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I No L''o Ito >:T> P,-F 'G't'3'>T9 a I I no l''o Ito >:t> P,-f 'g't'3'>t9 FORM.2A. (See Rule - 4) NOMINATION PAPER Election to the House of the people r- *] J L I (To be used by candidate *ffi*cognised political party) I nominate as a canclidate for election to the House of the people ircrrr the 12. - Tiru {.Xgj Parliamerrtary Constituens,. clandida-te's narne Balli Durga Prasad Rao, Father's1Me+l+e*:s / l-In*sbendk name Late 'Balli Fenchalaiah' His postai address t6-528, Karnakamma street, \,enkatagiri row,, venkatagirin sPSR Nellore Distriet, Andhra Pradesh. His name is entered at sl. No. Il4 in part No' 256 of the electoral roll for l22-!'enkatagiri (Assernbly Consrituencv comprised within) 23 - Tirupati (S.C.) parliamentary Constiruency. My name is Srinivasulu Reddy sannareddy, Son of surya prakash Retldy sannareddy and it is entered at Sl' No. 422 PartNo. 258 of the electoral roll for the t20-Gudur (Assemhly constituency comprised within) 23 - Tirupati (s.c.) parliamentary constituencv. Date 25-03 -2{}ts ,\" t. raf Slr;nature of proposer S sBu:\Ast,lu ll€oay PART - II (To be used by candidatJFidffiup bv recoenised political partv) We hereby nominate as candidate for election to the House of the People from the Parliamentary Constituency rlame Father's / 's / husband's name His postal address His name is entered at Sl o in PartNo ofthe electoral roll for Constituency, (Assembly comprised rnith in) _ Parliamentary W'e declare that we of this Parliamentary constituency and our natnes are entered in the electoral roll for this constituency as indicated below anci we append our signatures below in token of subscribing to nomlnatlOn. Particulars of signatures Name of Elector Roll No. sl. component FullName Signature Date No. Assembly Part No. of sl. \in Constituency Electoral Roll that pa\ .| I 3 4\ 5 6 7 I ,) l 4 5 6 8 9 10 N.B. - There should be ten electors of the constituency as proposers. 2 PART - III I, the candidate mentioned in Part I i k{F(Strike out which is not applicable) assent to this nomination and hereby declare - (a) that I am a citizen of India and have not acquired the citizenshipo of any foreign State / Country. (b) that I have completed 63 years of age ; ISTRIKE OUT c(i) or c(ii) BELOW WHICHEVER IS NOT APPLICABLE] (c) (i) that I am set up at this election by the Yuvajana Sramika Rythu Congress party, which is recognised*{ational*rff / State Party in this State and that the symbol reserved for the above party be allotted to me. OR (ii) at this election by the party-, r.r,hich is a registered party /that I am contesting this election as an independent candidate. (Strike out and that ttre sy'inlrols I have chosen, in order of preference, are (i) (ii) (iii) (d) that my n.1me and my father's / metherh / husbandh name irave been correctly spelt out above in English (name of the language); and (e) that to the best of my knowledge and belief, I am qualified and not aiso disqualified for being chosen to fill the seat in the House of the people.. *I further declare that I am a member of the Scheduled Caste (Mata) **Caste/tribe which is a scheduled **caste/tribe of the State of Andhra Pradesh in relarion to l22-Yenkatagiri, SPSR Nellore District (areal in that State. I also declare that I have not been, and shall not be nominated as a candidate at the present general election/the bye-elections being held simultaneously, to the House ofthe People from more than two Parliamentary Constituencies. Date 25-03-2019 of ,)' PART - III A (To be filled by the candidate) (1) Whether the candidate : (i) has been convicted (a) ofany offence(s) under sub-sectiSon (1) ; or YES / NO (b) for contravention of any law specified in sub-section (2) of section 8 of the Representation of the People Act, 1951 (43 of 1951) ; or (iD has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more If the answ'er is "Yes". the candidate shall furnish the following information: (i) Case/fi rst information report No.A[os. NOT APPLICABLE (ii) Police station(s) NOT APPLICABLE District(s) NOT API'LICABLE State(s) NOT APPLICABLE (iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convected NOTAPPLICABLE (iv) Date(s) of conviction(s) NOT APPLICABLE (v) Court(s) which convicted the candidate NOTAPPLICABLE (vi) Punishment(s) imposed [indicate period of imprisonment(s) andior quantam of fine(s)] NOT APPLICABLE (vii) Date(s) of release from prison NOT APPLICABLE (viii) Was/were any appeal(s) / revision(s) filed against above conviction(s) NO (YES/NO) (ix) Date of particulars of appeal(s) / application(s) for revision filed tYg't APPLICABLE 4+ 9- .a_) (r) Name of the court(s) before which the appeal(s) / application(s) for revision filed NOTAPPLICABLE (ri) Whether the said appeal(s) / application(s) for revision has/have been disposed of or is/ are pending NOT APPLICABLE (xii) If the said appeal(s) / application(s) for revision has/have been disposed of : (a) Date(s) of disposal NOTAPPLICABLE (b) Nature of order(s) passed NOTAPPLICABLE (2) Whether the candidate is holding any office of profit under the Governrnent of India or State Government? NO (lbs I NO) If yes, details of the office held NOTAPPLICABLE (3) Whether the candidate has been declared insolvent by any Court? NO lyag / NO) If yes, has he been discharged from insolvency NOTAPPLICABLE (4) Whether the candidate is under allegiance or adherence to any fbreign country? NO 1ygg7 No) - Ifyes, give details NOT APPLICABLE (5) Whether the candidate has been disqualified under section 8A of the said ect by an order of the President? NO (YES /NO) - If yes, the period tbr which disqualified NOTAPPLICABLE (6) whether the candidate was dismissed for comrption or for disloyalty while holding offrce under the Government of India or the Government of any State ? NO ( YES i NO) - If yes, the date of such dismissal NOTAPPLICABLE (7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply or any goods to that Govemment or for execution of works undertaken by that Government? NO (YgSl No) bc^{\ tr If yes, with which Government and details of subsisting contract(s) NOTAPPLICABLE (8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which tire Central Government or State Government has not less than twenty-five percent share? NO lygg i NO) If yes, with which Government and the details there of W (9) Whether the candidate has been disqualified by the Commission under section l0A of the said Act NO (YBS i NO) - If yes, the date of disqualification NOTAPPLICABLE Place : Nellore Date : 25-03-2019 Signature 6 PART. IV (To be filled by the Returning Officer) Serial No. of nomination paper E I This nomination was delivered to me at my offtceat lLPq\ (hour) on Lf .O 2ol l-'. 3. ? (date) by the *candidate/proposer (Illame of the Proposer Date .O q. 2*o \ 2 S 1 23- I AND J0lttlT C0tttCI0R, NELI"0rl; iiil" PART. V 015 Decision of Returning OfficerAccepting or Rejecting the Nomination Paper I have examined this nomination paper in accordance with section 36 of the Representation of the People Act. 1951 (43 of I 951) and decide as follows :- Date P*etuming Offrcer ftlerforation) PART. VI Receipt for Nomination Paper and Notice of Scrutiny (To be handed over to the person presenting the Nomination Paper) Serial No. of nomination Paper a\ L3 .,: *Score out the word not applicable. ANo J0lt{I C0ttEcToR, ilt' SRI POITI SRIRAMUTU NilLofft !'. 7 I t <-ffi ? \--\ t\-1 ', I a+: ,l: = 6 * I ! E D 7 B B =a'ff E ZE _t-,-_4 \ oo L oo.t oo-t oo1 o oo.l oo 1 001 oo.t oo 1 ()01 ol oo1 oo-l 1 e90 6d ANDHRA PRADESH A 334698 el cHAlJnnK;I** o sp . tl,rt ts' P E\t :,Y,||Q.HT" a Jr * L'No'1i4"'li i:'l/?011 R.No.09'';:,'.;i.r 101 7'2019 F" ""r"r" "dr i.ol w ho m.....,.SEL " D.No. 1 ? -?iJ6. r.:, r-TKALIPETA Verrkatagiri, SPSR Nellore Dt I FORM - 26 I ( See Rule 4,{) !B . AFFIDAVIT TOBE FILED BY THE CANDIDATE ALONG WITII r NOMINATION PAPER BEFORE THE RETT]RNING OFFICER . FOR ELECTION TO THE HOUSE OF THE pEOpLE (NAME OF THE HOUSE) FROM 23-TrRUpATr (S.C.) PARLTAMENTARY CONSTITUENCY (NANTE OF THE CONSTTTLTENCY) PART. A t I, Balli Durga Prasad Rao, **Sor/daught€rir+ift of Late Balli Penchalaiah, Hindu aged 63 ' years, resident of 16-528, Karnakamma Street, Venkatagiri Town. Venkatagiri, SPSR Nellore .DistrictrAndhra( Pradesh (mention full postal address), a candidate at the above election, do hereby I solemnly affirm and state on oath as under. TlFo ftao ,43)tl M.A., B.L, BJJ.SA Advocate & NotarY triitly,,lli,*Hi'l#Lif,il I q) I.1:P,:l,9, .t+ "t",..''.*,"I l bLr \'\ (1) I am a candidate set up by Yuvajana Sramika Rythu Congress Party (**name of the political party) / t* . (**strike out whichever is not applicable) (2) My name is enrolled in l22-VenkatagiriAssembly constituencv comprised in 23-Tirupati (S.C.) Parliamentary Constituency ofAndhra Pradesh at Serial No.
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