Surjya Kanta Mishra, Son of Late Janardan Mishra Aged 62 H Years, Resident of Village Khakurda P.O

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Annexure - 1 avit to be furnished by the candidate alongwith Nomination Paper r.**.8tcifrr Before the Returning Officer g rH/ or election to West Bengal Legislative Assembly (Name of the House) X'rom 225-Narayangarh Assembly Constituency (Name of the Constituency)

I, Dr. Surjya Kanta Mishra, son of Late Janardan Mishra Aged 62 H years, resident of Village Khakurda P.O. Khakurda, P.S. Belda, Dist. Paschim

H Medinipur (Mention full postal address) a candidate at the Election do hereby

solemnly affirm and state on oath as under:- H

H (1) I am a candidate set up by Communist Party of India (Marxist) (name of the political party) g

s l2 APi zafi u rH EI @ of PAI{ and status of filing of lncomeTm{GEm:

income shownin Names Permanent The finmcial yecfor Total 4'*o' Account whichthe lastimme Income Ta:< Return (in Number ta:r retutn has been Rupee0 rP,AN) filed. income for I Self AJJ PMO269R MyennuA MI L 2010-11 is Rs. 89400/- which does not come under purview of Income Ta:r. The certificate in respect of above, issued by the Accounts Offrcer, W.B.Sectt. is enclosed.

Spouse- 2 Apr 'Nt L Smt.Usha Al [L l* Misbra .l ---triF I Deoendent I - f\ttt- l\ l, l- 3. Nr t- 4 Denendent 2 NIL AetL - t\\(L- - ntt L- - Lt_* 5 Dependent 3 ^l

cogrrizance has been taken by the (3) The following case(s) ivare pending against me in which court: ,j against me in which The details of cases where the court ffi;ffiang ii has been taken by the court' has taken cognizance, sections ofthe cognizanie i Act and description ofthe offence for H which coenizance taken and Date Name ofthe court, CaseNo. to It-. oforder taking cognizance :

a court of law (other those referred to in Form 4. Cases in which I have been conlicted by .t_ T[Ja;t ffifcasetSections of the Act and description of the offence for

Name ofEreourt (il Case No' and Date (s) of order (s {*t* lU* l"{t'l;

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of myself' my ofrhs asses (ooul|cdimnable etc') 5) That I give herein below the details spouse and all dePendents : '\ A. Details of movable asseB : have to be given joint na,e indioatingthe-ext€..et:fjoint oumership *S ,. *;T; in iJJl'i'*t"t'"lT Amotmt" Date of Deposit' the 2. In case otO"poritlfrri'ilot""G-d"tuifu i".iril'g and Brurch are to be giveo i;#;ffiiiBant/rnstitution in Stock Exchange in respect of gonaslSt * p* tf,.i""t'iti*i-t valug 3. Vatue of *e6!iio;o given *a *iJri""tr in casi of non-listed oompanies should be listed compani"u onthe income of the candidate' 4. Dependent; r,".' *"LiJ;;Ho[,ffi,1[,1f,[t6*"rd"i, given r.p*ut ry in respect of each investnent) 5. Details inoluding .*;ii. to be Dependent- Dependent Dependent- I -2 J

DeffiffitftsinBank UCOMain Branch, Ar I1-* accounts (FDRs, Term DePosits NlL N [1- and other tYPes of DePosits Kolkata- including saving accormts), Rs.22,817.83 as on 4.4.11 Deoosits with Financial f-\ I L- &rL_ AllL Institutions, Non B anking SBI,W.B.L.A. l'\tL Branch Financial ComPanies and as Coonerative societies and the' Rs.4818.84 *o'*t in each such dePosit on 31.03.1'1 Public Provident Fund l..t t t- A0rL Rs.1,53,737.00 ^|lL_ as on 30.3.2011

ileta-smentinBonds, Debentures/Shares and units in companies/Mutr.ral Funds and others andthe amount inNSS, "iinvestment Postal Savings, Insurance Policies and investnrent in any Financial insm'rment in Post OfEce or lnsurance ComPanY

Qfr x*^LwJ'*-

ril rl iii-t i'r ilr.l ll [. t- $TNEXTURE - NIL ilIL ffi@mpan)r,Jrustetc. and L other receivables from debtors NTL Nrl N(L 7 andthe amoun0 Motor NIL rD Vehicles/Aircraft s/Yachts/Ships NIL fU(L N11: (details of Mike, Registation N{L i,lo. erc. Year of Purchase and amount) (ffity) mnery, bullion and valuable NIL 50 vii) grams NX4* thing (gve detils of weight and rt,lL present cost value) Rs.100000/- ^I1[- aDDrOX. NIL viii) Any other assets such as value NIL ,{ {(- Arl L- 1,e41_ of claims/interest Rs.1,00,000/ ix) Gross Total Value Rs.181,373.61 A{t1- N lt-l ru1

assets B. Dchik of lrnqov.able also have to be ' indicating the extend ofjoint own,rship will ["t" 1. P.p.td.s inioiniownership indicated 2.Eachlandorbuildingorapartrrentshouldbementionedseparatelyinthisformat.) lr t 2 fi.nendent 3 Self Spouse Deoendent I Deoendent H Description D Agricultural LanA Locaions$) NIL NIL N(L NIL Suneynumbed$ NIL m il (t- NI L- ltr L_ Area (Total N ,{tL N.1? measurement in 'acres) Whethet inherited NrtL f\lL- NTL ru$* *tt- Date of Purchase in case ofselfacquired Ast a- f\r l A- oronertv NIL Nr[- ,.0(; Cost of land (in case at the ofpurchase) nor t- rulL Nl t- time of purchase h{tL Ntl-- Any investrnent on- the land bY waY of development, N01 L- Ar tL- Nl l- ?Llr/ construction, etc. N1L Approximate ,vJ- r- l,oi l- nu I'r- Current market value fiL i-r* qf K^t* w'4"" ItIErrunE.l, fr/ ii) Non- Agricultural Lrnd Location(s) MouaKhaffi Survey PS Betda Nit numbe(s) Dist. Paschim Mediniptn Nt> N( L tulL

tuea (Iotal 33.5 Decimal measursment (1/3 acre apprtix) Al {.L lL IlrL Aor L in acre.) i\ Whether i, inhedted Yes Jl \L AIL l+t L NI L- li, F !i.i property (Yes |lr orNo) rl I Date of .i purchase in (L case ofself ru IUIL &t L ac.quircd /(r lL- &u- DroDertv Cost of land (in case of t'L purchase) at d.{tL /q rL Nte- ttt L thetime of ^r ourchase Any invesffient on A house has been the landby constucted onthis NtL tu (t- Ar tL N/L way of landwithtotal development expenditure of constuction Rs.3,30,000/- etc. Approximate Land: Rs.502500.00 current House '500000.00 Artf- N IL_ NTL NIL market Total Rs.1002500.00 rrqlrre

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+ lr il l, ii :l I AfNEnUm.

,i) Commercial Buildines (including aPartments) NIL NIL Location(s) NIL NIL NIL Q"-ro.r -rrmhpr Ic\ Built up Area (Tota 1L NLL NLL t\414_ Measurement in sq.ft.) ft1L Whether inherited Property ^+ (Yes orNo) Daie of purchase in case of ttl turL A+( L fqt L tu11_ selfacouired property t t* (in case of tosfif property "L: purchase) atthetime of N l1- H{L Al 1t- All L ourchase ^lx Any inveshent onthe propotyby way of rurL Arl l- N1L N1'L- dwelopment, construction NIL etc. NIL Approximate current mryket NIL NIL NIL NIL value

iv)

Residential Govt. Buildings ownership flat (including bearingNo. B- NIL ll, apartrnents) 10 in Kareya A0tL- Location(s) Housing NPIL t,l Survey Estate,98 ^ptL numbe(s) Karea Road, Kolkata - 19 Area (Iotal 450 sq.ft. NIL AtfL measurement AltL f\ar L in so.ft.) Builtup Area 550 sq.ft. (total NIL Ntr- &IL- measurement N1L in sq.ft.) Whether No inherited property (yes NtL NIL f't tL tatL or no)

Date of purchase in r\t t case ofself 12.01.2005 NIL N{t- l,ttL l-- acquired rrooertv qYt(*t4j'l'* / -r/ tNritEx"lJililr.'F Y/

rt of .,ropertY (in Rs.2,04,000/' e'ase of l1- Ll- N(t- purchase) at il N Ll- it the time of

Any investnent on the landbY No NtL /,ltL INVL way of AJIL i ! !' development, l- Ii constuction ii etc. ApP,roximate currcntmarket Rs.5,50,000/- fl tt NIL tutL tso{ L valuc v)O&on NIL (srnas NfL NtL inH€stin N r[- AltL

mmertv) I I I vi) Totel I cunent Rs.15,52,500i- i marketvalue NIL Nrf-- kf> of (i) to (v) ^{tL above

public financial institutions and government :- I give herein below the details of liabilities/dues to Dependent Dependent Dependent sl. Description Self Spouse(s) 1 2 J No Nil r) Loan or dues to Nil f Institutioi Irtl L Ml^ ir; (s)""fn'io""ciol Name of Bank or FI Amount outstanding Nature of loan

Loan or dues to anY other Nil Nil individuals/EntitY other than lN lL Nt{-- /+ tL mentioned in (i) above Name (s) .l I Amount outstanding t Nt,L- I furL ,\ lL- NI L_ I l,nv other liabilitv tuil- I --- fu.t{ -- rqt --- Nl L ,i Gand total of liabilities NIL NIL iD Government I)ues l.r,tL -l!!- ryfL Dues to deParanents dealing NIL NIL with Govt.accommodation W t{*M|1* u r lnHEx"UFIF " NIL NIL Dues to diiPartuitnts dealing N\t- Ar lL- with supolY of water NIL NIL ^ilL ffito@artments dealing ArtL NIL NW with supplv' of electricitY Puest'aeparmentsdealing NIL NIL with supplY of NlL /\DI L L r^r ^-l^^--./*nlrilae ^PT dealing NIL NIL Dues to deParfrnents tL NIL A+{ with govemment tansPort^ Al L (including aircraft s and helicopters) Nr (L AlItr- N 1"L- Incometax dues NIL NIL -L-- r,. 't t- Fr t Alt WealthTax dues NIL NIL Ta:t dues NIL NIL AtL Service a.t-t^tt[- L- ^0tz*t 7.- Tnv T)rres NIL NIL Nt L_ =J/D*-.rt- NIL NIL [$t L- t*tL- ^e Sales til( uues N(^$t TI-Il+iio, n{,,.c NIL NIL r\tL- L- L ^{1 ffi;;r-[f all (?nvt drres NIL NIL f,? t Al l-- Itttt

7) Details of profession or occupation': a) Self .- Social Service b) Spouse - Social Service g) MV educational qualification is as under.: with ur form of the oertificate/diploma/degree Give details of highest d;i;;utiffirity "au.ution tt'" in which the course was completed ) cogrse) Name of O, Sriooifoft.ru"irrttity *i v"ar

Course Year School Final 1963 1964 lvllulllluurg vuuwSv PreffiEGq- EtIT-r:^^t ft^tl-aa l-rrfianlr MBBS t97l fficolltse,Cuttack DTco (oiptomain r974 TrrberculoSis and Chest Diseases) W il-J"-ttil,*

I l- INHEX'?URE'ff

(9) ABSTRACT O['THE DETATLS GIVEN rN (1)TO (U) ABOVE

Name of the Candidate DR SI.'RJYA KA}ITA MISHRA 2 Full postal address Vill. & P.O. Khakurda P.S. Belda Dist. Paschim Mediniptr J. Nurrber and name of the constitudncy and State 225 Narayangarh Assembly Coristituencv. West Bensal 4 Name of the Political Party which set up the Communist Party of India (Man

9. Highest educational qualification: MBBS, DTCD @iploma in Tuberculosis & Chest Diseases) (Give details of SohooVUniversity education with full fonn ofthe certifrcate/diploma/degree course)(Name of the SchooUCollegeAlniversity and the year in which the course was completed)

Name of the SchooVColleeeAJniversiw Course Year Baramohanpur H.E. School School Final 1963 Midnapore Colleee Pre-Universitv (Sc) t964 SCB Mdical Colleee. Cuttack MBBS t97t SCB Medical College, Cuttack DTCD @iplomain t974 Tuberculosis and Chest Diseases)

VERIT'ICATION

I, the deponent, abovo named, do hereby verify and declare that the contents ofthis afEdavit are true and conect to the best of my knowledge and belief,.no part of it is false and nothing material has been concealed there &om. I fiuther delare that : (a) there is no case of cosviction or pending case against me other than those mentioned in items 3 and 4 above; (b) I; my spouse, or my dependents do not have any asset or liabitity other than those mentioned in items 5 and 6

Verified at Kolkata this the 12e day of April, 2011

:nmi EtlATTfCilltrn - llotlry Ooif I6tL kqrl.IoDae , tl Enttttcnorl} tro F -n,T/rofrorl, tvl EulflIGrrCrr* iUl Supratck Syarnar. QarUna(S)of rhclkcffifit lhdcd oa tdenfifieatiol ol Advoo{?,L.-.-\ i' v i "<----z -"ru-*/ " '{.,!,","?i;lil# v fioo-.1!o.05, lst, \ '--1' tfrJ,',t r nJor .\"1 & r,olcah-lg@Ol r . ,ry'-' 12 *n \'r-*r \ ' u/ zotn -- Annexture "A'1

ST BENGAL #***t+:'rY;.-1.r-*l'tt"t-'i:1i.Hl # 3[ ##: 11 ,''1i# EfB"ffi;l F.RM26 (seerute4A) B re46- ny# candidate before the returning officer for election to West Affidavitti- to u#f,ft#iffie @. Bengaf Le gislative Assembly from 225-Narayangarh Assembly Constituency.

Mishra aged about 62 yearc, il, Dr. Surjya Kanta Mishra, son of Late Janardan F Medinipur resident of Village Khakurda, P.O. Iftakurda, P.S. Belda, Dist. Paschim as under: - candidflte at the above election, do hereby solemnly affirm/state on oath

H imprisonment fo1 two years or 1. tr am not accused of any offence(s) punishable with court(s) of more if, a pending case (s) in-which a charge(s) has/have been framed by the compefent j uri sdiction {'*)'* MJ'*

F 0r

H 1 2 APR 2011

B fo&sta-?(so0l "A'i Annextrrre

If the deponent is accused of any such offence (s) he shall information : I)oes not arise., . (0 Case/First information report No.A.[os...r[{Jl-,... . itt) Police Station(s)'....,..... Disrrict(s) ...... h,.!.+-...... State(s) (ii1) Section(s) of the concemed Act (s) and short description of the offence(s) for which the candidate has.been charged . . . . . r.\J:. I L-...... (rv) Court(s) which framed the charge(s) ...... 4{ l, A- ...... (v) Date(s)'on which the eharge(s) irty*o. fiamed .. .fJ.l. h . . ... (vi) Whether all or any bf the proceeding$) have been stayed by any court(s) of

2. I have not been convicted sf an offence (s)[other than any offence(s) referred to in sub-section (1) or sub-section (2) or covered in sub-section (3), of section 8 of the Representation of the People Aot, l95l (43 of 1951)and sentenced to imprisonment for one year or more.

If the deponent is convicted and punished as aforesaid, he shall furnish the following information : Does not arise

(i) L (i, (iir)

(rv)

""'1"".l"" (v) Date(s) on which the sentence(s) waVwere prooo*."d . ., [!.tA- . .. (vi) Whether the sentence(s) has/have been stayed by any court(s) of competent

Place: Kolkata {,,;r^r- il* t+ol* Date :12.04.2011 Siffature of Deponent )a*+i1;a \ ''rr"' Q*h4 $",,,' ' .uu.a"pU Fncrlnur^r No - tr- Stf/sstJtqq7.

Itr. &prrtcf gyeu*r ryac. c. c!,,*1?;& C. OAPost C6ce Etrset, f,oou No, OS, lst. Floor folkata*eoooot

1 2 APR 2011

\rr* r * t*-,-*; "Ei mrt SaBsii;i:i..'l Annexir:re tiff.&Iff*i, i'rij; l'.rft

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. **"ATION

I, the above-naured deponent, do hereby veriff and declarc that the contents of this affidavit are tue and corect to.tlre best of my knowledge and belief, no part of it is false and nothing material has been concealed therein.

Verified at Kolkata this 12s day of April 201 l.

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1 2 APR 2011

1 2 AFR 2011

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