Asset Declaration Form for Filing Nomination Papers to Contest Elections

Form No. 3

ASSET DECLARATION FORM FOR FILING NOMINATION PAPERS TO CONTEST ELECTIONS

1. A candidate shall declare the income, asset and liability including that of his spouse(s) and dependent children in one form. 2. The declarations shall be submitted at the time of filing the Nomination Papers.

Part I – General Information a) Details of the Declarant

VPIC No:

Name of the Party: (if applicable)

Present Address: b) Details of Spouse(s)

VPIC No:

If employed, name of Agency: c) Details of Children

If employed, Citizenship ID Name VPIC No. Date of Birth name of the Card No. Agency Form No. 3

Part II – Declaration of Income, Assets and Liabilities

If you or your spouse or your children own assets, please provide details under the relevant sections of the Tables A-E given below:

Table A: Immovable Property

Plot/ Name of the Relation Estimated Type of Thram/ Date of registered to the Location market Property House Acquisition owner Declarant value No.

Table B: Shares and Stocks Declaration Form

Company Number or Name of the Relation Estimated Certificate of Business Date of registered to the Market Number Shares/ holding Acquisition owner Declarant Value Stocks Shares/ Stocks

Table C: Vehicle/ Machineries Declaration Form

Acquisition Name of the Relation Type of Registration Estimated (Inherited/ registered to the Vehicle/ Remarks No. Value Purchased/ owner Declarant Machineries Others) Form No. 3

Table D: Declaration of Interest bearing Deposits

Relation Types Name of the Account to the of Bank/Companies Amount Source owner No. Declarant Deposits

Table E: Declaration of other Assets and Activities not specified

Relation Name of the Type of Estimated Date of to the Remarks if any owner Assets/Activities Value Acquisition Declarant

Part III – Income Statement

Types of Child Declarant Spouse(s) Total Income 1 2 3 Income from employment Rental income from land & building Interest income from deposits & securities Income from shareholdings Income from hire of vehicles or any other Form No. 3 property except land & building Any other incomes not specified above Grand Total

Part IV – Liabilities (Loans)

Creditor (Name Name of Loan Loan Remarks if of Financial Purpose Debtor Amount Outstanding any Institution)

Part IV – Personal Income Certificate

I hereby enclose the Personal Income Tax Certificate issued to us by the Taxing authorities for the year…..

Declaration:

I hereby declare that the information given in this Form is true and correct to the best of my knowledge. In case any information is found incorrect, I assume full responsibility thereof and shall be liable for prosecution as per the laws of the Kingdom of Bhutan.

(Name and Signature of the Declarant) Dated:

Countersigned by:

(Name and Signature of Spouse) Dated: Form No. 3

(Name and Signature of Children) Dated: