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\\ \WI5°\Oa ,' Ad• FORM 2B See Ode 4) NOMINATION PAPER \\ \WI5°\Oa ,' ad• FORM 2B See ode 4) NOMINATION PAPER Election to the heKtslnhvr A-ssetnhlc nl 9] oiilpm > lnlr IglitP 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 Legislative Assembly from the 81 _ Alingg(rr Million Moluat Jlm Father' s name( Dr rA.ssembly constituency . Candidates tame Dr . f]aghant P S - Manigacchi ^Ihstne ( llarbhanga Nagendm Jha His postal address Village tk P O. His name is entered at S. No 436 in Pert No. 195 of the -),noes) roll for 8892 j. ] ) Xtrnmr Jhu and It is entered at S. No Lc;ranser ) Assembly eonstintcnty_ My nano in 1bmtisl ^constituency. 918 in Part No . lob of the electoral roll for the 81 Alata ar Assemhl 37T°71a/a//^ (Signature or proposer) Date October 5 2010 Y PART II (To be used by candidate NOT set up by recognised political party) We hereby nominate as candidate for election to the Legislutive Assembly from the ..__.. _. _...... _,..___- Assembly Constituency S Candidates name ___, .._. _. _..... .__ __.... __. Father s / mothers / husbands name. ...... _.- His postal address His name is entered at SI. No ....... _ ..................... in Part No............. _........__.of the electoral roll for ....... ....... ............ ............ .....,.. Assembly Constituency. We declare that we are electors of this Assembly Constituency and out naives are entered in the electoral roll for this Assembly Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:- 1 'arficulars of the proposers and Nwu signatures Electoral Roll No. of proposer Full name Signature Date SI. Pan No. of Si. No. No. electoral Roll in that Constituency Part 2 3 2 3. 4. a. 6. 7. 8. 9. 10 N.B. There should be tin clu Wig of constituency its propose rs_ PART III I, the candidate mentioned in Part I/Part II (strtke out which is not appllcablel assent to this nomination and hereby declare - ,al that 1 have completed __vears of gr STRIKE OUT b(i) OR bfii) BELOW WHICHEVER IS NOT APPLICABLE( CONGRESS party, which b) fit that I am set up at this election by the INDIAN NATIONAL is recognized National Parry/State Part}' in this State and that the symbol reserved for the above party be allotted to me. Aoolicable party, which is a registered- (ii) that I am set up at this election by the Not unrecognised political party/that I am contesting this election as an independent candidate (Strike out which is not applicable) and that the, symbols I have chosen, in order of preference, are:- )...................... .. (if ........................................ (ii)......................................... (iii (c) that my name and my father's/mother's/husbands name have been correctly spelt (name of the language) out above in De arm (Hindi) (dl that to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State. s is a__.."Caste/tnhe which "I further declare that I am a member nl the l in relation to o. _..__.._...__..... ,scheduled ""caste/tribe of the State i ................(area) in that State. I also declare that I have not been, and shall not he, ""nominated as a candidate at the held simultaneously, to the Legislative present general election /the bye-elections being Assembly of ...................... (State) from more than two Assembly Constituencies. t 0.c ail ( (S tgnuht re of Candidalel Date tk'Iober 05, 2010 out this paragraph, if not applicable. the Words not applicable. "Score out by the Election ' means a political parry- recognised N B . A 'recognised political party and Allotmen1t) order, 9b8 in the State under the Election Symbols ( Reservauoo concerned. PART III A ITo be filled by the candidate) Whether the Candidate - (il has helm rnnvioted (a) of any otfence(s) under sub-sccuun (III of 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 (ii) has been convicted for any other offence(s) for, h,ch he has been 'nl fur two A'etu s ar tnorr 6t'ntrii ed lit t tn1 ) tiSorlnlt If the answer is -Yes", the candidate shed) furnish the fnllmving in (alma. nin Case First information report No.iNos. liil Police station lsl -..... --Districtlsl State(s) tit) Secuon(s) the concerned Act(s) and brief description of the offence(s) for which he has been convicted ..................... fiv) Date(s) of conviction(s) V) Court(s) which convicted the candidate ''--"- I ) p1) Pulu lliment(s) unposed Imd eats pc nod of im Prison men.I sJm )d/nr 4uuntum of (toe(s) ............... (vii) Date(s) of release from prison _..._..- (viii) Was/were any appeal(s)/revision(s) filed against above conviction(sL..Yes/No (ix) Date and particulars of appeal(s)/application(s) for revision filed (s) Name of the court(s) before which the appeal(s) /applicoUan Is) fur revision filed (SI) Whether the said appeal(s) / apphcunon (s( for revision has/hive been disposed of of is/are pending. -" (>oi) If the said appeal(s)/aPPltcauon(s) for revision has/ have been disposed of - (a) Date(s) of disposal (b) Nature of order(s) passed __.....,. _..-- Place: QenW ur ignature of the candidates Date : October OS 201o a PART IV U(h<rn the leninunp To be jibed Ni 4 C _(hart1 Senal No of nomination paper at m niGcc`^ This nomination was delivered to. me on `candi¢arel PVopdser. ----„^,1%p-', G...Idatel by the Score out the word not aPPI'cz'bl° -------------------- Pnper PART V No,ntrtahen or ReleetnfI the Anvpring nrmurg ()jfcer of the Reprtsen^annn (^curnn of he d accordancea per ^^^th veruonf^lo n^. T °`I r 1 ° ^. nominaU°n m 1t^h P' l^ ows' d`\ r m pl • have examine d e a q F u rr` (-kN)l9^S.': ,` People Act 151 apddeei 44 , he , p C i..1lJA ?»11ov+Ak 1hra m r 2 Qtvrd A i _. ^r-1z`. i Date ........... (perloranon) .... FORM 26 Zt "^*- eft 'T noev (Sec rule 4Al to be furnished by the candidate. before the returning officer for el a iikry to e Assemb(u (name of the House) from 81-,A6rtngnr coil stituencc( name of uencv) I. Dr. Madan Mohan Jha , son of D.r_N<ogenriru ,ha aged about J, year, resident of villa e (L P..O- Baghan_PS___Mar ht_ Uis[nct_ borbhaniwu (Bfhorjcandidate at the above election- do hereby solemn!y efhrm; state oil oath as under:- l. I am/am not accused of any offence(s) punishable with imprisonment for two "ears or more in a pending case(s) in which a charge(s) has/have been framed by the court(s) of comp-, ent l u risdictIon . If the deponent is accused of any such otlence(sl he shall titrnish the Iollowlne into nnunun (i) Case/ First Information report No./ Nos. Not Applicable (ii) Police station(s) Not Applicable District (s) Not Applicable State(s) Not Applicable (iii) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged Not Applicable (iv) Court(s) which framed the ('harge(s) Not Atlph• (v) Date(s) on which the charge( s) was /were framed Not Apphcuhle (vi) Whether all or any of the proceeding(s) have been stayed by an) court(s) of competent jurisdiction Not Applicable 2. 1 have been/have not been convicted of 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 R of the Hepr'osenta l inn of the People Act, 1951 (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: (i) Case/First information report No./Nos_ Not Applicable (ii) Court(s) which punished Not Annhcable (iii) Police station(s) .NOI )LwOrablc I)islri( I I') Not Apphrohly State(s) Not Applicable (iv) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has ever been charged Not Applicable Iv) Date(s) on" hich the sentence (s) was/were pronouncjQ / Aupi cable ^^ A A.^ , Ia0f r2 vi) Whether the sentence(s) has/have been slaved by any of competent juri sdicti on Not Aopl cpble Place Laheriasarm Signature of deponent Date: October05 2010 --------------------------------------------------------------------- ----------- ----- VERIFICATION 1, the above-named deponent, do hereby verifit and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief, no part of it is false and nothing material has been concealed therein 'veri(i<al at Lohenusurui this /i lh day of OUOber,AU10 t ^v d^AL^ Signature of deponent 2 c^ ^ ^i ^I tie c_ 1Dc e ^ ( ^C Iti 'Al t( rr`' ^1oie: The columns in this Form which are n,,1 + pphca ble In the rlepnnnm muy be struck off.' o c, IF" Y KbWled by M - 1 - - 4v N vclar.a h.f,4-. I A. K. Sin Annexure- I VIT TO BE FURNISHED BY CANDIDATE ALONG NOMINATION PAPER for election to Legislative Assembly ( name of the House) from 81- Atinanyar constituency ( name of the constituency ) I, Dr. Madan Mohan Jha, son/ of Dr. Naoendra Jhu, aged 52 years, resident of village & P.0- Baghont P S - Man gacchi District Da bhanga candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Stri7ce out whichever not applicable) (1) The following case (s) is/are pending against me in which cognizance has been taken by the court:- (i) Section of the Act and description of the offence for which cognizance taken : 341 , 323, 379, 504 IPC (ii) The Court which has taken cognizance : Sub-Divisional Judicial IMvaoistrate Darbhanoa (iii) Case No.
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