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!$sdraoao NON JUDICIAL

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\ C€dilicate No. tN-KA813534660260 1 3R Cortilicaie lssued Daie 25-l\4ar-2019 02:31 PM KA-DK Accounl Reference NoNACC (Fly kaksiclos/ MANGALOBA ! Unique Doc. Relerence SUBIN,KAKAKSFCLOB9358232288861 OR Purchased bY SUDARSHANA M Description of Document Article 4 Atfidavit Descnplion AFFIDAVIT z Consideration Price (Rs ) 0 lzercl First Party SUDARSHANA M Second Party NA Slamp Duty Paid BY SUDARSHANA M Stamp 0uty Amount(Bs ) 50 (Fifty only)

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Prea3e$€lRlvtpqtrow this rine ty (See rule 4A) t{ AFF'IDAVIT t TO BE FILED BY THf, CANDIDATE ALONG WITH NOMINA TION PAPER BEFORE THE RETURNTNG OFFICER FOR ELECTION

OUSE OF PEOPLE (NAME OF TIIE HOUSE) FROM 17 DAKSHINA (CENE CONSTITUENCY (NAME OF TttE CO|.iSTTTUBNCY)

rcTloN tlcr li rRrron!i tnsfi !.. *'.,\g4

a PART A SIIDATTSIIANA son Of RAMESH t( N,VASA.N.; .sHAN'rr.r il;l; a candidare"fl'^Iili{i,1il;:ffiil"lii;l,l;.i?}ll ar rhe abo\e :T;n"j:;::l,:*.' "adress). etecrion. do herebt soternnty arrlrm and srare on

(j) I am a candidate set up by BHARATIYA JANATA pARTy (** Dame ofthe political party) / **** am contesting as an lndependent candidate. (* *strike out whichever is nol appticabte) (2) My name is enrolled in 2 '.i*;;;"i#ff l"ll"1?',;"T..."?,",ffi T".f,:Tff "J,"::,Tffi lli.": (3) M) coltact telephone [umbefls] i ,o (ir "ua,,,,,",''ooi'1.",j*;1','."#:;J1""il''::i:::::1,;il,;;,JLl,' any) is (i) twitte.@sudarshamoodabidri

(ii) facebook page https://wwhfacebook.com/sudarshanmoodabidri

(iii) lnstagram-sudarshanmoddabidri

(iv) Facebook_sudarshanmoodabidri

(4) Details ofperrnanent Account Nlumber (pAN) and retunri status offiling oflncome tax

Ine rtnancial year for ruLar which Income showl in lncome the last Income Ketum (in tax return .l&\ Rupees) for the has been filed ta.t fu. nnun.iai l"uri completed {as on J l', March) AMBPM2I25M 20t3-20t4 2,4t,626.00 2014-2015 2015-2016 l,cz,gst.n q,lq,eza.o6 2016-2017 2017-2018 +,+e,lss.o0 s,st,o:+.oo AGIPHT3O6Q 20t3-20t4 HEMAVATHT z,lq,zts.oo (wrFE) 2014-2015 2,87,91t.00 20t 5-20t6 2016-20)7 2,93,',708.00 20 t7-2018 3,08, t25.00

HUF (ifcandidiGi Nor Applicable Not Applicable

Not Applicabte Not Applicabte

NotApplicable Not Applicable (D Not Applicable 4. Dep€ndent I NO PAN Not Applicable HRUDAYESHA ALLOTED (lt, (soN) (iii) Applicable (iv) -MtNot Applicable Not Applicable

Not Applrcable (D Not Applicable 5. Dependent 2 NO PAN l.lot Applicable KRIPESHA ALLOTED (ii) (soN) (iii) Not Appjicable ligJNot ApPlicable (v) Not Applicable

Not APPlicabl€ (D Not Applicable 6. Dependent 3 NO PAN ALLOTED (iD Not Applicable (iii) Iot,+ppticable CHIRANJIVESHA (iv) Not Applicable (soN) (v, Not Applicable @nd Incaseof noPAN It sho uld be clearly slated 'No PAN allotted ".

(5) pending criminal cases .,..' penditrg crimin'l case lgainst me' '' { i} I decltrc thrt lherc is no pendiry ageinst the (T;k this rltemarive ifihere i! ro criminrl case (ii) t"ria"i" NOT APPLICABLE against alternativc below) "tu ""n" OR

pending against me: ( tVX (ii) The following criminal cases are ' D then lick-lhis flfthere are pending crimina/ases againsi thc I'adidate' give details or all ulr"*atin" unA score o-flalternative (i1 abovfnd peoding cases in the fable below) Table

NIL NIL NIL (a) FIR No. Nil

rnd rddress of Polic€ Station Applicable Not Applicable Not (b) Casc No. with Ntm€ of NotApplicable Not Applicable Court

Not AppltcoDle Not Applicable Not (c) S€ction.(s)of Not Applicable Applicable conc€rned Acts/Codes involv€d (give no. of the Section, e.g- Section .... of IPC' Not or Not Applicable Not Applicable Not Applicable W*oi>>:\lre{q.{n Applicablo t ' r,.jd' iMry ERRoRS/copnn r!1t{! EI0.T&P' U .,:.. // +;d-b | ., .... | .j,\ ,r/ '- -"t:t' B-"tltd- Not applicable Not applicable been framed (Mention YES or No) Applicabl€ Not Applicable lf ansrver against (e) Not above is YES' then qive the dtte on which iharges were framed Not applicable WhethertnY Not applicable Not applicable App€al/ApPlication for revision hts been filed against the proceeding (Mention YES or No) (6) Cases olof convictionconvrc.ron any criminal offcnce' (i) I declNre that I have not bccn convict€d for - iif"r.illl"r,"^**", ifthe catrdidat€ has not been convicted )"i *.rt-" xor APpirCABln against alterrative (ii) below) OR

Table

NIL NIL (a) Case No. NIL Not Applicable Not Applicable (b) Name of thc Court Not Applicable Applicable Not AppltcaDle Not Applicable tc, Seclion of Not Ach/ Codes involved (qive no. oflhc Secaion,e.g. Section ..... of lPC, €tcJ. Not Applicable Not Applicable (d) Eiili aescription of offence for Not Applrcabrc Not Applicablc Not Applicable (€) Dst€! of order of conviction Not Applicable Not ApPllcaDle Not Applicable (f) Tunishment imPosed Not Applicable Not Applicable Not Applicable Whettrer anY ,rPPerl has been Not Applicable filed against convictlon order lMention YES Not Applicable Not Applicable (h) rransrver to lgl aSove is VrS' give Not Applicable Det.ils rnd Pres€nt status of aDDsal

paragraphs (5) and (6)

clesrly wdte' NOT Icandidttes to whom this ltem is not rpplicabte sbould (i) APPLICABLE IN VIEW oF ENTERIES rN 5(i) and 6 Nbovel Noter lcttcrs' l Deta be cntcrcd clearly rnal lcgibly in BOLD

mtely for each case unaler dillerent

'' \".ar, L ' ii',',;"1-r., 3. D,eteils should be given iD reverse chronological order, i.e., the latest case to b€ mentioned tilst and backwards in the order o{dates for the other c{ses

4. Additionel sheet may be added if.equired,

5. Crndid-at€ is responsible for supplying all informatior in compliance of Hon,ble Supr€me Couft'sjudgment iD W.p (C) No.

6. (7) I give That herein below the details ofthe assets (movable and immovable etc.,) of myself, my spouse and all dependents: A. Details ofmoyable asscts:

Note: joint l. Assets in name indicating the extent ofjoint ownership will also have to be grven. Note: 2. In case ofdeposit/lnvestrnent, the details including Serial Number, Amount, date of deposit, the scheme, Name of the Bank/Institution and Branch are to be given. Note: 3. Value of Bonds/Share Debentues as per the crment market value in Stock Exchange in respect oflisted companies and as per books in case ofno listed companies should be given. Note: 4. 'Dependent' means paxents, son (s), daughter (s) ofthe candidate or spouse and arly other person related to the candidatg whether by blood or maniage, who have no separate means of income and who are dependent on the candidate for their livelihood. Note: 5. Details including amount is to be given separately in rcspect ofeach invesrmenr. Note: 6. Details should include the interest in or ownership ofoffshore assets. .,offshore ,,includes, Explaoation,- For the pupose ofthis Form, the expression assets details of all deposits or investments in Forcign Banks and any other body or institutions abroad, and details ofall assets and liabilities in foreign countries'; sl. D€soiption Self HUf tI[MAVATHI -3

(D Cash in hand RS.45,m0,00 RS.!0,0(X).00 NOT NII, NIL NIL

(iD Delails of deposit in Bank accounts (FDRs, Term Deposits and all other 520101015074680 520t0t015 6464 Rs.12I2.00 types of deposits Ib.5095.00 H.D.F.C Bfll, Axis auk, Moodabidd Nol including saving Applic accounts), Deposits 9180rm9870051| Not with Financial, 21241r00000 36 Rs.5,500.00 Institutions, Non- Rs.10,000.00 Banking Financial MCS llant, Companies and Co - Moodabidri, operative Soci€ties Acc.No.20543 and the amount in 4822500t00577801 Rs.1242.00 Rs,5,500.00 each such deposit ICICI Bank Moodabidri V.S.S.N, Kailamba ACC.No. ll550l50t I85 Rr.l5m.00 Rs.6,200.00 MatmbhoonriV.S.S.N,

Moodabidri Acc.No.00l0l00l4l5 {! l$cc.No. Ra2l00.00 n

\ .-:-,4 . 't' 1/ . .: i1 ,. '', - '. "-r/ b"s*+ 9l30l0(X | 243048 Rs. 7Js0.00

Nivamollhri, BanlqMoodabidri, V.S.SN, Shinadi Acc.No. 2293 Aoc.No.l60,1 Rs.5,000.00 Rs.8650.00 MCS Bank. Moodabidri, Acc.No. 15197 Nol R* 2325.m aPpl'c

V.S.S.N. Kaikamba

0010100t397 Rs.2,r50.00

V.S.S.N, Shirtrdi [email protected] Rs.8,650.00

V.S.S.N, Kaikamba

Rs.1928.00 Bharalh V.S.S.N, Moodabidri

Rl, 1314.00

IOB Bank,

Rl.r,000.00 Tolal- Totrl- sr,129.00 24,087.00

(iii) Detaih ofinveshent it Shares in MCS Shares in MCS Bank, Bonds Bank, Rs.50,000.00 Debcnturcs/Shafes and Rs.s0,000.00 Shares in Shares in

tunds and other and rh€ VSSN Rs. 50,000.00 VSSN Shar€s in N"avamaitri Rs.50,000.00 VSSN Nol Shares in Rs.10,000.00 NIL NIL Navamaitri VSSN MalrabhoomiVSSN NIL Rs.I0,000.00 Rs.1000.00 Matrabfioomi VSSN Rs.1000.00 Ashaya VSSN Rs. Ashaya VSSN 1,000.00 Rs. 1,000.00 Bharath VSSN Rs.1,000.00 Puml Chits Pvt Lt4Kaikamba, Rs. 2,50,000.00 Total- Total Rs.3.63.000.00 Rs. 1.12.000.00 (iv) Detaih ofinveslment iD NSS Llc tu. 3,00.000.00 NSS, Postd Saving Rs. 3,000.00 lnsurance Pol;cies and LIC Not inlestrnenl in NIL Rs- 2,50,000.00 LIC NIL Rs.1,00,000.0 0

N- Total- Total- Rs.3,00,000.00 Rs. l,o0,o00.oo \*\oooo I :","1 .flu

{, es"$"t P€rsonal loans/advancc Chandramangala Pe6onal Advance to p€uon Siven to any or Tradels, Sndarshan cnlity including finn. Moodabidri, Rs.4,22,000-00 compdny, 'Irust ctc.. tu.50,00,000.00 Nol and o$er reccivable NIL f.on debtors and thc NIL NIL

(vi) H€ro Honda TOYOTA INOVA AircranVYachlYShips Model 2008 Model 2008 Nor (Derails of Makc, KA,-l9X 1220 KA-05,MF 4635 NIL NIL NIL Market Value Market Value tu.20,000.00 Rs.8,00,000.00

(vii) Gold 640 gm Cold 800 gm Gold 40 gm Cold40 valuablc thinss(s) (sive (Purchase.Value (Purchase Value Market Value gm Gotd 40 dctaih of $eighl and Rs.6,00,000.00) Rs. 1 0,3 5,000.00) Rs, t.2o.oo0,0o Mark€t sm Ma*et Value Market Rs.19,00,000.00 Rs.24,00,000.00 Rs, Silver 3000 gm 1,20,0q1.00 Rs, 110,000.00 Market Value Rs.1,50,000.00

Total- Total- Rs. 20,50,000.00 Rs.2d,00,000.00

(viii Any olhci assels such as NIL NIL Nol NIL NIL NIL ) valuc otclainvinrcrest

(ix) Gross Total RS, RS. RS. RS. RS, value Rs 77,84,129.00 40,68,087.00 2J0.000.00 1J0,000.00 r10.000.00

B, Detrils oflmmovable Assetsi

Note: l. Properties injoinl ownership indicating the extent of_ioinr ownership wilt also hav€ to be indicated

Note:2. Each land orbujlding or apartrnent sbould rnentioned separately in this format Note:3. Details should include the i SL Description Self Spouse Htl Dependent -l Dependent -2 Dep No l' nt -3 (D Aqricultural Lapd Moodabidri Location(s) Taluk Thodar Survey numbers (s) Village 25138- NIL NIL NIL NIL Block 3 Moodabidri Taluk Puttige Yillage 54214

Area (total Measuring No! appl measurement ln l)0.14 acres. Not applicable Not applicable Not applicable acres) 2)0.60 acres

Whether inh€rited Nol Nor appl property (Yes or No) NO Not applicable Not applicable Not applicable

N01 l)16.04.2013 Not applicable Not applicable Not applicable appli t. 2)27.12.2014

'!i Li .'./ N$*+ Cost of Land (in r)16,000.00 Not applicable Nor Nor appl case ofpurchase) at 2)2,40,000.00 Not applicable Not applicable the time of purchase Total- lc Rs.2.56.000.00 Any Investments on Not applicable Nol the land by way of Not applicable Not applicable Not applioabl€ appli development, lc constructron etc. Approximate r)3,00,000.00 Nol Current 2)12,00,000.00 aPpl market Not applicable Not applicable Not applicable value, Total- Rs.15.00.000.00 le (iD Non -A!ricotturrl Moodabidi Puttige !!lC Villagc, NIL appl NIL NIL Locarion (s) 6]E'2, 55 /tD

Arca {toral measuf €moDt Nol Nol in sq.t.) 1.00 lcrcs aPpl appli

Ic Not No1 NO Not onnlicahle apPl appli

Dalc ofpurchasc in case Not Not 16.08.2012 appl

Cosi of Lnnd (in casc of Nol purchase) at the tine of Rs.15,00,000.00 Not applicablc appl Not applicablc Notapplicablc appli

Any Inveshents on the Not Not IIs.30.00,000.00

R!,1,00,00, 000.00 appl

le

(iiD Connercirl Buildinps Not Not (including apanments) 213/lBP 9 & NII- appl NIL NIL appli 213llBP3 D.No 3-143/6

Arer (tolal mea$femcDt in E.n.) I 163 sq.ft appl

lc Built-up Ar€a (toLl Not Not | 163 rq.ft uppl

Nor NO uppl Notapplicablc

31.08.20r3 appl R, i,.'1P,{Y\ ' r+'\ I /Y": ., - l',"7q ./6tjiV . -n.L b.,NC' Cost of prcpedy (in ca5. R5. 10,00,000.00 Not No1 ofpurchase) at the time appl Not applioable Nor rpplicablc apprr

Any Invdtments on lhe Rs. 5,00,000.00 Notapplicable Nol Not Nol appli@ble apPli icab

Rs.2s,00,000.00 Notapplicable No1 Not appl

(iv) Residential Not Buildinss appl (including NIL NIL NIL NIL NIL apartments): -Location(s) Survey numbers (s) Area (total Not Not measuf€ment tn appl sq.ft.) Not applicable Not applicable Nol applicable Not applicable le

Built-up Area (total Not Nol measurement in Not applicable appl appx sq,ft.) Not applicable Not applicabl€ Not applicable lc

Whether inherited Not Nol property (Yes or No) Not applicable Not applicable aPpl Not applicable Not applicabl€ appli

Date of purchase in Not case of s€lf- Not applicable appl acquired propefty Not applicable Not applicable Not applicable

Cost of Property (in Not case ofpurchase) at the time ofpurchase Not applicable Not applicable Not applicable Not applicable

Any Investments on Not applicable Not Not applicable Not applicable the land by way of appl appx developmen! Not applicable construction etc. Approximate Not Not Current market Not applicable appl valu€ Not applicable Not applicable Not applicable

(v) OtheB (such as Not Not interest in property) Notapplicable Not applicable appl appli Not applicable Not applicable

("i) Nor NIL NIL NIL ;#ffi.-=\ ,Rs. NIL F e)9hore \o,oo,ooo,oo {t i ERRORS/C0RRECTf0* r-r. q/ eF fu-"tte* (8) I give herein belowthe details of liabilities/dues to public financial institutions and govemmenr:

(Note: Please give s€parate details ofnam€ ofbank, institution, entity or individual and amount before each item) sL. Description Sclf Spouse HUF Depend€ Depen Depe No nt-l dent- nd€nt 2

(D l,oon or Dues of Vande mataram vsss Bank/Financirl Moodabidri,Morgage Loan Instilutions(s) tu. 32,59,660.00 Name of Bank Sri Brahma Finance Financial Shirtadi Mortgag€ Loan institution, Rs.16,42,337,00 applic NIL Vande mataram vsss NIL NIL NIL ou$tandrng Moodabidri,Overdraft Nature of loan Loan Rs.3,40,000.00 MCC BanlqMoodabidri Overdrafr taan Rs. 2,00,000.00 Total- Rs.54y'1,997.00

Advance from Sudhh Rao Rs. 20,00,000,00 individurh/ertity Advance from Hemavathi NIL NIL NIL NIL Rs. 412,000.00

Any other Pural Chits Pvt Ltd Pural Chits P\'t Ltd Not NIL NIL NIL litbility Rs. 3,oo,ooo,oo Rs. 4,25,000.00 Grand totsl of Rs. Rs, Not NIL NIL NIL liabiliti€s. 8r,63,997.00 4t5,000.00 iD Governm€nt (A) Hrs the Deponent been in occuprtion or accommodaii6il6iiiii-E!-lIi YES/ Dues: Government at lny time during tast ye_rrs th€ ten before the dri€ of NO Dues to notification of thc current electio[? (Pt. dealing with (B) lf ans*er (A) above is YES, the fo owing d€ctaration may be furnished lick Govemmenr namely:- the (i) Th€ address ofthe covernment Accommodation: aPPr opfta (iD There is no dues paysble in r€spect of 6bove covernm€nt le Accommodalion, tow'rds:- (r) Rent. naur (b) f,lectricitycharges e) (c) Watcr chrrg€s; and (d) Telephone cbarges as on 06-0j-2019 (dare) NIL Ithe dale shoutd be the tast drte of thc third month prior to the month in which the etcction is notities or rny date thereaft€rl. Note: -'No D[es Certificates from the ,genci€s concem€d in respect of rcn! electricity charges, water charges rnd telephone charg€s for tbc rbove Government rccommodation should be submitted. \.. \\ \*\\ 'iu )..rr' \ \ t !",'. :::l:,rJ:'ia..l " ii.:l '"..- Jl\b Nn I t :'i'' I \ N,Net -P(*)el/ rz 11

(iii) Dues to depaftnent Nit Nil Not Nil Nil NIL deating witb applic Govemment able transport (includiog aircrafts and helicoDters) (iv) Income T&.( dues NIL NIL Not NIL NIL N]L applic able CST du€s NIL NIL Not NIL NIL NIL appllc able (vi) Municip.l/Propen NIL NIL Not NIL NIL NIL y tax dues applic able (vii) Any other du€s NIL NIL Not NIL NIL NIL applrc

(vi;i) Grand total of all NIL NIL Not NIL NIL NIL Govemmentdues applic able (ix) Wlether any other NIL NIL Not NIL NIL NIL liabilities are in applic dispute, if so, nention lhe

and the aurhority before which it is Dendins, (9) Iletails ofprofession or occupation:

(a) Self - BUSINESMEN (b) Spouse - BUSINESMEN (9A) Details of sources(s) of income: (a) Self - INCOME FROM BUSINESS"R.ENT,COMMISSIONS (b) Spouse - Income from Business and commissions

(c) Source ofincome, ifany, ofdependents, " NIL" (9B) Contracts with approp ate Govemment and any public company or companies

(aJ details ofcontracts entered bythe candidale NOT APPLICABLE (b) details ofcontracts ent€red into by spouse NOT APPLICABLE (c, details of contmcts entered into by d€pendents NOT APPLTCABLE

details ofcontracts entercd into by Hindu Undivided Fanily or trust in whichthe candidate or spouse or dependents have interest NOT APPLICABLE

details ofcontmcts entered ioto by Partne6hip firms in which candidale or spouse of Or dependents are partners - YES, One ofthe Partner in Cbandramangala Traders, Moodabidri details ofcontmcts, entercd into by private companies in which candidate or spouse or dependents have share- YES On€ ofthe Patner in PuralChits Pvt Ltd., Ka;kamba,Mangaluru

Qualification is as under:

School, Moodabidri - l99l Uriversity College, Moodabidri - 1993 College,Moodabidri 1996. N",N+- (Cive details ofhighest School / university education mentioDing the full forrn ofthe certificate drploma / degree course, name ofthe School/College/ Universib/ and th€ year in which rn€ course was comDleted.)

PART - B (II) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (TO) OF PART _ A :

I Name ofthe Candidare SRI. SUDARSHANA 2 Full postaladdress S/O RAMESH KOT|YAN, D.NO. 4/320, KASTURI SHANTHI NIVASA. NEAR MARIGUDI,MARPADI VILLAGE, MOODABIDRI.5T4 227. 3 Number ald name of the Constituency and State I7, 4 Name of the polilical party which set up the candidate (otherwise write BHARATIYA JANATA PARTY 'lndependent') 5 Total number of pending NIL criminal cases 6 Tot6l number of cases in which convicted NIL 7 PAN no Year forwhich Total Income last Income Tax Shown Retum filed (a)Candidate AMBPM?I25M 201'7-20Ia 5.54.014.00 (b)Spouse AGlPH7306Q 2017 -2018 1.58.903.00 (c) HUF NOT APPLICABLE NIL NIL (d) Dependent NIL NIL NIL

8. Details ofAssets apd Liabilities (includi4q olfsbore assets ) in rupees Description Self Spouse HI]F Dependent -l Dependent-2 Deperde nt -3 Movable Ass€ts Nor (Total Value) NIL NIL NIL NIL NIL

B, Immovable Assets Asset applic NIL NIL NIL NIL I Purchase Price of self - Nol acquired immovable NIL propeny NIL NIL NIL

II Development/constructi Nol No1 on cost of immovable applic NIL pmperty after purchase NIL NIL (ifapplicable) III Approximate Current Nor 4. @g-i"e- NIL NIL applic NIL NIL -rtrriil;\,i eerf:* NIL Q),Ii4a.q (TOtatdbh

EnRotvcsFnicr,0ils Ea T\i Wii \ epr\'q9' .*, f, 13

Not Not 9. Liabilities applic applimble NTL NIL NIL NIL

(D Gov€rnment dues Nol No1 (Total) applic applicablc NIL NIL ablc NIL NIL

(iD Loans from Bank, Not Nol Financial Institutions applicabl€ and otheN (Total) NIL N]L NIL NIL t0 Liabilili6 that sre trnder dfupda

(D Govemment dues Not Nolapplicablc (Total) NIL NIL NIL NIL

(iD Loans from Bank, Not Nol applicable Financial Institutions NIL ML applic NIL NIL and others (Total) able

Highest educational qualification: S.S.L,C, in Jain High School, Moodsbidri-lggl P.U.C, in Jain Pre-University College, Moodabidri-l993 B.COM., Sri Dhavala College,Moodabidri. 1996. (Give details of highest Schooy Universiry education mentionins the full form ofthe csrtificata/diploma/degree courses. name of the School/Coltege/ University and lhe year in which the couBe was comDleted.

\

ERR0RS/C0RRE0T|0NS ErE, N i u*,J B-"\et-

P.T.O 14

VERIFICATION

l, the deponent, above named, do hereby verit? and declare that the contents ofthis affidavit are hue and conect to the best ofmy knowledge and beliefand no part ofii is false and nothing material has been concealed there from. I further declare that:.

(a) there is no case ofconviction or pending case against me other than those mentioned ill items 5 and 6 ofPart A and B Above;

(b) I, my spouse, or my dependents do not have any asset or liability, other than those mention€d in items 7 and 8 ofPart A and items 8, 9 and_10 ofPart B above.

Verified at MANGALURU, this the 26\ay of Tuesday MARCH 2019.

Note: 1. Aflidavit should be filed latest by 3.00 PM on the last day of filing nominations.

Note: 2. Affldavit should be swom before an Oath Commissioner or Magistrate ofthe First Class or before a Notary Public.

Note: 3. All columns should be filled up and no column to be left blank. Ifthere is no information to fumish in respect of any items'Nil" or'Not applicable',, as the case may be, should be mentioned.

Note: 4. The affidavit should be either typed or written legible aad neatly.

Note: s.Each page ofthe affidayit 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

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