $ tt I I I ll ilt ilt I ililil ItI *.o#f: ir; I I I I ilt il I llilfl Il[ ', ;!i I II lt I ill il I ilil[ IlI B*-ir?a E Siee li!i lt I il ll ilt il I ililt IlI iil ;!3 I I I I l]t il I l]il1 I]t I lt I I ill lll II lltil[ Il[ l-J I g a 3 I I a : i; ! t :l t i l- t t ! 1. i i: ?, I ! ti i' I E i I 2 I ! ! I ! ) ! ! i , I j I I E E I 5 ! ! I z :! i, :i !: i, t I ii ! !l j ii ,i ! :i t, I 4{rl"t"' { .=.sg II III I IIIII I IIIIII IIIIII -IIIII IIII II IIIIII IIII IIIIII IIIIII IIII II 4{r'€e,L t)1 W{4 BY AITES1ED ru*ffimr IIIIII IIIIII IIIIII IIIIIIIIIII IIIIII IIIII IIIIIIIIII I IIIII I IIIII I IIIII +i?e.,il ATIESTEO EY ly IIfIESIED -Ut BY a),:-,]ir.-"o.,. g:t"1"".:*+i$ r ___-T Tft ------_al - I = - -f r T------.l:- + -=] + l I T-- t-- -- r a- T_ -- f-rT- X4 ATTESIED BY .?isdfls.{fi{;' lt 4rlrJil BY AIIESTED ^^.r*o^pi"llljR'" {"m1""',tu"le . F=: {g l-- l ---- * t f--l - l l l -l = l gY ATTESTED j #:w" I,z II II I I II II rIII III II I III TTII I-_T T l l BY AIIESJE9 ruf,iLiiffil m ATTESIED BV 18) I $r h.r.nr beldv rhc .lrrrrls.l 1,,'l,il,!.5/(l!.\ r,, I)'rlnr! fi,N,nll nrsttuuons 3nd {Note Ple@ srw spdale delails oi.m. oI bdk, inslituiion, entitv o. individu6l dd Mount beroE ea.h it.m) &!k, vebiL ljd 0.nm 4hd 6dHdur./.!dt, Nm.(s) 1r) 64rid.d H6 the oeoo..^t b..n in o(.upaiioi ol a.comm.daiion prcvidedbylh.c*mm.ntalab b€ror. the dareof^onfl.arionofthe cur€nr ele.iion ? , a.sw.r to (A) ,bove b YEs, th. iolrowlns d{la'ation may b. (i) D. :ddE* .f rh. cowrnfi€nr rc.omod.rio.l (i) Ihec B no du€r p.y.bl. in ,.tp€.t ot .bov€ Govemmenl {d) relephone.haE.rason ..--.--(dalel lrh€ dareshould b.the lasl dar.ofthe rhlrd pno.tolhe month in whl.hth€€le.tion 15.orm.d oranvdaEtheEatr.rl. Note No Due5 Ce.tlrlcate' frcm rhe aS.ncies concehed ln @sped of r.it, .l.d cilt ch.,3es, wal.r.ha4es a.d lelepho.e .ha4es for lh€ rbove Oovenm.nt .c.ommodation shoold be l *l{?r..trl -VNIL t D.8nd r, hF o',ID.rndm,l 6d e*h{ any ddd labiliri.s are 1"",h",,$b.'*"h.h,,' (9) Det.[. of p6r6..toa or occrpatio!: la) SelfAsialturist / So.ial Worker {bj Spouse Aaialturist / Busin.ss (9A) Dctarb of$urc.(.1orln one: (a) s€lf Aoialtu.e dd sard ircn Ptrli@ent .ns.Aoiculture / Bush.ss income 'rsn\ oI DeDendenrr BJs:nei, (98) @ntur wfth apprcpnate Govmmdt dd dy public compdy.r compsies: (a) Deraos of conracts enteed bt' the .edidat€ NIL (b) Details or conbacts entered into by the spous NIL (cl Details or .onEacts cntercd into by rhe dependents - One olthe dependdt, Shri Gaursg Patel, has en@red into contrad with Hindustd Pelrol.um corporation Ltd. For trading of p€$oleum prcducts. (d) Details or.ontra.ts entered into by Hindu Undiwided F@ily or rrust in which ihe cadidates .r spou* or dependents hav. interest (€) Details ol conbacts entered into by pahdship fnas-NIL in shich cddidat.s or (.otrc. .r de.endenb de Dders NIL (l Details ol contracts entered into by private compdy in which cadldates or sPouse ordeperdenrs hav. snm -LLI llo) lly eduett.n r qIdmc.tion t3 aB ud.r. qualiBetton s.@ndary Schel cerlii.ate (SSC) F-rd Fa ed sciool/ontrElty shre somth Kelvdi Msdal Ligh sch@I, Dabhel Do@. Lar ofP*.t!g 1974 SSC E]d laiLd lciv€ delails ol hishest School/ Unilersity education mentioning the tull fom ot the erti!.are/diploma/desree cou.sei nme ol the school/ Colege/Universiry ed the yed in which the cou.se w6 completed.) 4{tatrt 4-r*ar'" BY ATIESTED o:t#1,ru1 PART - B (I] ABSTRAC'T OF TIIE DETAILS GTVEN IN IIITO IlO)OF PART - A: 1 N:rnc .l r l,e .:n,lra:re P,lel Iil,rh}jri R3htrbh.i 2 ttouse No. 206 C, Sab.i Kutir, Dungri Falia, Kachigd Nani Daman- 396 230 3 Number and Nme of the constituen.y Parliamentarf Constituen.y, U.T oi Daman & Diu Name of the Political party which set up Bharariya Janata Pady 'lotal Nunber of pending criminal cases T.tal NDmber.aca.es in shi.h .onvi.l.d \il (a)Candidate Lalubhai {b) Spouse T@naben Lalubhai 88,28,042 (c)HUF l-€lubhai B. Patel HUF aABHLS36OD (d) Dependent- 1 caurdg Patcl 2017 lt3 I1.11.466 (e) Dependent-2 Shivdgini Patel 1,50,127 li Dependenl-3 N.A. h 'G\ y'. 44tll TTESIED BY w, Dc&n5 or.\Erk lnd hbnniB lindudiq orshorc ssctt in Rupees uov.sbk (rotd vduc) ^$€* Ia) ell-a.quircd as*s troEl Lb) ih{ii.d i .fl" Lro! \" !4 itFN.lmnd,", rrd€Lr rnditurids and orhers lToral) Iffrtutions and orheG froEL) Hieher Secondarr s.hool cefrilicate lHsc) EEn ron Ssdai< vidvalara Hieh Schdl Danan in 1930 {Giw deb s o, hreh.* s&oov un n iom oi the cednab/d,pbEa/&g!.. coun., nam. or the s.hool/ c.uqe/ univelrty sla de ye{ E q hrch de couc. Ms .ohpretd l w ATIESTSO AY DEI BABITBHAI, the d.p.n3nr, r,rr. rrurrd, Lld L.rrL! !.r,I! f,n.l decLre Ll,ir Lh. .orlcnLs oI Ll,is alii.tari r. L.nr dd ..rrc.r ln thr bcst ol my lmorlcrLg. and beLnil J no p: oI il is lalsc a..1 noltin,j] nrlcn.l IRS br.r ..rr.rl.d rll.i. Irom I i.l l}Ldc is f..is. o1.o.ri.t o. .r t...line.:s.3qainsi m..ihe, thar rh.s. mcnrionc.l i! it.ns - ind 6 oll'a A rnd ts ab.re lb) L nLr spors., o. nr dcruduls d. L.1 L,uc an! .ss.1 .r I lnrlitl. .ll nL.nlr.rrd ni rLcnr 7.nd 8 DIPan A!.d uns 8.9 3nd iO olPan B 3b.le VenE.d rL Drur rLis th. r '{la! oaAr. r0l9 Noter L A1'. '1. llroJlo oc I l.d ."'.c' o) 00 P[4 on h" l, , l"J ot :l'iA i.s '- b ', " ote 2. Aliidavit should b. swom belore on Oarh Commissione. or Magr6t ste of ihe nrst al,ss.r hPr.r., N.i.ru Pxbli. Not.: 3. All columns should be 6,led up ad no collmn to be left b] k. If dEe i6 no infomation to tumish in respect ol dy iten, either 'Nil" or 'Not Appli.able". as fie case may be, should ie mentioned. rotc:4, IhcdJ]id".rr.horldbc1Ll-"'.).pedorv rr-, '-Eb') J d np"'l\ Itote: 5. Each page ol rhe Afiidavit slould be signed by the depo.elt and th€ AIfidavil shonld bed on each paAe th. stmp of rhe Notary or Oath Comnissioner or nDgishate hpr..c $h.m ihc Affid.vit is swom .'.\ .ff,rmrd !ehre,h9 ,, . /- ta JL-' t-vl.Ua,' l/!i- *boisid.ntified wfiom I P.e.allv Kn.w II w COMMUNICATION WITH REGARDTO AUIHORISED PER5ONS TO INTIMATE NAMES OF CANDIDAIES SET UP BY&ECOGNISED NATIONAL OR STAT€ POLITICAL PARTY OT Rf 6ISTERED UN.RECOGNISED POLITICAL PARry, [see parcgoph 13k),ld)dad le)al the ttectioh synbots lReseruotiah ond Allotnent) Otdet, 19631 The chiel E ectoralOffcer, ql: ,r-.0.8 .h.AM3rJ.. ..R...-)-l ? T I nlru r. ult I fo, rhe 1-14!lArl !)rplrall f4R!.1A!\,1EN.LRY (c'ltt-''Lb' sublc.t: General/3{e Eledions ro ,,,tl/! 1_ .,,,,,,,,,,,,,,,,,,.Yh,14,d0n.!DI!qA &{ri ,,i.1lf (stere/Union reft itory)- ALlotment olsymboh author sat on orpe6onsto ntimate namcs ofcandldates ln puBuance of parasraph 13(c), (d) and (e) ol the Eledion symbols {Rere aton and alotm.n0 order, 196a, rhereby communtate thar rhe rolrowlns pe6on(s) has/have been Pa1v. "ur o".ed o, he w_.ih i. \r'ondl Pdlv/iH* 0.-r -J.. )(+ ar 8 "L'(l . /E r!p,€c+!,<.sl11m p#,. ,o,n'.na'p the names of the candidares proposed to be sel up bvthe pany at the. ect on cit€d abov€ oistktF)/. reaG) co Nt tuen.y/ Name oi pe60. authorised .onnituenciesin rcspect of whl.h he has been aurhorised /!A{73 s'rA-t€ PREC tb€d-r. J-1ArAr.! alL, P4RrrA v t lcPALo4At K1A+$eL )Al!i^^i ,.]ru IAA!€I4 2 VIlrEI< P, }A)HAKAR $eN te*eraql lgl\1 ,1-)ArrA/.'lll, PAR x,{M,^r., a )rU nRa}E/, FORM'B' NOTICE A5 TO NAME OFCANDIDATE SETUPAY THE POLIIICALPARTY ISEEPARAGRAPHS 13(B), (C)AND (FIANO 13A OF THE ELECITON SyMSOTS (RESERVATION AN D ALLOTMENT) ORDER 1953] The Returning ollicer lor the 1 l6r-j.n.f.l ! l?zrl,a ln pursuance of parasraphs L3(b),lc)aod (e)and l3Aorthe Ele.tion svmbos lRe5ervanon and ALlotmenr) Order, 1963, rhe.ehysrve notice on behall of Aharatiya lanata Party O lhat the pe6o. whose pa.riculatr ar€ rlrnkhed in columns (2) to 1a) below 6 the approved candidare of the party above nafred, and (ii) thepe6on whose parti.u ars a.e mentioned in co umn5 (s)to (7)below6thesubstrutp cand date olrh€ Fny, who w !lst€p-in on rhe approled c.ndidate s.ominanon beins rrjected on s(uriny or on hs withdraw ngfrom the comer,lfrh. sub{tute calddate i5 strll a contesting candLdate, at the ensuinC Ceneral /!|t-election from thisconstituencV: ,l I IAfEL tt tlt ,L{ lt PATEL nr )l TARONAAEN L.ALUBT/hI L )u^J, 3 ra )16 pt .L..Dt !!. nqt 4u tt{ 7a 'r".""r**tn*".y..J.:.0I341{ L! tl 1 *"a,0"...... f,41,4i.....u O 4 .. 6400 a4 4. ",-" "r,r." {"^B nomination paper /b /rote lkD t No or Nohinarion Paper lqp wherher fil.d (wrjr. Y.s /xol ir theft i! anv defed hhon@mins in th. docume.ls , lhe eme Afridavir \F3, t NtouPLE re (a)wh.thar.ll.olumns arc,irled uP Pa.r a -(t) (b)rrnot, whi.h r.€ brankcolumi(, (pleale tee.iry) t(OtD,60) tun 4 - La)to)-ti) hl") G)wh€rh.rrh. dflid ir irsrorn Ytt !omsAand s lappll.able in th. c Copy ol ca*e Certificate (if th. catrddaler.alms to 5e.urty Depo! I lwhrihermade I oarh afitmat on lwhether d3de ) tEs Ih. folrwln€ docuhenB v1i.h h.w mt be.n fihd should befi!.d as (b) ab@e mentlon.d corumni ih the Affi&vlt h rom 26 h.vebe. l€ft b ltrt. Yo u mustsubmit an th aftldavil with colu ns dulv filled op beforc ln. 6mm.neme.r oI {tutinv of nomiEliont hlliia *hl.h the mminrlto. o.p.r *ill b€ lhble ro h)-'- q o Reiuhing ofricer l-oiman& Diu Paniam.nl.ryConstiru€n y \ AFFIDAI/TT of PATEL LALUBHAI BABUBHAI H. No. 2O6-G, Sabri Kutir, Dungri Falia' Kachigam, Nani Daman, Dist-Daman, ! frt ) , J .E I J 0 E NE I r-"t rt El ! -l?ai F] I l,l E ES l la 1 001 0€- 1 (-rc) 1 ()c) I -NON*JU Ieltrfl ?tA 6tq. 3:H"tl-&*fi]iffir RAJNII j rc'iA;iDEt tlO'e " Partiqrlar Attestatioh 1U r 1 I FORM 26 I (See Rule 4A) I AFFIDAVIT TO BE tr'ILED BY TIIE CAITDIDATE ALONGWITH NOMINATION PAPER BEFOR"E THE R.ETURITING OFFICER FOR ELBCTION TO THE HOUSE OT THE PEOPLE (LOK SABHA) FROM I - DAMAN & DIU PARLIAMENTARY CONSTITUEITCY PART A I I, PATEL LALUBHAI BABUBHAI, son/deughterlr*ife of PATEL BABUBHAI GAIDABHA I Aged 63 yearc, resident of H. No. 206-O, Sabri Kutir, Dungri Falia, Kachigarn, Nani Daman, Dist-Daman (UT) (mention I full postal address), a candidate at the above election, do hereby solemnly alfrrm and state on oath as under:- --W*Dl ATTESTED BY 11 , *orn,*ffiu. ronor,- Advocab & Notary Daman (U.T.) tNDIA Reg. No. DMN-009 Serial No. 73284 Daman Treasury, dated 25-Mar-2019 Value of Stamps Papers Rupees ONE HUNDRED Name of the Purchaser LALUBHAI B PATEL Residing at KACHIGAM. NANI DAMAN Son/Vvife of _ Agent MAYUR D HALPATIPurpose Affidayits Name of Parties to the Transaction Sought _ A"t (' Ar^J Signature of Treasurer Signature of Purchaser .rdt INlKAT . OFDA DtsT. I .rg. \\ Yr ATTESTED BY A)^ nn Ntxlhr e mHogL -wfi #"tru!i'itli'l Ptrtt ll) I m a cdddore e, up bv Bh*sbvr JraB ' (*n@. ol lhe politicd panv)/t'*eonte.li!*"_raC'r"a'u''edid'!&_ (_6tik our shich*r i3 not appli@bL) -s of & (2) ;y trec is orcIled in I - Dmo & Diu PT lime't, ConsEtu'nc,' U't DaM ll+ ...' Du lNm. of U. consurudryud th' sBt'l sr s€nat No 12?nPanNo'70 ' T.l.phon. \06. m lot O.?oO')210?aa (Ml9a25l22a5a d tii,.."I t3J Mvconuct ir My o_oail ID is [email protected] ud . My seul M.du 5@m(!l (,1a)) is/F li) F@tek - daBddiud@gman.@d (l-srubho Pat'l) it) lvitrcr - da@@.difioan.com (@hrubhai0oT) (nrl Nil (4) Details of PcrMenr &count Number (PANI sd tle sratus of fi1ing or Incomc T Rdun: Total lncom. 6hom i! In6m. Ts Rcom (i. R3-) rot the ldt ,iE [email protected] Ya3 @pleEd la on 3r{ Md.hl 1 I tA[0Et l{& Dd, 1n) rrL ,rL. 1.,1.," aQAPPr66'rR 2017 la 2ol4 l5 NotApplicable r,i 2013 l4 NotAtph.abl. l 2017 13 N.lApplicabl. ML 2016 l7 NolADplicable 2ol3 14 NotApplicablc NoL: It is mudaio.y for PAN hold.r to mertion PAN and in €s ofno PAN. It should b. cl.sly stared 'No PAN Atlott.d' BY ^flE9IED 4tw-[^ *i|$hifl$:" o.*"il'o*;,", + fb ki aer.e z :iE1sE EEEE q t .,- #/-e-a=Z=i\h lsl Pcndtns clhinal ca&3 )I d.clar. tlr.t th.e t5 ro !.!dr!a cdrrnal e.. .gain r o.. (Ttct til. .ltcF.tiw. (r r tn B L no crltbar 6!. r.ndt g .g.rn t th. tudi.Lte ad *itt. nql APPITCAILE .g!t rt .lt6E.tiw lill h.lowl *b foUo-lls c.tDra.r cae. & p.!ill!8 .g.ln.t r.: $t _ llt) at. llf t!.r. are !.Eilt!E cdEhd cas.. ag.tttt tte cudt&te' tll.n tt t tlis altGm.tlre rrd i.oE oll alt.Eatlv. (ll aboE, ed give dot.Ilr oa at1 }.n.iiaa ca.'E - ltor aPPucAalE -.- FIR No. wirh n@e and addess ol Polie sr,rio. mnem.d ll Case No. with Nme oI the Court section(s) or conerncd Acts/cod.s involve.l Giw No, of thc Se.tion, c.A. S€ction...... of IPC, etc.). iril Brief description oI o[.n.e wletncr chaises havc been frmed (rl ll ds{.r i. YEs, thcn siv. the date ol which charse. rere tramcd whethe. dy Appeal/appliation to. l dision has ben f .d aAainst th. t procedings (Mentio. YES o. Nol 16) cr..' of convt.tlon d.cla.. tLat I hav. not n6.n .on!'tctcd for cly cdhhel ofi€n... (ltck tnis qlt.erttw., tf tho 6.tldate h.. rot b.e! c6vtct.d ard wdt6 XOT APTLICABLE )f'w ,.salr.t rn m.ttv. lx) bcloB) OB Ittl I b.ec h66! .orvt t.d for th. ofi.lc.s D.lttoled tel6P: lif th. c.ldidate h6 6.€n .onvt.t.d, th6, ttck thts altemativ. sad !c.& olf .It.E.ttee ltl abov., ard aIv. d.t.I. t! tbc t.ble beld) s{ all€sJEo -il""r$ lU - rrxogL **:'HF"'$$'x, W. )ir?fo S.ctiors of Acts/Codes involv.d .o- oI the Serion, e.g S€ction.. Bri€f descnption oI o,Ien.e lor which Dalcs ol orde.s ol conwictio. wh.th€r 6y Appeal/APplicariof, revision has be. nled against procedinss (M€ntioo YEs or NOI I b (sl above is YEs, MLAeerdL L MLAeet@d. (6A) I haw siven fun ad up ro-date inJo ation to mv political partv abour aI peding oiminal cass against me and abour all case6 of.onviction as siven in pBraeraphs [6rud.t.. to ehoa tht tt D t not aPpltc.D|r .hodd cr.ury wdte lIoT aPPucAlLE Irt TEE vIEv oF ExarElE€ rr 5{i} 6d 5lt)' .ho@l 1. Detelt. .hould De e!t!&d cledly 6d legslv h BOLD Ltter.. 2. D.trlL to be gtv.n eDaFt ly fot ..ch c.* ua.iei dilteeat .ohn. agih.t e..h it 6. 3. Det I. .nodra D. gIED tr tdetu .hEEologlc.l ord.r, t e,! tn Lteat ca* to D. mertiote.t Otst .rd b.cLwd& ttr the ord.t of datc. for th. otlrer 4. Ar!.UUon r 3n.Gt d, !G add.d tl EqulFd s. C6dd.tc tE E.tD tbt. for $pplyt g.[ b6t@tloa lD coaDll.!@ of tL. Hor'bt. SupreDG courtts Ju.lgm.nt h VP lc) xo.536 oa2o11. (7) TtEt I givc hein t€loc lhc detans ol th. a.&t3 (n@ablc dd imB@U. ctc.) ol mr*U, dy .Pou* md alt dcPcndots: Notq l. Ai6er. in joi.t nme i.di€ting th. crldt of joint Me.ship wiu al& haE to be Not : 2- !n s* or d.Fsit/lnresd.nt, lh. detans includins sial nuEb.r, @omt, &t or d.posii. th; d1d., Nu. ot Ban*/ID.tituti@ dd Bmch @ to b. Not!: 3, Value of Bonds/She Dcb.niurcs de pet lh. .uEelt ffikct value in stock dchose i! rq;1or list€d @6pani6 od I pd rioks in ca& of nm-lbt d @Dpei6 .hould b. 3i@. -.cO O.{ lsrJ^ "'"'{-.^*oi" ""ri*)1,."""i",-fl!os rro " 'a/.'-o i 4 -., 4sci:" Notc 4. D.p.nd.nt E.es paEnt3, &n(sl, daueht rls) or rhc.eddate o. spou* and e, ott!. !.mn Elated to lrE cddidalE vtEthr. by blood or aaria8., *ho hav€ e *pamt Deans ofin@d. ald who m d.p.ndcnt on the.alrdidat for rlsir liv.lilbod Not :5, D€raJs includiox afroEl is to b. Srven epaEtely in rcsp..t of .ach inv.stm.nt. Nore o. Debns should n lude rh. inr.r3r D or oM.Bhrpol ofishoF asls. E pr@d@: ror tlE prEpe of tiL Fotu, thc .rEBlo! "or.hoE et " I!.lsalra, d.t L o{ dl .t.po.ltr or trE.toat tr ForcLr bolr ud uy ottcr tody ot lutltrtto! .bo.l, ad a.t ll. pf dl B.t .!d ltr6lrlde b foElt! .o6t'tc.'i 1 AlbsiFtdEr'34E6 ,- _T_--- !aan6/ Mled hna rd 066 f -Lar$, ATTEATED BY M <.1 4s('v ATTESTED BY 0-T e &t 1..6L d D&, qb& !!!&,&,dEfud. ,:;.1 0l&[s!F|}Idl,Yd2ol3 ofuD$!Fl,F4)Ycr]m ':- :: :::l ;r I :: ] t-lt*,*t I t-l Not.: l. P:.operti.s in joinr Msship indicatins the.xr.nt drjoinl omcrship vin al$ har€ to be irdicatcd, Note: 2. Each lsd d building or apadm€lt should b. m€ntioned spdar€lv in thjt I'loG: 3. Dctail .hould include the int.(3r n or omeBhip of on hde assls i<+.rc ATTESTED BY *,*#;.ro"o.. .-- \T. gY A1IES1EO -*--.4lsml ^ \ +?P$r E EO BY a +4(I ATIESGD 9Y ry,#*,**. l ,,.ft:*-. 1L\ ATTESIED BY i: L *",*k i( ATTESTEO BY h ! "! L 444'J^ AIIESTED BY .tt At I \) L: a'. 4-scl^ w I rilu irq ATTE5TED BY 4cr-F lu/ , "^,",*nft "o" ?t:"ll'#,11"J' a I ATTESTED !]' 44Ql; t\1r a )i - -l 4Irrs,lED keJr 8y Hm#;r*" ATTESIED BY 4r,rJe ftr { ,( AIIESTED Bf, *rr--La r" I I tP/4 ATTESIEO 16x-.;; BY ?l{,#f[{.{iJ' I 13) I si\e hddn below lhe detans of liabilities/dues ro lubli. fi.scial insiitutrons ad Note: nea* erve sepdate details oI nde of bdk, institution, entily .r individual dd mount be{ore each item) Bak, vchi.r. ban lrnnova Has rhe D.poie been n ortupanon ol accommod io. provided by the Goverim.nr at abytime durnsthe la*r.nyea6 rl her.rerhe d*e oriotifi. io^ ofth L0l rfanswerto (A)above isYtt lhe folrowlru dedahtion may be (l) rhe addre$ orthe Governmentacdmodation: {lll lhere is .o due5 paFhh ii €sp.ct of abfle Goverim.nt acmmmodation.t wards {d) telephone charses as on - (date) fihe date shoold be the hsl date oJ the rhhd pnor to the month inwhrch theeledion is notified oranvdate therearrerl Note 'No Dues &niticare' from the agencies oncemed in res@d ot rcnr, electricltv .harEes, waEr chaBes and ielephohe chaEes ror the above covernment ac.ommodation should be iddudDs airdts and 4$u, AITESIED BY \, I ATIES-'ED BY M -|6r:If, 1r) n n!di+ut.'if$'[mdontn. l9l Dct.iL ot prof€3td or o..uPrtion: la) SellAericultu.ist / social Wolker (9A) D.t t , ol [email protected].) ol lrco6.: (a) s€lf Asidlrure sd salN f.om Pdrim.nt lb) soou* Aqidltuc / Busi.ess inM. lc) SourEs or h@m., f any, or D.p.ndents - 4 tra.t witn appror.iatc GoEmment dd dv public 6Ep&y or compafles: (a) Details or @nt.act. .nt.r.d by the cddidat. NIL F) Derejls orcontact..nt red into bv th. spou3. (.1 Der6ils or conkact. .ni...d into bv the deped.nt.-Nlt-. One of th. d.pcnd.nt, Shn G rmg Par.l has cnttrd ilto cmua't wirh Hindust& P.nol.uh Corp.rrion Ltd For rndins olpeEoleum Products' (d) o.tans or mtract3 .ntd.d intd by Hindu Uadivid.d F6milv or trusr in {hich thc .sdidate. or srou* or dcp€ndents haE i,t€61 -!!L. (€l Dera s or contra.t. .ntered into bv Pstn.Ehip fms in snich cmdidat's or spduse or depend.nb a.e p,in.E-NlL. vhi'h o' 0 Delails of cont acts cntd.d into iy prival. coopmv in 'sdidat's ,poxse or dePtnJ(nr\ hr ( lo) Iy .iher,@.! qultiettd L u rrLt Qrirriettoa sccondary sch@l c.tifrelc lsscl Ex@ FaiLd &toUE t6tt, sht. somnath K.tvdi Msdal ha.h schdl, Dabh't DMs' Y6 olk*ttng 1974 ssc Ex@ raned d.lals ot h'eh.sr School/ Un'veBD edudLon mcnronng thF tuU lom ol tll' li"iji"".ia'rr.-"i.o-'Giv. he sthool collcs'/unne s'w dd rh' v' in whi.h th..ou.e vas cotuPl.t"**1.,-".t d.) -+4€*A TIESIED BY .*$Yii$.i:'' %'i;rl:uiiril oo'! ,rr; i ATTESIEO iY U*, 1]I) OF THE DETATI,S CIYEN IN (1)TO (1O]OF PARA - AI 'SSTRACT Hou* No 206 C, Sah.i (utn, Dungri F,lia, Kachigm Nani Daftan - 396 230 Nuhber and Name of the constitucncv Parliam€ntary ConstituencY, IJT oaDama. & Diu Nee of thc Political party shich s.t up Toral Number ol pending cnmrnal.dics I .1 1 (a) c&didarc - L€lubhai (b) Spous . Tmnab.n Lalubhej Irl HUF Lalubhai B Potel HUF 2At7 |\ (dl DependenLl Gaurang Patel 2017 llJ (e) Dependent 2 Shivmgini Parcl 3,50,127 {0 Depend€nt-3 Not ApPlicabi. ll -[6 a"0 ATIESTEC AY a BY AIIESIEO -A-$f.f4 .*,*ffqq5;'. X'""'l'i";"tu"* I . ofttole rrltlr! R!r... E ! I G) *naqurd n$.6 OoEr I R I Hider s uu rdm or ihr eru'Eb/dPb /d.F ;,* *-. dd; *-r, c.n */ u ;E ry ud d. r h sh(h,h.our Er .*Fkrd ) ATTES I tu "ilif}l3^'j]3., i'#"tJK.Ill",# ATIEATED BY +{1'r-,a "$ir#,1,,ii,ryi vERS.rCAarcn ,, IATEL LIITESAI aAAUEEAI, the dep@e!t, ahove @ed, do hdeby veri& @d de.rart 6at the conrents of this a6davit de lrue ed @aect to the lest or ay lrrwledep &d beli€l dd no part of it is Ials. ed nothing materiar lEs been concealed the.e 6on, I turther la) there is tu c6e of conviction or lending c* asainsl ae oth.r thm those m.ntioned in item6 5 dd 6 of P.rt A dd B abovel (b) I, ny +ouse, or ay depdrlenls do not have dy ass.t or liablity, othtr rhd those hatided in itds 7 ed a of P6it A dd ftds a, 9 dd 10 of Pa't B above. Vsin.d at Dmd, rhis the 4'h day ofApril,2Ol9 4r,ftQ N.te: 1. Allidavit shoxld henled latest by 3:00 PM on the lasl day ol frlins nominations l[ot6: 2. A{idavit should b€ smm before on Oath Commissioner or Magistral. ol rhe First Class or befoie a Notary Publi.. 3, All .olumns should be nlGd up and no column to be lett bldk lr th.re is no inlornation ro tumish in respect oI ay item, either "Nll" or "Not Applicable', as the ff... c6e may be, should be mentioned. The .lfidavit should be eirhd typed .i Eitt.n leAlbly dd neatly Ea.h pag. of the Afiidavil should be siened by the deponeat end the Afidavit should f bed on €a.h pag. lhe stmp oa the Notary or Oath Conmissioier o. @giskate ber.r. wh.m tn. Amd,vii is sw.m 1't t, 6aao7 whotsidentifi.d whoh I P.&.aily l(ncw, h. Irtl