F T'r.Ro.6Z-) NOMINATION PAPER Election to the House of the People O,L: Lrq PY"
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FORM 2A (Sec RULE 'l) f t'r.ro.6z-) NOMINATION PAPER Election to the House of the PeoPle o,L: Lrq PY" .ts4. es l"r lr I Ro BELOW IS NOT APPI-ICABI,E STRIKE OFF PART I OR PART II 'il,'I]ICHEVER PART I (To be used by candidate set up by recognizcd' political party) I nominate as a candidate for election to the House of ttre People from the Not Applicable Parl i arnentary Constituency. Candidate's narne .......NA......, Father's name ..........Not Applicable............ His postal address . .. .Not Applicable His name is entered at S.No ...NA... in PartNo ...NA... of the electoral roll for ...NA...... ....NA..... (Assembly constituency comprised within)...NA... Parliamentary Constituencl' lVIy Nameis ......NA...... anditisenteredatS.No....NA... inPartNo....NA... olrhe electoral roll fbr ...NA... *(Assembly Constituency comprised within) ...NA... Parliamentar"r' Constituencl,. rRKJ, & Date: 25-03-2019 Signature of Proposer -l- PAR-t-]I (To be used by candidate NOT sct up by recognized political party) We hereby nominate as candidate for election to the House of the People from the I l-Machilipatnam Parliamentary Constituency Candidate's name Yarlagadda Rama Mohana Rao Father's Name (Late)Yarlagadda Neelachalam. IIis postal address 19/289-8, Chilakalapudi, Machilipatnam-521002 Krishna District, Andhra Pradesh. Ilis rrame is entered at S.No 747 inPart No 42 of the electoral R.oll for 75 -Machilipatnam (Assembly constituency comprised within) I l-Machilipatnam l)arl ianrentary constituency. We de'clare that we are electors of the above Parliamentary Constituency and our names are entered in the electoral roll for that Parliamentary Constituency as indicated below and we ;11.rpend oui signatures below in token rl, subscribing to this nomination. PARTICULARS OF 111i] PROPOSER AND THEIR SIGNATURE 5.No Narne of Elector Roll ull Narne S ignature Date C'omponent No.of ['roposer I Assernbly I Constituenc Part No.of S.ldo iir Electoral tLat Roll l'a rt tl ) J 4 5 6 7 a 75 Machilipatnam 42 ]i3 Y Krishna Mohan rl 5 Machilipatnam 42 372 Y Chandra Kumar Ll-.'^J* 25BrLl 42 6t0 R Ratna Rao I -J 75 Machilipatnarn I 617 R Ganesh Babu 4 75 Machilipatnarn I R Somesr.vara Rao ( 5 Machilipatnam 42 1 62) 25 s t-i7 6 175 Machilipatnam 42 60q R Srikrishna zs I 7 75 Machilipatnam 374 Y Gowtham Kumar Ls Ir1 I 75 Machilipatnam 12 7l Y Jaswanth sls l !1 2, 75 Machilipatnam 42 354 P Nageswara Rao UJU/ 2-s 13/ t1 l0 75 Machilipatnam 36+ D- =\r1 N.B 'l'here should be l0 electors of the constituenuy as proposers' _)_ / (^,**, k^?'" PART- III I, th6 Candidate mentioned in PART 1/Part II (Strike out which is not applicable assent) ro this nomination and hereby declare : - (a) That I am a citizen of India and have not acquired the citizenship ofany foreign State / Country. (b) That I have completed 56 years ofage: ISTRIKE OUT c (i) OR c (ii) BELOW WHICH EVER IS NOT APPLICABLEI (c) (i) That I am set up at this election by the ...NA.., which is a recognized National party /State Party in this state and that the symbol reserved for the above party be allotted to rne. OR (ii) That I am set up at this election by the Bahujan Maha Party, which is a registered unrecognized political party that I am contesting this election as an independent candidate (Strike our which is not applicable) and that the symbols I have chosen, in order preference are: i) Helicopter ii) Pressure Cooker tii) Whistle d)'lhat my name and my father's/mother's/husband's name have been correctly spelt out above in English; e) That to be best of my knowledge and belief, I am qualified and not also disqualified tbr beine chosen to fill the seat in the House of the people. * I turther declare that I am a member of the NA * *Caste/tribe ** Which is a scheduled caste / tribe of the state of NA in Relation to NA .................(area) in that state. I also declare that I have not been, and shall not be nominated as a candidate at the presenl general election / by - election being held simultaneously, to the House of the people fr.ont more than two Parliamentary Constituencies. Y L,*.,Ion (Yarlagadda Ra ma Mohana Rao) I)atc 25-03-2019 Signature of Candidate ''Scora out the words " assembly c onst ituency compris ed w ithin" in the case of Jammu and Kashmir A ndaman and Nicobar Islands, Chandigarh . Dadra and Nagar Haveli , Daman trnd Diu and Lakshadeep. --l- * Score out this paragraph, ifnot applicable. ** Score out the words not applicable. N.B.A"r'ecognized poritical party" means a poriticar parry recognized by the Election cornmission under the Election Symbols (Reservation and Allotment) order, l96g in concemed the state PART _IIIA (To be filled by the candidate) I ) Whether the candidate i) Has been convicted NO a) Of any offence (s) under sub-sectiorr ( l) or NA b) For contravention of an), law specified in sub _ sections (2) ofsection 8 of the Representation people ofthe Act, f lif 1+: of l95l) ; NA or iil Has been convicted for any other offence (s) for which he has been sentenced to imprisonment for two y"u., o, ,o.". NO If the answer is "yes", the candidate shall fumish the fbllowing information. ii) Case / first information report No. / Nos NA ii) Potice Station NA iii) Secti on of the concerned Act(s) and briefdescri ,(s) ption ofthe offence which he has convicted been NA NA ir,) Date (s) of conviction (s) ...... NA v)Court(s) which convicited the candidate......... NA vi) Punishment(s) imposed {Indicate period of imprisonment and / or quantum of fine(s) ... ........NA ....... vii) Date(s) ofrelease from prison NA viii) Was were any appeal (s) revision (s) field against above convicrion(s) ... NA -4- 1il",nOm0 L*0- ir ) Sate and pafticulars of appeal(s) application(s) for revision fleld NA x) Name of the court(s) before which the appeal (s) application(s) for revision filed: . NA xi) Whether the said appeal(s) application(s) for revision has have been disposed ofor is are pending NA xii) Ifthe appeal(s) application(s) forrevision has/have disposed of... NA...... a) Date(s) of disposal NA b) Nature oforder'spassed ...... NA 2) Whether the candidate is holding any office of profit under the Government of India or State Govemment ? No If Yes. details of the office held NA 3 ) Whether the candidate has been declared insolvent by any Court? No IfYes, has he been discharged from insolvency............... NA 4) Whether the candidate is under allegiance or adherence to any foreign country? NA.. 5) Whether the candidate has been disqualified under section 8A ofthe said Act by an order Of the President ----------- No If Yes, the period fbr which disqualified NA 6) Whether the candidate was dismissed for comrption or for disloyalty while holding office under the Govemment of India or the Govemment of any State? No If Yes, the date of such dismissal NA (7) Whether the candidate has any subsisting contract (s) with the Govemment either in supply of any good to that Govemment or for execution of works undertaken by that Government ? No I f Yes, with which Government and details of subsisting contract (s) NA 1Q-H\Oarnok"Q-" -5- (8) Whether the candidate is a managing agent, or manager or Secretary of any companyYr Corporation (other than a cooperative society) in the capital of which the Central Govemment or State Government has not less than twenty -five percent share? ..... \g lf 1'cs. with which Govemment and the details thereof NA 9) Whether the candidate has been disqualified by the Commission under section 10A of the said Act No lfyes, the date ofdisqualification NA {o Y [LmolY? t, (Yarlagadda Rama Mohana Rao) Place : Machilipatnam Signature of Candidate Date : 25-03-2019 -6- t PART-IV ( To be filled by the Returning O{Iicer) Serial No . of nomination paper This nomination was delivered to me at my office at (hour) on (date) by the candidate/propose (name ofproposer ) Date : Returning Officer 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 ol the People Act, 195 I (43 of 1951 ) of and decide as follows. Date Retuming Officer Perforation PART_VI Receipt for Nomination Paper and Notice of Scrutiny (To be handled over to the process presenting the Nomination Paper ) Serial No. of nomination paper.......... -l'he nomination paper of Shri Yarlagadda Rama Mohana Rao, a candidate for election liom the I I - Machilipatnam Parliamentary constituency was delivered to me at my otlice at (hour) on_ (date) by the candidate/ proposer. All nonrination papers will be taken up for scrutiny at _(hour) on (date) at (place) Date : Retuming Offlcer *Score out the word not applicable -7- ffii;IMPAdflry&] --S- /as Y TI q f qTf€fCF frtrffircfr€ ! 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