FORM 2A (See rule-4) NOMINATION PAPER R.O.9 NSR PIc e on to the House of the people st. I xo..zkl.h ?,,.l.a 5..1 Kl) 7 Dac....?{1.0.}.:....h.1.1...... \ Trme....l.l-.;.?f_.W...... II

Venue. Do

STRIKE OFF PART I OR PARTII BELOW WHICHEVER IS NOT APPLICABLE PART I (To be us by candidate set up by recogni zed political party) 1. I Nominate as a c .lidate for election to the House of the people from the NARASAPURAM Parl entary constituency. Candidate's name ather's name HIS Postal Address His nam s entered at Sl.No

the electoral roll fo r...... Assembly constituency. My name is ...... and it is entered No...... part as Sl. No oft electoral roll for the......

Date: Signature of proposer. PART II (To be used by candidate NOT set up by recognized political party) we hereby nominate as candidate for election to the House of the people from the NARASAPURAM PARLIAMENTARY constituency. candidate's name PENMETSA stvA RAMA RA",u (vtssAKoDERU stvAl Father,s name vtswANADHA RAtu His address PANCHAYATI POSTAI OFFICE BAGK SIDE, VADTAVANIPALEM, PAIAKoL MANDAL w.G.DIsT His name is entered at Sl. No.58 in Part No.128 of the electoral roll for EPIC No.Ap1Oo61O312255 parliamentary constituency. We declare that we are electors of this Assembly constituency and our namesareentered intheelectoral roll for this Assembly constituency as indicated below and we append our signatures below in token of subscribing to the nomination:- Particulars of pro posers and their signatures sl Elector Roll No. of Full name Signature Date No Proposer Pa rt S.No. in No.of that part Electoral Roll L 2 3 4 5 6

1 42 L264 MANTENA PRASADA RAJU cYr.fll.s-0"'[b.r:> 2 L42 460 NADIMPATLI CHINA SUEBA RAJU .^v."/, v'g6) 3 155 34 MANTHENA VISWANADHA RAJU --tr"u,;efir&E- 4 15s 155 MANTHENA SAMI[i{r sUDHA M 5 59 894 GADIRAJU SUBBA RAJU G,9 5 6 377 DODDIGARTA MUTYAM .%-Y4rrtr*^ 7 L27 1284 NADIMPATTI ROHIT SIVA PAVAN liQ S.6"- VARMA Vorrq 8 37 66s BALAM GANESH KUMAR tr4 9 157 560 DATTAVENKATANARASI MHA RAJU D:r--fl<-\ 10 L32 4 P.V.s. J. RAMANJANEYA RAJU PvS PENMETSA. N,B.: There should be ten electors of the constituency proposers. PART III l, the candidate mentioned in Saru /parfll(strike out which is not applicable) assent to This nomination and hereby declare that- (a) I am a citizen of lndia and have not acquired the citizenship of any foreign State: (b) That lhave completed 40 years ofage; isTRrKE OUT c(i) OR c(ii) BETOW WHTCHEV rs NoT APPUCABTE) @ (l) I am set up at this election by the party, which is recognized National Party in this State and the symbol reserved for the above allotted to me. OR

(ii) I am set up at this election by the ...... party, which is a registered unrecognized 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:- (i) ...... GAS STOVE...... (iD...... GASCYUNDER ...... (ii0...... FRyTNG pAN...... d) My name and my father's name have been correctly spelt out above in ENGIISH ( name of :he language; and e) That to the best of my knowtedge and belief, I am qualified and not also disqualified for being chosen to fillthe seat in the HOUSE OF THE pEOptE. . tfurther declare that tam a members olt[e ...-._.-_-..,...... * Cast/Tribe who is a schedule caste/tribe ofthe State of..,...... in relation io=;:,,... (area) 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-election being held simultaneously, to the HousE oF THE PEoPLE from more than two PARIIAMENTARY constituencies. e61s ) E 3. ,1 F,"n'x,t"ftng,Qr4o.

PART III A (1) Whether the candidate- i) Has been convict--- (a) Of any offence(s) under sub-section (1); or No (b) For contravention of any law specified in sub section (2), FI 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 which he has been sentenced to imprisonment for two years more lf the answer is "Yes", the ca idate shall furnish the following information : (i) Case/Firstinformation eport No/Nos (ii) Police Station(s) (iii) Section(s) of the concer n d Act9s) and brief description of the offence (s0 for which he has been convict (iv) Date9s) of conviction(s) (v) Court(s) which convicted the (vi) Punishment(s) imposed {indic e period of imprisonmentgs) and /or quantum of fine (s))----- (vii) Date9s0 of release from prison (viii) Was/were any appea l(s)/revision ) filed against above conviction(s)...... Yes/No (ix) Date and particulars of the ppeal (s)/application (s) for revision fi1ed...... (x) Nae of the court(s) before whc the appe s) for revision filed (xi) Whether the said appeal (s)/a pplication (s or revision has/have been disposed of or is /are pending...... (xii) lf the said a ppea l(s)/a pplication(s) for revisio has /have been disposed of (a) Date(s) of disposal...... (b) Nature of order(s) passed...... (2) whether the candidate is holding any office of profit under the Government of lndia or state Government?....No...... (yeslNo) -lf Yes, details of the office he1d...... -\...... (3) whether the candidate has been decrared insorvent by any court?..No.....(r+s/No) -lfyes, has been discharged from insolvency \ (4) Whether the candidate is under allegiance or adherence to any foreign country?...... N O. (\aeslNo) -lf Yes, give details (5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the President?.....NO ...... {Yes/No) -lf Yes, The period of for which disqualified (6) Whether the candidate was dismissed for corru ption or for disloyalty while holding office under the Government of lndia or the government of any State?...... NO...... (\qes/No) -lf yes, the date of such dismissal....-\...... (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 of any goods to that Government or for execution of works undertaken by that Government?...... NO...... -.. (\aes/No) \ -lf Yes, with which Government and details of subsisting contract(s).....\ (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 the Central Government or State Government has not less than twenty-five percent share?...... NO...... (\qeslNo) -lf Yes, with which Government and the details thereof (9) Whether the candidate has been disqualified by the Commission under Section 10A of the said Act...... NO...... (Yes/No) -lf yes, the date of disqualification.....\...... Place:..N.Q.R P.1.t.1-:o.lf+ h ? S"o?"ro ku. Date:...... L--s...-.J.:..r t signinire oithe candidate. PART IV

(To be filled by the Returning Officer)

Serial No. of Nomination pa per......

This nomination was delivered to me at my office at...... (hou r) on......

(date) by the * candidate/proposer...... (Name).

Date Returning Officer *Score out the word not applicable. 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 of the people Act, 19S1 and decide as follows:_

Date Returning Officer,

(perforation) 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......

The nomination paper of ...... a candidate for election form the...... -......

Assembly constituency was delivered to me at my office at ...... (hou r)

On (date) *ca by the ndidate/proposer. All nomination papers will be taken up for scrutiny at...... (hou r) on (date) at...... (ptace)

Date: Returning Officer *Score out the word not applicable. ) )

.-

No. :ol ,-or

(Name of the constituency) E PART-A r *tuma stvl muA RAru (vtssAKoDERU stva). .. son ot vtswANAoHA RAIU Aged 40 years, resident of NEAR PANCHAYATI OFF|CE, VADALAVAN|PA|-EM, pAtAKOt- MANDAI, W.G.IDST, A.p,, (m+tioned full postal add.ess, a candidate at the above election, do hereby solemnly affirm and state on ^q oatti as underr 1)_ lafi-a€4Cdst€--5e{-{B+y...... xxxxxxxxrc()uxxxxxxxxxxx...... I ("name of the politicai party)/ ** am contesting as an TNDEPENDENT CANDTDATE (Strike out whichever is not applicable) v (2) [y name is enrolled in PALAKOL ASSEMBIY CONSTITUENCY andAp State, at Serial No 58in partNo.128 (3) l0y contact telephone numbe.{s} is/ 9502565569 and myemail id(if anv) is,r,, {4) of Permanent Account Number and status ot oI lncome Tax retuan. sl. Names PAN The financial Year for which Total income shown in the last ldcome-tax return lncome Tax lin Rupees) has been filed 1 self CWPP4924H Nil Nil

z. I Spouse Nil Nil N

3. t Dependant-1 NIL NIL NIL

4 Dependant-2 NIL NIL I NIL 5. Dependent-3 NIL NIL Ntt I

eru!""^"pq., Attosl€d fi MA-JllLllh-NNAsA RAo M.A., L.L.M.. I@TARY&ADVOCATE OPg: M.R.O Oftlcc' BHIi,AVARTT.1,W,G, Ot..A.P,,lndiA 2 (5) am I not accused of any offence(s) punishable with imprisonment for two years or more in a pending case(s) in which a charge (s) has/have been framed by the court(s) of competent jurisdiction.

lf the deponent is accused of any such offence(s) he shall furnish the following information. :-

( i) The following cases) islare pending against me in which charges have been framed by the co urt for an offence punishable with tm rison m ent for two earS 0r more:- (a) Case/First lnformation Report No/Nos together with Not a pplicable complete details of concerned police Stations/Districts/state. (b) Sections(s) concerned Actfl and short description of the Not applicable offence(s) for which charged

@ Name of the Court, Case No. and dated of order taking Not a pplicable cogn iza nce:

(d) Court (s) framed the charge(s) Not applicable (e) Date(s) on which the charge(s) was/were framed Not applicable

(f) Whether all or any of the proceedings(s) have been stayed Not applicable by any Court(s) of competent urisdiction. (ii)The following case(s) is/are pending against me in which cognizance has been taken bythe court {other than the cased mentioned in ltem No(i) above) (a) Name of the Court, case No. and date of order taking Not applicable cognizance

(b) The details of cases where the court has taken cognizance, Not a pplicab le Sections(s) of the nct(s) and description of the offence(s) for which cogniza nce taken.

o Details Appeal(s) Application(s) for revision (if any) filed Not applicable against the above order(s) (6) I have not been convicted of an offence(s) (other than any offence(s) referred to in sub- section(l) or sub -section(2) or covered in sub-section (3), of section 8 ofthe Representation of the People Act,1951 (43 if 1951)) and sentenced to imprisonment for one year or more. lf the deponent is convicted and punished as aforesaid, he shall furnish the following information; ln the following cases, I have been convicted and sentenced to imprisonment by a court of law:

(a) The details of cases, section(s) of the concerned act (s) and Not a pplicable description of the offence(s) for which convicted (b) Name of the Court(s) and, Case No. and date(s) of order(s) Not applicable

@ Punishment lmposed Not a pplicable

(d) Whether any appeal was/has been filed against the Not a pplicab le conviction order. lf so, detalls and the present status of the appeal

d Atte s te

MA!LULA SRINIVASA RAO o * 7 S,*,fu* ?-i" M.A.. L.L.M., NOTARY & AOVOCATE FI OPP: M.R.0 Oltice' BHtirAvaRAlil.1.W.6.Ol.. A.P'.lndla 3

(7) That lSive herein below the details ofthe assets ( movable and immovable etc) of myseli my spouse and all dependents: A. Deta ils of movable assets: -Note: 1. Assets in Joint name indicating the extent ofjoint ownership will also have to be given. Note: 2. ln case of deposit/lnvestment, the details including serial number, Amount, date of deposit, the scheme. Name of the Bank/lnstitution and Branch are to be given. Note:3 value of Bonds/share Debentures as per current market value in stock exchange in respect of listed companies and as per books in case of non -listed companies should be given Note:4: Dependent here the same meaning as assigned in Explanation (V) under section 75A of the Representation of the People Act, 1951. Note:5. Details includi amount is to be iven separate in respect of each investment. SI Description Self Spouse Dependent-1 Depende nt-2 Dependent-3

No. (i) Cash in hand 30,000 NIL NIL NIL NIL (ii) NiL NIL Nil NIL NIL

(iii) Details oI investment in Not applicable Not applicable Not applicable Not applicable Not applicable Bonds, debentures/shares and units in companies/Mutual funds and others and the amount (iv) Details of investment in Not applicable Not applicable Not applicable Not applacable Not applicable NSS, PostalSavin& lnturance Policies and investment in any Financiallnstruments in Post office or lnsurance Company and the amount (v) Personal Not applicable Not applicable Not applicable Not applicable Not applicable toans/advance Siven to any person or entity includingfirm, company, Trust etc., and other receivables from debtors and the amount

!sivoQ*^"Qqu T AtreSted M.A LL R .N.156 * fwrvrrrt=--.- MALLULA SRINIVASA RAO A M.A.' L.L.M.' OF NOTARY & ADVOCATE OpP: M R.O. Oftlce. EHttlAvaRAM-1,w,o.Dl.,A.P .lndit 4

(vi) Motor ACTIVA NOT NOT NOI NOT Vehicles/Aircraft s/Yachts/Ships AP37CB5899 APPLICABLE APPLICAELE APPLICABLE APPLICABLE (Details of Make, Registration 2014 number etc year of purchase and amount) Rs.61,000/-

(vii) Jewellery, bullion and valuable 112 grams of NOT NOT NOT NOT thing(s) (give details of weight Gold APPLICAELE APPLICABLE APPLICAELE APPLICABLE and value) Rs.2,80,000/- (viii) Any other assets such as value NOT APPLICABLE NOT NOT NOT NOT of claims/interest APPLICABTE APPLICABLE APPLICABLE APPLICABLE IX Gross Total Value 3,47,000/ - Ntl NIL Nil B. Details of lmmovable Assets: Note: 1. Properties in joint ownership indicating the extent ofjoint ownership will also have to be indlcated Note :2. Each, land or building or apartment should be mentioned separately in this format sl Description Self Spouse Dependent-1 Dependent- Dependent-3 No. 2 (i) Agricultural Land NOT NOT NOT NOT NOTAPPLICASL€ Location (s) Survey APPLICABLE APPLICABLE APPLICAELE APPLICABTT numbe(s) Area (total measurement in NOT NOT NOT NOT NOT APPLICABLE acres) APPLICTBLE APPLICAALE APPLICABLE APPI.ICABLE Whether inherited property NOT NOT NOT NOT NOT APPLICAELE (Yes or No) APPLICIBLE APPTICABLE APPLIC-ABTE APPTICEBL€ Date ofpurchase in case of NOT NOT NOT NOT NOTAPPLICABLE self-acquired propeny APPLICABLE APPI-ICIBTE APPLICABTE APPI-ICABI.E Cost of tnnd ( in case of NOT NOT NOT NOT NOTAPPLICABLE purchase) at the time of APPTICABLE APPI.ICIBI-E APPLICEBTE APPLICABLE purchase) Any investment on the NOT NOT NOT NOT NOT APPLICABLE land by way of APPLICABLE APPLICIBI-E APPLICABI-E APPLICABLE development construction etc. Approximate current NOT NOT NOT NOT NOT APPIICABLE market value APPLICIBLE APPLICABTE APPLICABTE APPLICAEL[ ( ii) Non-Agricultural Land; NOT NOT NOT NOT NOT APPLICAELE Location(s) APPLICAEI-E APPLICABLE APPTICAELE APPLICABLE Survey Numbe(s) Area (total measurement NOT NOT NOT NOT NOTAPPLIC-ABtE in sq. ft) APPTICABTE APPI-ICABLE APPI"ICASLE APPLICABLE Whether inherited property NOT NOT OT NOT NOTAPPLICABL€ (Yes or No) APPLICABLE APPTICAELE APPTJCIBLE APPLICABI-E Date of purchase in case NOT NOT NOT NOT NOT APPLICAELE of self-acquired property APPLICAELE APPI-ICABI-E APPLICTBI.E APPTICEBtE Cost of Land ( in case of NOT NOT NOT NOT NOT APPLICABLE purchase) at the time of APPLICABLE APPIICASTE APPLICABI-E APPI-ICABLE purchase

P.s,* B^n"Qou, Artestad t't\ilWwv MALLULA SRINIVASA RAO tt.A , M.A., L.L.M., n r,b.1552 NOTAR,Y & ADVOCATE OP-o: M.R.O Ofilee. BHtrrAVaRAU.t.w.o.D'1..A.P .tn6a 5

Any investment on the land NOT APPLICABLT NOr NOT NOT NOT by way ofdevelopment APPLICABLE APPLICTSTE APPLICAgI-E APPLICISLE construction etc.

Approximate current NOT APPLICABTE NOT NOT NOT NOT market value APPLICIETE APPLICAEI-E APPLICABLE APPLICABI.E ( iii ) Commercial Building NOTAPPLICABLE NOT NOT NOT NOT (including apartments APPLICIBI-E APPTICABTE APPI-ICABLE APPLICTBI.E Location(s) Survey number (s) Area (total measurement NOTAPPLICAELT NOT NOT NOT NOT in sq.ft) APPLICABTE APPLICABLT APPLICABLE APPTICASLE Built up area (total NOTAPPLICABL€ NOT NOT NOT NOT measurement in Sq.ft) APPLICABLE APPLICABLE APPTICABTE APPTIC}BLE Whether inherited property (Yes or No) il Date ofpurchase in case NOT APPLICAELT NOT NOT NOT NOT of self acquired property APPLICABTE APPTICAELE APPI-ICASTE APPLICAELT Cost ofproperty ( in case NOTAPPLIC-ABLE NOT NOT NOT NOT ofpurchase at the time of APPUCAE[E APPLICABLE APPLICABI.E APPLICASLE purchase Any investment on the NOIAPPLICAELE NOT NOT NOT NOT property by way of APPLICAETE APPTICAELE APPTICABTE APPLICABLT development, construction etc Approximate current NOT APPLICAELE NOT NOT NOT NOT market value APPLICIBI-E APPTICABIE APPI-ICABI-€ APPLICABTE ( iv) Residential Buildings NOT APPLICALE NOT NOT NOT NOT ( including apartments APPTICABTE APPLICABLT APPLICABLE APPTICABLE -Location(s) -Survey number(s) Area (total measurement NOT APPLICABEL NOT NOT NOT NOT in sq.ft) APPLICABtE APPLICABTE APPLICABLE APPTICABLE Built up area (total NOT APPLICABLE NOT NOT NOT NOT measurement in sq.ft) APPLICABTE APPLICIBLE APPTICABLE APPI-ICABLE Whether inherit€d Not applicable NOT NOT NOT NOT property APPI-ICTBI,E APPTICABLE APPTICABLE APPLICABLT ( No) Date ofpurchase in case NOTAPPLICABLE NOT NOT NOT NOT of self acquired property. APPLIC-ABTE APPLiCABLE APPLICABLE APPLICAELT Cost ofproperty ( in case NOTAPPLICABLE NOT NOT NOT NOT ofpurchase) at the time of APPLICABLE APPLICABLE APPLICABI.E APPLICTBLT purchase Any investment on the NOT APPLICABLE NOT NOT NOT NOT land by way of APPLICIBTE APPLICABLE APPLICABLE APPTICABLE developmenl construction Approximate current NOT APPLICABLE NOT NOT NOT NOT market value APPIICABLE APPTICABI-E APPLIC-ABtE APPUCAB[E (v) Others (such as interest NOTAPPTICABLE NOT NOT NOT NOT in property) APPLICABLE APPLICABL€ APPLICABLE APPTICABTE (vi) Total ofcurrent market NOT APPTICABLE NOT NOT NOT NOT value APPLICABLE APPTICABLE APPLICABTE APPt"tCASt-€ Of (i) to (Y) aboYe

Attested

siuo po-n **'Y[*Iffiil6*oo 5 n.A. I Q;u, IOTARY & AOVOCATE ooo: M'R'O ' Office' eH'r,,liv(nnu'r'w'o ot''A'P'lndla 6

(8) I give herein below the details of liabilities/dues to public financial institutions and Government:- (note: please give separate details of name of bank, institution, entity or individual and amount before each item) SI Description Self Spouse Dependent- Dependent- Dependent- No. 1 2 3 (i) Loan or dues to Gold Loan in NOT NOT NOT NOT Bankf inancial lnstitution(s) Muthoot Finance APPTICABLE APPLICABLE APPLICABLE APPLICABLE Name of the Eank or financial PalakolEarnch institution, Amount Rs.70000/- outstanding, nature of loan Gold Loan in Union Bank Palakol b.anch Rs.2,00,000/- Loan or dues to any other NOT APPLICABLE NOI NOT NOT NOT individuals/entity other than APPLICABLE APPLICABLE APPLICAELE APPLICABLE mentioned above Name(s) Amount outstanding, Nature of Loan Any other liability NOT APPLIABLE NOT NOT NOT NOT APPLICABLE APPLICABTE APPLICABTE APPLICABLE Grand Total of laabilities Rs.2,70,000/- NOT NOT NOT NOT APPLICABLE APPLICABLE APPLICAELE APPLICABLE (ii) Government dues: Dues to NOT APPLICABLE NOT NOT NOT NOT department dealing with APPLICABLE APPLICABLE APPLICAELE APPLICABLE Government accommodation Dues to department dealing NOT APPLICABLE NOT NOT NOT NOT with supply of water APPLICABLE APPLICABLE APPLICABLE APPLICABLE Dues to department dealing NOT APPLICABLE NOT NOT NOT NOT with supply of electricity APPLICABLE APPLICABLE APPLICABLE APPLICABLE Dues to department dealing NOT APPLICABLE NOT NOT NOI NOT with supply of APPLICABLE APPLICABLE APPLICABLE APPLICABLE telephones/mobiles Dues to department dealing NOT APPLICABLE NOT NOT NOT NOT with government transport( APPLICABLE APPLICABLE APPLICAELE APPLICABLE including aircrafts and helicopters) lncome tax dues NOT APPLICABLE NOT NOT NOT NOT APPTICABLE APPLICABLE APPLICIBLE APPLICABLE Wealth tax dues NOTAPPLICABLE NOT NOT NOT NOTAPPLICABLE APPTICABLE APPLICABTE APPLICABLE Service tax dues NOT APPLICABLE NOT NOT NOT NOT APPLICAELE APPLICABLf aPPt-icI8t-€ APPLICABI-€ Municipality/property NOTAPPLICABTE NOT NOT NOT NOT APPLICABLE tax dues APPLICABLE APPLICIBLT APPLICIBLE

Sale tax dues NOT APPLICABLE NOT NOT NOT NOTAPPLICABLE APPLICABTE APPI-ICABL€ APPLICABTE Any other dues NOTAPPLICAELE NOT NOT NOT NOTAPPLICASLT APPI-ICIBtE APPLICABLE APPLICABLE (iii) 6rand total of all Govern ment NOT APPLICTELE NOT NOT NOI NOT APPLIC-ABLE dues APPTICABLE APPLICABLE APPLICTSTE (iv) Whether any other liabilities are NOTAPPLICAELE NOT NOT NOT NOTAPPLICASLE in dispute, if so mentioned rhe APPLICABI-E APPTICABI.E APPLICABI.E amount involved and $e aulhority before which it is pending.

A v 54 Attesteg l\Nv'^I\t'1/L---- i tl. L!u .x g.^" p'7u. MALLULA SRINIVASA RAO R ,tn a562 ls,* t M.A., L.L.M, v NOIARY & ADVOCATE F Opp: M.R.6. Oftloe, EHtfrrav/iRAM,t.w.o Dl..A.P..tnd.. 7 (9) Details of profession or occupation: (a)self UN EMPLOYEE (b) Spouse HOUSE WIFE (10) My educational qualification is as under:- lorH clAss Completed in the year-1995 (Give details of hiShest School/Universlty education mentioning the full form of the certificate/diploma/degree course , name of the school/college/university and the year in which the course was completed. PART.B (lU ABSTRACT OF THE DETAILS GIVEN IN (1) ro (10) oF PART-A: 1 Name of the cand idate Sri PENMETSA SIVA RAMA RAJU(V|SSA(OOERU S|VAI 2 Full Postal Address NEAR PANCHAYATI OFFICE, VADALAVANIPALEM, PATAOT MANDAL, W.G.DIST ANDHRA PRADESH 3 Number and name of the cons$tuency and State 58 NARASAPURAM PARTIAMENTARY CONTITUENCY ANDHAR PRADESH 4. Name of the political party which set up the INDEPENDENT candidate( other write independent) 5 (i)Total number of pending cases where charges NOTAPPLICABLE have been framed by the Court for offences punishable with imprisonment for two years or more (ii)Total number of pending cases where the NOTAPPLICJBI-E court(s) have taken cognizance {other than the cases mentioned in ltem No.(i) above) 6 Total number of cases in which convicted and NOTAPPLICAELE sentenced to imprisonment for one year or more{except for offences referred to in sub- sections(1) or (3) of section 8 of Representation of the People Act, 1951) 7 PAN Year for which last income Total income Tax return filed shown Candidate CWPP4924H N Nit Spouse Nit Nil Nil Dependents Nit Nil Nil 8. Details of Assets and Liabilities in Rupees Description self Spouse Dependent Dependent-ll Dependent-lll -1 A Movable Rs.3,40,000/- NOT NOT NOT APPLICABLT NOT APPLICABLT Assets(Total Value) APPLICASL APPLICABLE E B lmmovable property 1 Purchase Price of NOT APPLICIBLE NOT NOT NOT APPLI'TBLE NOT APPLI'ABLE self acquired APPTICABI.E APPIJCAEt€ immovable property

Attc6!ed $.4, LLII |.s,"W Qq" ,O"$*&KffiSARAO M.A., L.L.M., NOTARY & ADVOCATE OoP:MRO'Office' gHltulva'plt -r,w.G C[ A 'P''lrl(tra 8

II Development/construction NOTAPPTICASLE NOT NOT NOT NOT cost of immovable APPLIC-ABLE APPLICABLE APPI.ICABLE APPLICAELE property after purchase (if applicable) Approximate Current l market price of (a)Self-acq uired assets NOTAPPTICABLE NOT NOT NOT NOT (TotalValue) APPLICABLE APPLICABTE APPTICABLE APPLICABTE

(b) ln herited Assets Not applicable NOT NOT NOT NOT APPLICqBIE APPTICABTE (Total Va lue) APPLICABLE APPTICABTE 9 Lia bilities

(i) Government dues Not applicable NOT NOT NOT NOT (Total) APPLICABTE APPTICABLE APPLICABTE APPLICABLE (ii) Loans from Bank, Financial NOT NOT NOT NOI lnstitutions and other Rs.2,7O,O0O/- APPLICABTE APPLICABLE APPLICABLE APPTICABLE (Total) 10 Liabilities that are under dispute (i) Government Dues Not applicable NOT NOT NOT NOT (Total) APPLICABLE APPLICABLE APPLICABLE APPTICABLE (ii) Loans from Bank NOTAPPTICABEL NOT NOT NOT NOT Financial lnstitutions and APPLICABTE APPLICABTE APPLICABLE APPLICEBtE other (Total) lt Highest Educational Qualification: 10 class passed in 1995 (Give details of Highest school/University education mentioning the full form ofthe certificate/diploma/degree course, name ofthe School/College/U niversity and the year in which the course was com pleted) VERIFICATION l, the deponent above named, do hereby verifi7 and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief and no part of it is false and nothing material has been cancelled there from. I further declare that :- (a) there is no case of conviction or pending case against me other than those mentioned in item nos. 5 and 6 of part A and part B above. (b) l, my spouse, or my dependents do not have any asset or liability, other than those mentioned in ltem Nos. 7 and 8 of part A and item Nos. 8,9 and 10 of part B above. Verified at Bhimavaram this the 25th day of March, 2019. Qsi,aQ--fu". DEPONENT:'

o

c)

a + /ND\ (2,-^ NOTARIAL f,siuo W,) lil(lrrv..rrr-- RAO NOTARY ValH uptc 5-9-2022 MALLULA SRINIVASA M.A., L.L.M., Gtrr.r.C la NOTARY & ADVOCATE tfir ieSrro OpP: M'R.O. Otfice' 3il" u.--.l?E Eizs' :'z"tl BHIMAVARAttI'1.W.G. D1,A.P .lndh 9 Note : 1. Affidavit should be filed latest by 3.oopM on the last day offiling nomination Note : 2. Affidavit should be sworn before an oath Commissioner or Magistrate of the First class or before a Notary public. Note : 3. All column should be filled up and no column to be left blank, if there is no information to furnish in respect of any item, either "NlL" OR "Not applicable,, as the case may be, should be mentioned Note :4. Affidavit should be either typed or written legibly and neatly'' Note :5 Each page of the Affidavit should be signed by the deponent and the Affidavit should bear on each page the stamp of the Notary or Oath commissioner or Magistrate before whom the Affidavit is sworn.

(Ministy of Law & Justice Notification No H11019(4)/2018-[eg.[, dated 1O'h October, 2018 and Notification No. H-11019/13/2016-Leg.ll, dated 26th February, 2019.

Attested nnr-r-rthffiGrnao M.A.' L.L.M., NOTARY & ADVOCATEi.. OPP: M.R'O Office P''INdI? BHIMAVARAM.l,W,G Ot..A rlTl ildI {Titt/Voter I nformation

{fm State Andhra Pradesh frqH qqr Frqiqi *a/Assembly Bhinnvaram Constituency

Tl-g/Narne U,tr.do.a* $coB$

PRASADARAJU MANITENA frq/Gender M

qEql{qTm'qit5"/rPtc No GN\t2871861

frffqfr or cTq/Father's/Husband's $oal8$o"aa. Nane SAMBASIVARA',U

qFI -{ig7Part Number 42

qfrl $T Tfq/Pad Narne SPL. MPL ELE SCHOOL, SU RYAAIARAYANIAPU RAIU

Itmlf,r rqro/Serial No 1264

q6qH tlti7P611;ng Station SPL. MPL. ELE SCHOOL, SU RYANIARYANIAPU RAI\4

ffi{rcQtilfis/Potling Date 111 041 2019

5fr4 ftfulrrinteo On 312412019 10:53:10 AIvl

t\ble 1 Tlis orFrt ,s conpJter gerle a|ed and is prolioeo mV fot fE l{o.nElir to lrE vde(

-rhs Mte 2 i ls not an ideotiry docuneot.

Attested MALL LASR INIVASA RAO M.A.' L.L'M. NOTARY & ADVOCATE OpP: M R.O. Oftioe. gxrurviRttl-t.w.G Dr..A.P. Jndia qIfEIflI W{I/Voter I nformation

{lcrl/State Andhra Pradesh

frqH qqrmT{ *a/Assembty Palacole Constituency ;[q/Narne .l$*uu";o"ar

CHINSUBBARAJU NADIMPALLI

ffiq/Gender M

qEqI{ qe 3rqi6/eptc l.to HXD2529410

t6-I TFilFather's/H usband's X::u';o'a;r Narne SUBBARAJU t---- qrq r{qilPart Number --1i 1 42 _-JI qfq 6-I TFVPart Nanp LAI!KALAKODERU i q?r(rAr Fqifi/serial 460

ro-Et:t it-qlPotli ng Station MP P SCHOOL,NO,l SCHOOL WESTERN SIDE BUILDING I

re-

gfroftfurerinted on 312412019 1 0:55:1 6 AIt/

qU to flo vder t{xe 1 : Ihis qrtp-t is cqrp{ne. getErated dd is p@vkled fc. ltE irfdrYEtir

l.bte 2 : Ihb ls nct ar identny docurEr't.

Attesled

MALLU A SRI NIVASA RAO M.A.. L.L.M. NOTARY & ADVOCATE OP-P: M.R.O Otfice g111611y1p111t-t.W.G.Dt..A P .lndra qifql_f,r qilTf Vobr I nformati on

Tlvtt/State Andhra Pradesh

ftsrn qqr frqlr{ Sa/Assembty Palacole Constituency

Tl-q/Name s{3o"{o"ar $oo8$

VIS HWANAO HARAJ U IVAI\]T E NA t- fuq/Gender I M

cE=t-l{ !.{ trqiin/EPtc No HXD0623082

frilrffi 6 ngTFather's/H usband's tu €"O.$O.o'cB Narne SEETARAfu1ARAJU

qIrI Sf{ll/Part Numbor 155

qFI 6-I Tfr Part Narne SIVADEWNICHIKKALA

qA-erdrmqis/Serial No 34 I

, qd(l-l +E/Pollrng Staton M. P. Primary.School, North-West Corner Building, North Side Room, Sivadevunichikkala.

raqH o't dr-fi-g/Poiling Date 111 O4t 2019

ghs ftfulprintea on 312412019 1 1:03:40 AIvl

l$le 1 : Ihis output is conMel gienerated a.d is p!,r'ljed ont for the infonration to the vdea

fbte 2 : This is not an i(bntity del.lrrert.

-+*JiRA.uS"Ai Attested

MALLUiA SRINIVASA RAO M.A.. L.L.M., NOTARY & ADVOCATE OP9; M.R O' Office extlvllvanlil't.w c.Dl A P lndia Iffffl -f, f {tFtl/Voter I nformati o n

Yr'q/State Andhra Pradesh

ftqH qqr frqk{ fa/Assembty Palacole Constituency

fl-rl/Name B"oB $J6 Sood$

SAA]TH I SUDHA MAIITHENA

ffiq/Gender F

qEqlqqTF{ifrleptc No woo0782459

I ftmlcfr st qrqlFather's/H usband's So(e; s"a e{so"6 o.av $oo8$ Narne VENKATA KASI VISWANADHA RAJU MAIITHENA

ril-rl TigT/Part N umber '155

qIrI sl TfrvPart Narne SIVADEWNI CHIKKAI-A i

raqfflrmqislSerial No r38

wErc S.qlPotling Station M.P. PrinEry.School, North-West Corner Building, North Side Room, Sivadevunichikkala. l {d-{r{ Efr drftq/Polli ng Date 1',V 041 2019

58aftfu/erinted on 31 241201 I 1 1 :00:54 AIt/

I$te 1 : This outArt is conpder geoerated ard is paovired mV f d lhe irfc.nBtin to the vdor.

lble 2 r Thls s not ar rdentrty d@unert.

q"-fi- M SJ/- atteste d IrA MALLULA ^W\,ru----SRINIVASA RAO M.A.. L.L.M., NOTARY & ADVOCATE OPo: M R O' Oftice' AHi,taVAnll'I'r.W C Dt" A P"lndre qcrq[flI

{-q/State Andhra Pradesh frtrrq Hqr Mr{ *a/Assembty Bhirnavaram Constituency

{Irl/Name Kua5 o"ar fi"Aea$

SUBBA RA,IU GADIRAJU

BrilGender M q5El-q !-a mqifi/Eptc No tMH0969586 ft+r,qfr oi qrq/Father's/Husband's SSo o'ar n"Eo'ay Narne KRISHNAM RA,IU GAD IRAJU

qo rTrq \{iEfl/Part Number qm 6T TH/Paft Name Gandhi Kasturibha Seva Sangham, Bhintavaram qf,fldl rFqizF'i Serial No I 94 q6qll ihq7Pe111ng Station Gandhi Kasturibha Seva Sangham, Bhirnavaram rrd-{rq dl (lts/Pol|ing Date 11t O4l 2019

5Ba ftfu/erinteo on 3 l24l 2019'1 1 :06:41 AI\4

to the voter l.bte 1 : lhis odgn is conputer generated and is provided only for ttle infornEtion

l.bte 2 : This is not an identi$/ docurrent.

Attested

MALLULA SRINIVASA RAO M'A., L.L.M., NOTARY & ADVOCATE Opp: M.R.O. Office' BHIMAVA RAM'l.W.G Dt. A P.lndia q fiifflT q*il/Voter I nformation

{J\'.VState Andhra Pradesh ftflq qqr ffiq{ Sa/Assembty Undi Constituency -*---l TIII/Narne 5::el5o tr66d

MUTYAA/ DODDIGARLA frq/Gender IV

IIE=IFT q-{ m-Ififile ptc No RCU0447343 ($rcUJs TI[I/Father'si H usband's tr6dd Narne KANNAYYA DODDIGARLA qrq\{rqilPart Number 6

-rllPart TIrl E-I Nane Kaligotla. qa-eror mqio/Serial No 377 qaEf;I fiq7p.11;ng Station M. P. U. P.School, q-il{t{ o'l illll-s/Polling Date 11t 041 2019 gHaftE/Printed on 312412019 1:07:41 PM

l.bte 1 : This outpd is conputer g€odated ard is provij€d mV For tle irfqnEtir to ttE vd€r.

I\bte 2 : This rs not an identily d@unent.

Attested I,t\^t\/\t\Nr-.-- MALLULA SRINIVASA RAO M.A., L.L.M., NOTARY & ADVOCATE Op.p: M.R.O. Office, BHIMAVARAM-1.W. G. 0t.. A. P..lndia filtll-flT qT{Iruoter I nformation

{l-tt/State Andhra Pradesh frqH qqr FraIT{ *a/Assenbty Bhimavaram Constituency

Tl-sl/Narne 06315 aS $$5 $63$&o$Q

Rohit siva pavan varrna Nadinpalli ftrq/Gender M qEqrqTe6qi6'/Eptc No ilvH1295096 ft-orrcfu sT TrqlFather'dHusband's Sp$o o"u $&o$Q Nane krishnam raju Nadimpalli qFf \{lqilPart Number 141

1IFI 6T nlrl/Part Name Banda Veerr4u Mpl.Ele. School, Bhintavaram qirEfdl mqro/Serial No 1284 qa-Erc tqlpotting station Banda Veerraju Mpl.Ele. School, Bhinnvaram -.1 q-dsr{ dl f,r0-s/Polling Date 111 041 2019 gBo ftfutPrinteo on 312412019 1 1 :07:31 AI\4

I'l e 1 r this ouo.rt is conputer gene.ated rd b pro/rled onv fo.lho irfo.retimloltE vder l'.lXe 2 : this is not m idertily docureot

A ttc ste d

MALULA SRINIVASA RAO M.A., L.L.M., NOTARY & ADVOCATE Opp: M.R.O. Office. BHIMAVA RAM-1.W.G. Dt.. A. P..lndia qIfEfdI qftilVoter I nfonrntion

{I-.VSlate Andhra Pradesh furn qqr ftq'iT{ fra/Assenbly Bhinuvaram Constituency

{FI/Name 6d5$$o.6u'e;o I

GAiIESH KUMAR BAI-A / furilGender M qE6-1-1qepffi/Epro r.,ro r[/H0093443 fr-atEfr or crqlFather's/Husband's 5s$o"$ Name MADHAVARAO -l qrq riqyPart Number 37 qfrf 6T TH/Pafi Name CH INTHALAKORI GARUVU I-UO RAYMUDURU

:ffiqff,rpffi/Serial No 665 ra-cl{ ttglPoltlng Station M P Ele School, Veeravallipalem .i r*sT{ o1 ants/Poll i ng Date 111 041 2019 ffiffifulerinted on 312412019 1 1 :05:06 AIvl l$te '1 : this qrtp(/t rs conputer gerErated ard is paoviled mly for lhe info.rYEti,l to tl]e vder l'.bte 2 : lhis is rDt an identrty docunent.

Attesled

MALLULA SRINIVASA RAO M.A., L.L.M., NOTARY & ADVOCATE Opp: M.R.O. Office, BHIMAVARAM.l,W.G. Ot,,A, P,.INdla filtifdl {ifill/Voter I nfonnation

{c{I/$1s1" Andhra Pradesh f4tnq qrrr Frqh{ *alnsse mbt y Palacole Constituency

TIrI/Name $B;oir" ooa,, ooQ

NARSIMHA RAJU DATLA t, ftT/Gender M qeqnqam-rio'/EPtc No HXD2504660 ft-orffi tn-r crq'/Father's/H usband's Sodeo $E;oir. o.a*, 6.9) Narne VENKATA NARSIMHA RAJU DATLA lil-rl \qglT/Part Number 157 qIrI OT nlrl/Part Nanre Sivadevuni Chikkala q6qTfllrFffi75erlal No 560

Tilil{ i}tqlPolling Station M. P. Prinery.School, South-West Carner Building, Sivadevunichikkala. I 7 Td-{ri' of drrtg/ Polli ng Date 11t 041 2019 gBaftfu/Printeo on 31 241201 I 1 0: 59:02 Att/ fbto 1 : Ih€ o,rtprt is conputer g€nerated and is paoviled on, for tlle infornEldt to tlE vcter

It)le 2 : Thls E not an rdentry docurrBrl.

tte sle d + z MALLULA SRINIVASA RAo M.A.' L'L.M., NOTARY & ADVOCATE 6ovT OPP: M.R O' Oftice' gsrtrlVlnlU.t.W.G Dt.A P.lndta fif

rllNane 3 a rS I o"$:"oaJoS.:o"av 3.r$363

P V S J RAIVAT.IJAI{EYARAJU PENMATSA ftq/Gender M q5qHqeF-Ti6/EP|C No AP100610300383

&-m,nrh or ilq/Father's/H usband's $d5o"o"o5.:eao'ar Narne SATHYANARAYAN]RAJU

qFIqqyPart Number 132

qFI 6t Tfq/Pad Narne CHINTAPARRU

roEiotm-riolserial No 4

{trfl{ iFq/Polling Station ZP PH SCHOOL,SOUTHERN SIDE BUILDING EASTERN ROOM

{f,Elq Et alitts/Polling Date 111 041 2019

Xfro ftfu/erinted on 312412019 10:51 :58 AIV

fbte 1 : Ihis o{,tgJt is conpder ger€rated ard i5 pro/ijed d]ly for tfE info.nBtixl to tle vder

l.,lote 2 : This rs rd an dentry docu.rent.

Fl 4 o 4 Attested 2 6 MALLULA SRINIVASA RAO M'A.' L.L.M.' ov1 NOTARY & ADVOCATE ODP: M.R O' Offioe' gs1161vipq1-r.w.G Dt.. A P' lndia I \

a& / gGrr.r .

\'0"*o-P.r,S

AttGsr"' tunmary/ MALLULA SRINIVASA RAO '+ M.A., L,L.M., Z ,iIOTARY & ADVOCATE Opp: M.R.O. Office, BHrfuAvARAM.l.w.c. 0t..A. P..lndia Gov1 HXD252Ca10 ry.da 5oarrsl, 2-tl'a .,o.

I 2-111 i 1.,*.Llr.t ru 1,2 Alock .

Lr*aalod.ar U.jn vllao. , Vtbr Godav.ri

cLd's 6.aAo, a..|dt odblt .0r"0 ef.r.!ii, Nacfinal lr6.-)<4P r{556rt it! r 5Io i Er6riatra.'.or*at--., aE :8lD4.,* rra - 9.lah L.naf C-rr'-."r a6-!a lno) aOtnd ar.. ao-ar, A r. ra.r lq)l!lc6.4 b, rf /Sd: O /L 4I....ea ldd a {, rE tuaaD! ifo / Drar of&il b-cC{.i.'l.*moLcd15.-

A), '* 13, 4U o- Zfgrl

Atte sl e d I MALLU SRINIVAS A RAO z M.A., L.L-M., NOTARY & ADVOCATE OPP: M R.O Office' ovI. elitUlvAnlu.t.W C Ot.A P .lndh lI t-17 O6i!.J.r" $tuo0e"r, gtr;&L.ro fii- atd{)nog,a<)

I ,q&&Yrqicbilkk l n$d{)ats?.a I Sleolevqic l&rtr {ddr6JnE.?.o

=Vi. tl,'sil.'&"-@i

R t Attcsled z MALLULA SRI NIVASA RAo a- M.A., L.L.M., NOTARY A AOVOCATE Gov1 o Opg: M.R.0. Office. BHn AViRArvt-1,w. G. Dr..A. p..tndr? 1t&ttlt ],a

0s'si7* J6 / Or!.$5or:0!4 ehclr.t i}!.:pq+ a{.1 ur. +wC"*#.H *dr rrq r.|-r,. "o.rqr.*r .rb rt+.{5nd,l+ r.(,. L6r iaF,o P-l Irc. 3 ta|. ; t.r. tty|{El^rl| CrlE(rr^ IIAIE

4.."-01* /r-(- &n- Atte sted VASA RAO MALLULA SRINI M .A., L,L,M.

"-I?,ii.frirtlilfil'" '' :- *= od.:021022015 r${b 6!to rr4.. ardla ird{r.aa cl.at -i.0 [email protected] lro: oi.dri)a) !e 6115{, rfi. t q,. p{Ea !{r i l ar$di cqtlilJx'.r rlo a l5ln'rae 'a rr 5, ^$.d!6? P.,t noi r.r* 6l 'gtlrn3r.ln

Attesr€rt MALLULASRI NIVASA RAO M.A.. L.L.M. 1. NOTARY & ADVOCATE 2 OoP: M R'O' Office' r-{ P' lndte 6s eH,titlvtrmr,l'r'w.ODl .A ov1 i

l I j :l-105 F B VeedL Kehgolla . U.d' v/esl

I I I :i,*"#&'"i

I O8dti $o5sd! .,e,cD o.ir55 sQ'o 179 6(C, ,'6,iild Sdlra,S 5tl

:6i.a'd a*1..)ld, 5$5 n ! r' ' 5 t.! ra

6/ 451

Alteste d l^n a\ ,,u/r MALLULA SRINIVASA RAO M.A.' L.L,M' IIOTARY & ADVOCATE M.R-O. ofiice. eltrt OP.P: BHtlrAVimu-1.w.G.Di., A.P..lndi? ar-6d..Jn;go 6ofu6r Qv 1u1"'r, / G.ndo, :r6iqr6, / .t ELECTTON COMTflSSTON OF rlJOrA i,rcjr liii,r JI6;NJ o7{2-,t009 !66 d!' 6r9eO s.dJ - E!ICTORFBOTOTpEr{iirY cARo ild,nl-. .r2rlrr e6:!<, ;,!r a6:)!$! sn;r.ro liuJo, i6r!{ .f:r6o. .itJS,rCoO, srair ll llllllllItlllllllllllllllllllll rMB,2ss0e6 Adcr... I 7.l.rB0l, [nrm.l. ..i! I!..s.yy. Acfth.r AhiEv.r.n,ta...yyr Ac..ir.roh. W..t Oo.r.y..t, 5!42rll -ri(!.- .a / g.t :zlftNne &r{ 6!16r €or$ ELct .rl Lgt.r.rton 016. ra*ad a6rrt i{o aooS &o

'j, , B6 r.t l(8ca -{ ... .{d 5,i55 .ri ..-, ao .* rll 5s ae cd .! d. rq.c 5,).4 F5j. .&t rkc r & . a.]a 6. s,L.a. Ite.! ,o..€..lon of tt . clrd ls no guar.ntoe thet y ar! ehctor ln tho clrIlat.lectoril .oll. FLai3 c$€d( y( nemo in th. curllol olocto.rl roll t!€forE .vory otocti , ..{d a lf5.6!. rd:5. & tls .6. D'tr @t I& Father's Name : kriaqria'rt riiu lladimpalli 3f'65 J5l St !.3. N{f { a.laodi' t.iBct!.,c6) I)at ot tlirlh ,rEntlcrEd ln thL c.rd 3hall not be boat 'l 65 r proof qf ags f D. O. B. for any purpG. other th rcllst .dor| h .Lcto.J roll.

N .P 'S -Paron Vrvr", a Attestcd lV'tluuamr-- MALLULA SRINIVASA RAO M.A.. L.L.M. T{OTARY & OpD: M.R.O^DVOCATE Ofttce. RHIM^VARAU,T,W G 01..A.p,1a6,, IIH@r'+' 8 "J.rrn"O,rrr*a'*o rr.da tDg? So6$D , 6aliDaf6'eo 49p*1F ^oO rucuor ctullrsr o, r{DlA

175 lllHooSixait cJlHfd gl,Ut{ t.al 8b'f' ' ehefifio6 Omru , $al Gdrd

gsadta noaal! taD r^dt O.tlal .0.'o ri;rad 3ot63 -{o lr&-Oo5d( Ortal lqtSSaant

aqe tO t tdEalb.Ldli , i 8.s: O /I 16 /Dr..orBis x)oo0ta87

h-4 G* Attested Fl MAI-LULA ERINIVASA RAO + M.A., L.L.M. NOTARY & ADVOCATE z Op.p: tJt.R.O. Oftice, a= P..lndre + EHIMAVARAiI-1.W.O.Di..A. ovI . & HXD2-604660 e.dd .lag., so$DsD a-ail ,{,3oSFS r3t6r nFl./ s.{'tf!al ' l$trb , f5le, do,g , oht ll''.6c aLECtroN cq!o||6[lot 0, utDr^ TEEXTITY HXD2504560 +&) tii*vu.$ CtliltrL !,4.6 Elo*. , Xl.irh.Ft , Jcn td. e.lry1 ' vtad God.E l

6o, wfr $asslc*lr, arxb oat{.F.0 U6-M,''P r65tr lOEl tlo 66 r toio t6Jor o.. ct

:\it toiry&,,arq! & /ss: S /l. :

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Attc sled ' FI RAO + MALLULA$RINIV ASA U 4 M.A.. L,L.M. z NOTARY & ADYOCATE Ooo: M'R'O Ottice' lndra BHli,lAVahA '1.w G Ol A ',P i

I

1-1/3 I g'5, M5td;,. &oq$$o&o) ' 5f)arro'66 ffi cPd{ n0}de to$fD 69ot|.$

1 txsk , ChinbPqrru . [LIgrrQn €Qull$flqN.qf uDh Pel.kols(frsrdd), li'lrsl Godavsi AP r 0081 0300363

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86F J 6{"

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rPVSJRananl.n.yr{e roto r s.trro.dr*a', -

PclE/r Nttrl. jSdtrd'!.!r!a.Cu . 1Z?l 2 / Sor: S /U da /Drc ofBinh )o(xx,/1g64

PrJ':: Atles1eo ff/\\tu/A-- I MALLULA SRINIVASA RAO M.A.' L.L'M" , 2 I{GTARY & ADVOCATE + OPP: M.R O Otfice' 8Ht$ 361111Y1P1U't.W G Dt. A P.lnrtra Do6$, , S.r I O, M x)(rlxl1e78 i S{$ i6 , Drtr ot ltrtrlr s.6r\ lACt i 37 adoa6rt r l''19 l,z

o*,HMl4t'a r,fl;g:5$ig,f":i?

..--v-.'-u - naa,-tlfiXffii.rYilil nro ? Stro Q"^"A"TI, M.A.' L.L.M. I{OTARY & ADVOCATE OPP: U.R.O. Office. Bh AVARAlrr.w.G.Dl.A.P..lndra fi[qfdl {tt{I/Voter I nfonnation

{fv{YState Andhra Pradesh qrrr ftqpq FrqlT{ da/Assembty Palacole Constituency

Tlq/Narne 8$o"$oo"ar i.l33e53

SIVA RAIMA RAJU PENMETSA

ffirI/Gender M

qffii+ q-a mqi4'lEPto No AP100610312255

ftgrcft 6T qrqlFather,s/H usband,s ${3u{o"ar Nane VISHWAAIADHARAJU

qFr \4Eq/Part Number 128

qfrl 6] Tfrt/Part Narne VADLAVAAI IPALEM H/O U LLAIVI PARRU

ftrSrflrs-qio/Seriat No 58 '-l q(l{rl thilpolling Station M P P SCHOOL,SOUTHERN SIDE ROOM,VADLAVAAIIPALEM

TfrEn. dl frrfl-s/poil i n g Date 111 O4l 2019 gBnftE/Rrinteo on 312412019 10:56:32 A / t\trte 1 : Ihis outB.l is ctrrputer genefal.od ard is provijed ony for tlle hfonrBtioo to tle vc*er,

Nbte 2 r Thrs ls nct an idenhty docunEit

Atteste d ? s,,o Qo* Qqu *..rffi.^*oo

X@TARY & ADVOCATE ooc: M'R'O' O{lica' a,*^r[!tru'r.w o Dn A P tnde qFffi,- t"/ elEF" J.ffi-a-- u AASI{AAT {r 'anr.SITETT I I 55redo a up6 6!eQ* $iI6o' 6!'!il *d'' Oo55r51' r rDqobb $5Lt t !5g5 rgoff&5 r3e

s3rt$ so"j / Enro rnont t{o. : tOOi/1O4O0f1BO97

TO tt$ioRntlT"XlN P.nmCta Slv..am.I.lu lsAdJ r5s.5,.r, r aaaear h gmpt d Lblilfiy, not of citlzanship' Sr'O Vb*ana.tlr RAU t! PAIICHAYATH] OFFICE aAcx sroE oaline' VADTAV*NIFAIJM r To eltrbliEh Ue.tS$ al$lofi{ctto R Pehid;Wsst C{da1r8n, Ardi. Plad.dt - 534260 I

E lrq- 5 EiiroJF rFAirfF{rt.9o6' t2171305 tsor I ,rar $43{d S$-3 rii'rdi tl{itlrd .o6!c.doC 6{'66a&5ca r Adfnat hvatl Cm{0c*fm coutfy' hdpful in b eqr6 5o+8 ,/ Yq,r AaAhaar No. : r Aadhaar *t$ b. in tfirra' 7798 9186 3169 and Noft&varflmant seM€s fJF!6 - ie$.$o Y.r{-,'t -JE-.-'

I ltbrlc4 {-5c, Addro.s: gO Virwsn6rlha R4u. }tl6) Iisors|€t *ogrgilr.r PAT'CHAYATHI OFFGE EACK Pslmua SlIlI.n${u qFcthe. SO€. VADLAVANIPAL€U, **frs'*. P.qId, WEt God6vad, A.lrhra t- .&,6li PlNda.h, 534260 $&.t I: c, 516r lsta aF r.6$!t#..t

7798 0180 316S a r{atfai.att saa.l$ \

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The Returning ollicer

No.9 Narasapuram Parliamentar5r Constituency

Sir,

I am contesting candidate from No.9 Narasapuram

Parliameltar5r constituency as Parfy candidate/independent candidate. I request that my name may be printed in the Ballot paper as shown bellow.

Telugg

Enslish

Yours faithfully

(Signature of contesting candidate)

//Attested/ /

Returning ollicer No. 9 Narasapuram Parliamentary Constituency and Joint Collector, West Godavari, Eluru. * / €reaion ffm' "ndfdate A8ent l proporer wrtil€ su( mrttinc &c plalos,,erh of t le Subject: ,. Election to oS,S z tlouseJ from ,.. , .. A- -"*i'-.^1.+. 6r, ql_:d0...... the name ) / erection ,";;;;;,.,"" _ ...'...... (mention( of the ;.:#:- n",:rg of the , *;;::ratve Counci.l- bl the Asse&rr,

s.,s.c.o8, np^-,r son/daughter/''..'..?&.*t ...... (nan wife of ; : ?..,.. shri q and address], candidate for &*!s.[fl. the above *.-.3 ? " nomrnated. ro, tt. p*po"J;;;*d::'oned erecdon, ; as "r;; herewith mv photosraph nas been taken "" t-declare dunns th. ,r1l :*"*o"** ";;.:;"#ting that the photograph (Fir up tgig ****" tI"' ra,, when the ndrdate ".'"t.1 hirneerr is "ilil';:ffi:;::1""0"".

OR I "...... {nameJ, election a4rerrt / proposer of Shri address of ''"''"".....( na,lle and t&e candidare), son/daughterlwife of Shri ...... , a candidate for the hereby submit above mentioned election, the photograph of the said candidate for the purpose of printing snr$e on the ba.ll,ot the paper. I declare that the photograph has beea taken during 3 months before tlie the last date of notifi cation of election.

(FilI up this part $,hen the election agent/proposer is submitting thc photograph ). .P SignaturL u, of Agent oater eSlJ /z-,"t| ttame:...P...Sivc.Q-.,*a.....Q.j--u.-...... Addrass: ...Vi.LAJavIx?i.Q- ,ror4i;:.i-.;-tJ G.0.RT.No.89312018 r.sr1 . t(s Valid uP to 8'5'2023 t ''' 4/6. eaao

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erod RA .G.S. AGESWARA Ri-.- S.No Licenced Stlmp Vcnder Sotd ta... I'lo. 0$18{711919, R.LNo, 0i'tt.llZ2i'i it (See Rule 4A) Court ComPound, NARSAPUR' W.G.Dt Ay *,/ro 6ar a For Whoilfri did te along wlth nomi nation paper berore the returnins 2106256 pEOpt-E oriicer ror erQdl iB9{ the OUSE OF THE ( name of the House from NARASApURAM pARtLEMENTARy CONSTTTUENCy (Name of the constituency)

r pEr.jMETSA srva RAMA RAJU (vrssAKoDERU ..-o#r,r*ANADHA ,,ro,. RAJrJ t. Aged 40 years, resident of NEAR paNcHAyATt OFflCE. VADAIAVANIPA|-EM, PALAKOL MANDAI, W.G.IDST A,p., (mentioned furr postar addres5, a candidate , ,5 at the above erection, io hereby soremnry affirm and oath as underr state on 1) I ar+i-€a6did!+e+et-!Eby xxxxxxxxxxxxxxxxxxxxxxx. i*nameofthe political party)/.r am contestin I as an INDEP ENDENT CANOIDATE (Strike out whichever is not applicable My pAt {2) name is enrolled in AKOL ASSEMBTY CONSTTTUENCy anJ AP State, at Serial No 5g in part No.128 (3) My contact telephone number (s) is/ 9502565669 and my enraii id (if any) is -ntl {4) Details of permanent Account Number (PAN and status of filin of lncome Tax return. 51. No. Names PAN The financial Year for which Total income shown in the last lncome-tax return lncome Tax ( in Rupees)for has been filed the last five financialyears as on 31" March 1. Self. cwPP49)4H Ni (t) nil (ir) nil iti nil (iv) nil (v) nil 2 Spouse Not issued LJ I (i) I nil l- (ii) nii I i liiil rril ITTEST (iv) nrl \. l__ .. - (v) nil ,9. nd.za o, ADVOCITE & NOTAR ,l--.tl l\lA PU RSA F - 53A279. !{g 61 t''L ilOTAIY PUBL'C -T? g'vq p-To_ G.O.RT.No.893/2018 {L,^4, Valid t4 to 8-5-2023 2.',

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eJo \--\ 76 B RAC Dt .\ \i .G. S.NAG ESWARA S.No. {Y+.E{.SS{\. r .\ t-e-ZS-c-'J Licenced StamP Vc,lde .' d ,.-\ 0'18il2J2t:! So'rl t 1..!t0.0$ 18.07119891,R'L.No' FUR,',r/.G.Dt. ComPou nd, NARSA For Wh om 2 Coun Cell 9912106 256 3. HUF(lfthe candidate is I Karta/Coparcener (i) nil (ii) nil iii nl I iv ni (v) 4 Dependant-1 nil NIL N]L I {.) nil (ii) nil liii) nil I (iv) nil (v) ni 5 0ependant-2 NIL NIL (i) nil ii nil I tii nil nil a (v nli L Dependent-3 Nt NL (i) nll (ii) nil I (iii) nil

(iv) n I n,l NOTEj is mandatory for pAN Holder to mention PAN in the case of no.pAN it should be clearly stated no PAN allotted Pending criminal cases: ITTESTEI 0 I declare that there is no pending criminalcases against me (rick this alter native if there is no criminal cases pe nding again5t the candidate and write NOT PLICAB \ LE inst rnative l l-3 ADVOpATE & NOTARy \IAFSAPUR - 53a 225. lX6 L f{-oI+Y PUBLtc T-s;w?*t l-7,/ G.O,RT.No.8$/miS vat,d lp to 9.5.2023 I 3

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! >-\.-\ s.N ES RA.C \_, '\r.(J' S.N <, \o Licenced StlinP Vcnder Sokl i;, 0$18'.r12i2?:1 L..N0, 0$1 8{7119891, RLNo' PIJR, 'n c.i., t:or Whom. 3 Coud ComPound, NARSA (ll following criminal cases) is,/are pending aBainst me (if :99 't 2106256 candida te then there are penoing crimir,9eJal ses tick this alternative and sco re against the off alternative (it) above, and gi tab le below: ve details of all pending cases in the

(a F rst nfo m ati o n R e po N rt o N os to h e r h c rn p 8et o ete d et a s o Not applicabte Nol applicable con ce rn ed P o Not c e 5tat o ns/ D stri cts/5ta e (b appl cab e Se ctio s 5 con ce n ed Act0 a n d sh ort d e5ct p on o the offe n ce s Not applicable Not applicabie fo h ch cha ed Not applicable o Name of the Court, Case No. and dated of order taking cognizance: Not appiicabJe Not applicable Not applicable {d) Court (s) fra med the charge(s) Not applicable Not applicable Not (e) Date(s) on which the ch arge(s) applicable was/were framed Not applicabie Not applicable Not I applicable (f) heth e a or any h proceedings(s) of e h ave e b e n staye d b any Not applicable Not Cou S applicable Not rt( of com en t nsd ct o n (c) heth applicable er a n a ppea a p p ica on for re 5 on h as bee n li e d against Not applicable th e pro Not applicabte Not ceed n8s Me n o n es N o (6) cases 0f conviction applicable (i) lde cldre that I have not been convicted for any criminal olfence(s) alterna tive, if (other than an y offence(s) (rick the candidate has not been convi cted this and write NOT AppLtCBLE against aliern (ii) \- ative Eelow) 1 ,9,. ADVO0ATE & NOTARY P4 \IA RSAP0R - s3427S. W.GDI J!OTAFY PUBLIC -Fs,,q J.u:r\'..!..,.d:'i/1018 ?*W, valif nP to 8.5-2023 I

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AO G.G.S.N E5'niAn Vcrr(!€r Licenced StrinP l R.L.Nc,0! 13'J12,??: L..No.0$'18{7119891, .J/.C.J: '-{xg#s#ffi* NARSAPUR, Coud Compound, For Whorh"4\--;""'>""""" ':, Cell :991 2106255 (ii) I have been convicted for offences mentioned below; lf the candidate has been convicted, then tick this alternative and score off alternative (i) above, and ive details in the table below: (a) Case no. Not applicable Not applicable Not applicable

(b) Name of the court Not applicable Not applicable Not applicable o Section of Not applicable Not applicable Not applicable I Acts/codes involved ( give number of t the section,...... of lPC, etc) (d) I Brief description of Not applicable Not applicable Not applicable offence for which I convicted (e) Dates of orders of Not applicable Not applicable Not applicable I conviction t (f) Punishment Not applicable Not applicable Not applicable .\ I imposed ATTESTEt ndrt* ADVOCATE & NOTAR 7 ?t rlnsaf un - s34 275. w.G Dt itOrAFy pUBLIC P's;^ Prr.,,* W,. ;.'.f S;.I1o.893i2018 Valid np to 8.$2023 (

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s.N f-.t RAO -\, qJ G.S. AGE SWARA .Fr o, ced Stamp VcnCer Sokl tc... Licen .clliitz?l:t L..No,0$1E 07l1989l,RLIc Whop. NARSAPUn,'rl.G.;:. For Coutl ComPound , Cell : 99 12106256 I

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Not appllcable applicable Not applicable (e) Whether any Not has been I Appeal filed against order I conviction Mentioned Yes/no) Not applicable Not applicable (h) lf answer to (g) Not applicable I above is Yes, give details and Present status of a eal to my politica I party about all Pending (6A) I have give full and uP to date information conviction as given paragraPhs (5) and criminal cases aga inst me and abo ut all cases of 6I NOT APPLICABTE arT.:,no,r.,es Nor AppucABLE in to whomthis item is not applicable should clearly write viow of ENTRIEF lN 5(i) and 5(i), abovel e t "qffii:;;t1/' #ata. irb\DC.\TE B. i\3i1fiYa7+>ot) NAFSAPUR-s34275.wGDi' {orABY puBLtc TS;^ @ 0q, G.Q.RT.i,to.893/20i8 VatU up to8.6.202i 6 Note;

1) Details should be entered clearly and legibly in BOLO Letters. to be given separaterv for each cJse '' i:fl'r under different corumns atainst each Detairs 3) shourd be given in reverse chronorogicar order, i.e.., the ratest case to be mentioned first and back word in the order of dates for the other cases. 4) Additional sheet may be added if required. 5) candidates is responsible for supplying all'information in compliance of HoN,BLE Supreme Court,s Jud8ment in W.p.(C) wO.S:O of ZOf t.

below the details of the assets ( movabre :'"'#i::3];.,:'fiin and immovabre etc) of myserf, my spouse A. Detail of movabl a ts -Note: l Assets in Joint name indicating the extent ofjoint ownership wi, also have to given. Note: 2' rn case of deposit/rnvestment, be the detairs incruding seriar number, Amount, scheme. Name date of deposit, the ofthe Bank/lnstitution and Branch.r",o n" gir", Note:3 value of Bonds/share Debentures .. o"r.u.r"nir'.rt'ut rarru in stock exchange in respect listed companies and as per books in _t,;i"; of case of n;" .;;;;;ies shoutd be gtven Note:4: Dependent means parents,son(s) , daughters or tr," c.naio.t" related or spouse and any other person to the candidate whether by brood or-marriage, ;;; ;.r" no separate means of income and who are dependent on the candidate for their livelihJoj. Note:5. Details including amount is to be given separately in respect of each investment. Note :6. Details should include the intereit in ownership of ofishore assets.

Explanation; For the purpose ,,offshore of this Form, the expression assets,, includes, deposits investmen details of all or ts in Foreign banks and any other body or institution aUroaj, anO details of all assets and liabilities in foreign countries: sl Description Self Spo u se HUF Dependent- Depe n de Depe 1 No. nt- 2 ndent (i) Cash in hand -3 30,000 NIL NIL (ii) NIL NIL Oetails of d€posit in NIL NIL NIL NIL Bank accounts, (FDRS), NIL Nt Term Oeposjts and all other types of deposits including Saving accounts) Deposits with Financial lnstitutions , Non Banking Financial companies and cooperative societies and the amount in each such de osit (iii) Det.ih of investment in Not epplicable Not applicable sonds, debenrures/share, Not applicable Not Not applicabJe applicab romp.n ies/M utua I funds le

r1, !f/L ADVOCATE & NOTARY \tARSAPI'R P7 - 534 275 WG Dr iIOTABY PUSLIC -F?S;vc %,^^ G.0.RT.No.893/20,t8 IqL valid up to 8.5.2023 '7

{iv) Details of investment in Not applicible Not applicable Not applicable Not applicable Not Not NSS, PostalSaving, applicable applicab lnsurance Policies and le investment in any Financiallnstruments in Post office or lnsurance Company and the amount (v) Personal Not applicable Not applicable Not applicable Not applicable Not Not Loans/advance Siven to applicab e applicab anY PerSon or entity le including firln, company, Tru5t etc., and other r€ceivables from debtors and the

(vi) Motor ACTIVA NOT NOT NOT NOT Vehicles/Aircraft s/Yachts/Ships AP37C86899 APPLICABLE APPLICABI-E APPLICABLE APPLICABIE (Details of Make, Registration 20L4 number etc year of purchase and amount) Rs.61,000/-

(vii) Jewellery, bullion and valuable 112 grams of NOT NOT NOT NOT thing(s) (give details of weight Gold APPLICABLE APPTICABLE APPTICABLE APPLICABI.E and value) Rs.2,80,000/- (viii) Any other assets such as value NOI APPLICABLE NOT NOT NOT NOI of claims/interest APPLICABLE APPLICABLE APPLICABLE APPLICAETE IX Gross Total Value 3,4L,O00 / - N'I NIL Nil

-E S',,a!rr*^n Qqv _-: . } ^ ) 7-..'J AD\IOCATE & NOTARY \taRSAE't.,R _ 534 275 rrrG0l ilo'rAaY PUaLlc G.O.RT.No.893/2018 Valid up to 8-5-20?3

I I 8 B. Details of lmmovable Assets: Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated Note :2, Each, land or building or apartment should be mentioned separately in this format

Note;3, Details should includes the interest in or ownership of offshore assets.

sl Description self Spouse HUF Dependent-1 Dependent-2 Dependent-3 No. (i) Agricultural Land NOT NOT NOT APPLICIELE NOT APPLICABLE NOT APPLICAELT NOT APPLICASLE Location (s) Survey APPLICABLE APPLICABLE numbc Area (lotal ntcaSurcmenl NOT NOT NOT APPLICAALE NOT APPLICAELE NOT APPL]CA8LE NOT APPLICABLI ln acrcs APPLICABLE APPLICABLE Whethcr inheritcd NOT NOT NOT APPLICAELE NOT APPL CAELE NOT APPLICAELE NOT APPLICAELE Yes or No APPI.ICABTE APPLICABLE Date of purchase in case NOT NOT NOT APPLICABLE NOT APP NOT APPLICAELE NOT APPLICAELE ofsel uircd APPLICAELE APPLICABLE Cost of Land ( in case of NOT NOT NOT APPLICABLE NOT APPLICABLE NOT APPLICAELE NOT APPLICABLE purchase) at thc time ol APPLICABLE APPLICAELE hase) Any investmcnt on thc NOT NOT NOT APPLICASLE NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE land by way of APPLICABLE APPLICAELE developmcnt construclion ctc. Approximate culrcllt NOT NOT NOT APPLICABLE NOT APPLICABLE NOT A PPL CABtt NOT APPLICABLE markel value APPLICABLE APPLICAELE ( ii) Non-Agricultural Land; NOT NOT NOT APPLICAELE NOT APPLICABLE NOT APPt CABTE NOT APPLICABLE Location(s) APPLICABLE APPLICAELE Survc Numbe Area (lotal nlcAsuremcnt NOT NOT NOT APPLICABLE NOT APPL]CA8LT NOT APPLICASLT NoT A PPL CABLE Il n APPLICAELE AIPTICABLE Whethcl inhcrildJ NOT NOT NOT APPLlCABLE NOT APPLICAEL[ NOT APPLICABLE NOT APPLICABLE propeny APPLICABLE APPLICABLE (Yes or No) Date of purchase in case NOT NOT NOT APPLJCABTE NOT APPLICABLE NOT APPLICAELE NOT APPLICABLE of self-acquired property APPLICABLE APPLICABLE

Cost of Land ( in case of NOT NOT NOT APPLICABLE NOT APPLICABLE NOT APPTICABLE NOT APPLICABLE purchasc) at thc time oi APPLICABLE APPLICABLE urchrse Any investment on thc NOT APPLICAELE NOT APPLICASLE NOT APPLICABLE NOT NOT APPLICAELE land by way of APPLICABL development construction E etc. Apploximate current NOT APPLICABLE NOT APPL]CABLE NOT APPLICABLE NOT NOT APPLICABLE APPLIC}Bt market value E NOT NOT APPLICABLE ( iii) Commercial Building NOT APPLICAELE NOl APPL CABLE NOT APPLICABLE APPLICAET (including apartments E Location(s) Surve number s) Arca (total NOT APPLICABLE NOT APPLICABLE NOT APPLICASLE NOT NOT APPLICABLE APPLICABL measurement in sq.ft) E Built up area (total NOT APPLICABLE NOT APPLICASLE NOT APPLICABLE NOT NOT APPLICABLE APPTICASL measurement in Sq. ft) € Whether inherited I DroDertv (Yes or No) \ ,/,. 9aaat/rondaa ? ADVOCATE & NOTARY -fisi,a NAFSAPUF. S3A 275 WGD' w ?.dv e1 iloIAaY PUSLTC G.0.RtNo.893/20.t8 Valid up to 8.5.2023 ?

Date ofpurchase in NOT APPLICABLE NOT APPLICAELE NOT APPLICABLE NOT NOT APPLICAELT case of selfacquired APPLICAEL property E Cost ofproperty ( in NOT APPLICABLE NOT A PPL CABLE NOT APPUCABLE NOI NOI APPLICABLE case ofpurchase at the APPI.ICABL time of purchase E Any investment on the NOT APPLICABLE NOT APPL CAELE NOT APPLICABLE NOT NOT APPLICABLE prope(y by way of APPLICASL dcvelopment, E construction etc Approximate current NOT APPLICAELE NOT APPLICABIE NOT APPLICABLE NOT NOT APPLICASLE market value APPLICAEL E (iu) Residential Buildings NOI APPLICALE NOT NOT NOT APPLICAELE NOT APPLICAELE ( including apartments APPLICABLE APPLICABLE -Location(s) -Survey number(s) Area (total NOT APPLICABEL NOT NOT NOT APPL CAEtE NOT APPLICAELE measurement in sq.ft) APPLICABLE APPLICABLE Built up area (total NOT APPIICABLE NOT NOT NOT APPLICABLE NOT APPLICAELE measurernent in sq.ft) APPLICAELE APPLICABI-E Whether inherited Not applicable NOT NOT NO] APPLICAELE NOT APPLICABTE properfy APPLICAELE APPLICABLE ( No) Date ofpurchase in NOT APPL CABLE NOT NOT NOT APPLICABLE NOT APPL CABLE case ofselfacquired APPL]CABLE APPLICABLE property. Cost of prope(y ( in NOT APPLICABLE NOT NOT NOT APPLICASLE NOT APPLICAELE case ofpurchase) at APPLICABLE APPLICABLE the time olpurchase Any investment on the NOT APPLICAELE NOT NOT NOT APPLICABLE NOT APPLICABLE land by way of APPLICAELE APPLICAELE development conslruction Approximate current NOT APPLICAELE NOT NOT NOT APPLICAELE NOT APPLICABLE market value APPLICABLE APPI"ICABLE (v) Ofhers (such as NOT APPLICAELE NOT NOT NOT APPL CABLE NOT APPLICAELE interest in property) APPLICABLE APPL CABLE (vi) Total of current market NOT APPLICABLE NOT NOT NOT APPLICA8LE NOT APPL]CABLE value APPLICABLE APPTICABLE Of (i) to (v) above

\ g \ (?'sinoc.*,a ADVOCATE & I,IOTARY Wu, \TAFSApUR - 534275 !r,]G Dr tloTABV PUBLtC C.*.iii.il.;.dv-:ii8 V?lid uP to 8'5'2023

?o 10

(8) I give herein below the details of liabilities/dues to public financial institutions and Government:- (note: please give separate details of name of bank, institution, entity or individual and amount before each item) SI Description Se lf 5 po use HUF Dependent Dependent -1 Dependent -3 -2 No

(i) Loan or due5 to 6old Loan in NOT NOT NOT NOT NOT gan*/fi nancial lnstitution{s) Muthoot APPLICAELE APPLICABLE APPLICABLE AP PLICAB LE APPTICABTE Name of the Eank or fi nancial Finance institution, Amount PalakolEranch outstanding, nature of loan Rs.70000/- 60ld Loan in Union Bank Palakolbranch Rs.2,00,000/- Loan or dues to any other NOT NOT NOT NOT NOT NOT individuals/entity other AP P LICAB LE APPLICABL APPLICABL APPLICABLE APPLICABLE APPLICABLE than mentioned above E E Name(s) Amount outstanding, Nature of Loan Any other liability NOT NOT NOT NOT NOT NOT APPLIABLE APPLICABL APPTICABL APPLICABLE APPLICABLE APPTICABLE

E E Grand Total of liabilities NOT NOT NOT NOT NOT Rs.2,'l0,00O/ APPLICAEL APPTICABL APPTICABLE APPLICABTE APPTICAELE

E E (ii) Government dues: Dues NOT NOT NOT NOT NOt NOI to department dealing APPTICABTE APPLICABI APPLICABT APPLICABLE APPLICAETE APPLICABTE with Government E E accommodation Dues to department NOT NOT NOT NOT NOT NOT dealing with supply of APPLICABLE APPLICABL APPLICABL APPLICABLE APPLICABLE APPLICABTE water E E Dues to department NOT NOT NOT NOI NOT NOT dealing with supply of APPLICABLE APPLICABL APPLICABL APPLICABLE APPLICABLE APPLICABLE elect.icity E E Dues to department NOT NOT NOT NOT NOT NOT dealing with supply of APPLICABLE APPLICABL APPTICABL APPTICABLE APPLICABLE APPLICABLE telephones/mobiles E E Dues to department NOT NOT NOT NOT NOT NOT deallng with government APPLICAELE APPLICABL APPLICABL APPLICABLE APPLICABLE AP P TICABTE transport( lncluding E E a ircrafts and helicopters) lncome tax dues NOT NOT NOT NOT NOT NOT APPLICABLE APPTICABL APPLICABL APPLICABIE APPLICABLE APPLICABTE

E E Wealth tax dues NOT NOT NOT NOT NOT NOT APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABTE APPTICABI"E NOT NOT NOI NOT NOT Service tax d ues NOT APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABLE APPLICABTE NOT NOT NOT NOT NOT NOT APPLICABLE APPL CAELE APPLICABLE APPLICABLE APPLICABLE APPLICABLE M un icipa lity/qropert (J aurtarutta. ADVOCATE & NOTT.RY -R ci,q P"""q l.*7u ?Ll \IA BSA PU R . 534 275. VV G D ilOTABY PUBLIC C.'..,. R'i. iu.;. d-g:.iS{6 Vhlid up to 8"5.2023 rl

y tax dues Sale tax dues NOT NOT NOT NOT NOT NOT APPLICABLE APPLICABLE APPI-ICAELE APPLICABLE APPLICABLE APPTICABLE NOT NOT NOT NOI NOT NOT APPLICIBLE APPI"ICABLE APPTICAELE APPTICABLE AP PLICABLE APPTICABLE (iii) Grand total of all Government NOI NOT NOT NOT NOT NOT dues APPTICABTE APPLICABLE APPLICIBLE APPLICABLE APPTICABLE APPLICABLE (iv) Whether any other liabilitics NOT NOT NOT NOT NOT NOT dispute, so aTe in il' APPLICAELE APPLICAELE APPLICABLE APPLICABLE APPLICABLE APPLICABLE rrrenliored the anrount involvcd and llrc authority before which it is pending.

(9) Details of profession or occupation: (a)Self UN EMPLoYEE (b)Spouse HOUSE WIFE 9(A) Details of Sources of lncome: (a) Self ...... CULTIVATION (b) 5pouse...... Houses wife.... (c) Source of lncome, if any, of dependents,...... NlL.... 9(b) Contracts with appropriate Government and any public company or companies (a) Details of contracts entered by the cand idate...... Nil (b) Details of contracts entered in to by spouse...... Nil (c) Details contracts entered in to by dependents...... Nil (d) Details of contracts entered into Hindu Undivided family ortrustinwhich the ca ndidate or spouse or dependents have interest...... N11..... (e) Details of contracts, entered in to by Partnership firms in which candidate or spouse or dependents are parents...... ,..,...... N11 (f) Details ofcontracts entered into by private companies in which ca ndidate or spouse or dependents have share...... N11 (10) My educational qualification is as under:- lorH cLAss Completed in the year-L995 (Give details of highest School/University education mentioning the full form of the certificate,/diploma/degree course , name of the School/College/University and the year in which the course was completed.

lTTESrer \ -Fs;'." ,. 9)aeaoc/oandaa R ^, P.f, ADVOCATII & NJOTA \ i \ i.,.: r" ir' lil , a.:,1 1-.- /=-',J nlOTAPv PUBIIC G.0.RT.No.89312018 Vaiid uP to 8'5'2023

I )1- 72 PART-B 11 ABSTRACT OF THE OETATLS G|VEN lN (1) TO (10) OF pART-A: 1 Name of the ca ndidate 5ri PENMETSA SIVA RAMA RAJU(VISSAKODERU SIVA) 2 FullPostalAddress NEAR PANCHAYATI OFFICE, VAOALAVANIPATEM, PALAOL MANOAI-, W.G.OI5T ANOHRA PRAOESH 3 Number and name of the constituency and State 58 NARASAPURAM PARTIAMENTARY CONTITUENCY ANOHAR PRADESH 4. Nam€ of the political party which set up the aandidate( INDEPENDENT other write independent) 5 (i)Iotal number of pending criminal cases NOT APPTICABLE 6. Total number of cases in which convicted NOT APPLICABLE 7 PAN Year for which last income Tax Total Income return filed shown candidate cwPP4924A Nil Nit Spouse Nil Nit Nil HUF Nit Nil Nil Dependents Nit Nil Nil 8 Details of Assets and Liabilities in Rupees Description Self Spouse Dependent oependent-ll Dependent-lll -1 Movable Rs.3,40,000/ NOT NOT NOT APPL]CABLE NOT APPLICABLE Assets(TotalValue) APPLICAEL APPUCABLE E B lmmovable property 1 Purchase Price of NOT APPLICABLE NOT NOT NOT APPL]CABLE NOT APPLICAgLE APPL CABLE self acquired APPLICIBLE immovable property lt Development/construction NOTAPPLICAELE NOT NOT NOT NOT APPLICABLE APPLICABLE APPLICAELE APPLICABLE cost of immovable property after purchase (if a p plica ble ) Approximate Current l market price of (a)Self-acquired assets NOT APPLICAELE NOT NOT NOT NOT APPTICABLE APPLICAELE APPLICABLE APPLICABLE (Total value) (b) Inherited Assets Not applicable NOT NOT NOT NOT APPTICABLE APPLICAELE APPLICAELE APPLICABLE (Total Value) 9 Lia b ilit ies (i) Government dues Not applicable NOT NOT NOT NOT APPLICABLE APPLICABLE APPLICABLE APPLICABLE (Total) NOT NOT NOT NOT (ii) Loans from Bank, Fina ncia I APPLICAgLE APPLICAELE APPLICABLE APPLICABLE lnstitutions and other Rs.2,70,000/- (Total)

10 Liabilities that are under dispute (i) Government Dues Not applicable NOT NOT NOI NOT APPLICABLE APPLICABL€ APPLICAgLE APPLICABLE (Total) ^*"1"1 t\ ) aoc/rand,oa, ADVOCATE

(ii) Loans from Bank NOT APPLICABEL NOT NOT NOT NOT APPLICABLE APPLICAELE APPLICAELE APPLICABLE Financial lnstitutions and other (Total) 11 Hightsi faucational Qualification: 10'r class passed in 1995 (Give details of Highest school/U niversity education mentioning the full form of the certificate/diploma/degree course, name of the School/College/U niversity and the year in which the course was completed) VERIFICATION l, the deponent above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief and no part of it is false and nothing material has been cancelled there from. lfurther declare that:- (a) there is no case of conviction or pending case against me other than those mentioned in item nos. 5 and 6 of part A and part B above. (b) l, my spouse, or my dependents do not have any asset or liability, other than those mentioned in ltem Nos.7 and 8 of part A and item Nos. 8,9 and 10 of part B above. 1 A o tB ar is the 25'h day f March 20leltTESTEt + 3 F,'rbu j ^7 l--",l: PS'w .1.s. DEPONE A.D\r:-:!'."rr&i{CTARY G.C.F:r.No.893120i8 ,f*R{- PU LI ..1. Affidavit should'IIOTAHY be filed latest by 3.00PM on the last day of filing nomination : : 2. Affidavit should be sworn before an oath Commissioner or Magistrate of the First Class or re a Notary public. NOTABIAL : 3. All column should be filled up and no column to be left blank, if there is no information to :h in respect of any item, either "NlL" OR "Not applicable" as the case may be, should be mentioned Note :4. Affidavit should be either typed or written legibly and neatly" Note :5 Each page of the Affidavit shoutd be signed by the deponent and the Affidavit should bear on each page the stamp of the Notary or Oath commissioner or Magistrate before whom the Affidavit is sworn.

(Ministy of law & Justice Notification No H11019(4)/2018-Leg.ll, dated 10'h October, 2018 and Notification No. H-11019/13/2016-Leg.ll, dated 25'h February, 20L9.

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