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K( t.( )lt \i tA ri I \i,.. rrrlr ) l\ ( )i\i iN'-.,\ i irr\ j,ApEit ,t l:'l lii'tt i,, rjt.- i,/,, t,.., t)t i/!( R.O,9 NSB P/C /,t,t)i)li S1.11o.........,l.. ,F Detc....3'0.r...03*..L0..t3................ (r- T1mr......*.; )4; tnt vcnur...A..Q..0$n n+**I*.. :, li<itrl oi Irl,r.J.i r': oii p.\11 i. II Bi__l_oi\i \.\.Iil(_.Flii\,Elt IS \()1- ,TPPLIC.\BI,il . P.\It.f I i i-l i:,: rrrtri 5y, ,-a.riii1li11s .!ei ut, hv l.aa.,':ni:re.i Dolr lji:iti pilr.i.y ) I ,li:illtnata .r-.: ;t Can(lijatC 1iri 9l;q1iqi. nrr-?, IloLrsc ol' thc Pcr-rnlr j'..o*r l:'. rv+s,ag.o.pu R. ...parrraincn,..r.,,,lL . lnt ..'^"'' , ',i'', rto"r.riil,'nod,sr;ndrF+lmt;ll]:ilJ], suR)A hr,.,rrrn.i; n"n,e AJA Q,AyA uA Hj: r r,,,",, .,' .,,i I F<.v,s- '", -..1._'i{" d*" _' u r:,. ,,.,.,' . .;,.,, , uu i'l_: ,', ,,; (;,*ff$r.*?fl[r.:!or,lr.orr.,A+ t,,','::],:.o,:: *Or.. .. Y(A:;sci..bi1. cc,r,stiruencl, co,rp.is",i ,r i,t,,r61eSM;Illqi$;:;;'i,,,::,, \i r"r:'' ''.kAuunua?4ADA DFur. r,nd ir rs c'rcreJ ' , l5?.,.r il.. .r 5.\0...J4 in r,.rr.i ..;...r,,r.ii roll l,r No= & Un,O.f .,i;lrriisc.i - -.e",r1rrr.nrar\,consriruencv,er..,,;"j, lnr.ir,rJJ;.rc\. 'i i.rnin.1 Ay'6._Q, MARAlA.poq j i,,,. 4q,? ,&019 k("*-.-)----- Sigrratrrr.e o 1- Ptof,oser. i,.\R i :l i lrt l:t ll,\cii hV Cai)ilidatt \() i -.:r Liir ,ri i-_ri!jr,rrJ,.ti PLrirl,!31 ,1i,11y1 \\ .- lrr' -ir-\ nl),lt,.tt rts .:i:;rciidi:te il: cl"-iiilr; ,ir- i..r iirc I lrr ot' the .. l,eop ie t'roi,r ...... lrarl i.:::tiiilltr,v f..(lit riiit Liclr\. |Litnt c l: ;rtiler's/n.:otitcr-,s/hLLsbarrd,s l;iiiil! lli: i,,.,i,rl tirjijr..,,-, . Ilis nanrc is rnle rcd at S.No.. art No.... ..of the elect al roll {br ......'(As mb ly constltuenc_v comprised within) Pa lalllentilry constituerlc)'. \\;lticciare Iirirl \\c iii. clect0rs of e above Parliamentarv C'onstituency and uI rlalncs ara 'rlj.(r'r'r t1.. .i., ,:,'l "ll th| t ha J) arliamentary Constituency as indicated clcrrv an ci wc riirpc;ril oLtr sil;i:ilLii-'s lrclti,,r' in tok of subsclibing to this nomination:-- Plrticula ol the proposers arrd their signatures S l. utr N,Linc of Elector Roll No. ol' FLrll Nanr: S igna [)atc () ) c nl l-1(. n ell l Proposer :\sserlbIv Part No. of S.No. in ( (r ,>Lil Llenc Electorai thal pa/: Roll ) I ! 4 i. 6. tJ 9. i0 \.u.- Th e shoLrl.l be ten electors ol the constitltency as propo S PART III l. the candidate mentioned in Part I/Part II (Strike out which is noi applicable) assent to this i.romination and hereby declare- (rr) that I am a citizen ol India and have not acquired the citizenship of any tbreign State,lcountry. (b) that I have cornpleted. ... ...5..:7...............years of age; c(i) or c(ii) BELOW \VHICHEVER IS NOT APPLICABLEI ISIRIKL, OU1 pAR/ (c) (i) rhar I alrr set up at this election by the.!.U.VeIaNA...SBAnLil..&f+U..Cor,rE'pECS party. u,l.rich is a recognised National Party,'State Party in this State and that the syrnbol reserved for the above part,v bc allotted to me. OR 2 ir ) (/r ) tllll I anl et up at this election by the ... l)ill t\'. hich is a re {:istered-unrecosn is polit ica I parlyithat lam c testing th ls cli ()r1 as an independenl candidate trike out *,hich is not appli ble) and thar .i rnbols I have choscii- in order f pr elerence- erc: - (l) (ii ) . (i il). (!lr thli rr.. rrlrre and mv fathcr's, mother's,/husband's nirnte have been correctly spelt or-rt rr.l,r r,.' i 1...f/1;.$ LZ S H..... 1 name of the lan guage); (ci rl.il tu rirc lrest of t.nv knor.r'ledge antl belief, I am qualilied.tnd nor also drsqualilied ibr bc;r:.9 cit,osen to flli the serrt in the House ol the Pe otrlle- + i tlrthcr dcc lar-c t r I am a member of the' I tLs t libe whreh is rr sc !t,-'rltt tl "'=caste,'tribe ol the State of-.. .tn lation TO .,.... ....,(area) in thzrt State. Ialso dec lr tiiat Ihave not been,and shall ot be nominated as a candidate at e presen t gcneral e lec onrlhe bye-elections being heid ultaneously, to tlte House oi the eople lront r.r-ror-c l:lail o Par'liz,.nrcrrtary Constitucncics. urie .flO:5 :{9!3 rgnatur e ndidate YScore out the rvord.s "assembly constituency comprised w,ithin" in the case of .Iammu and Kashmir. Andanran and Nicobar Islands, Chandigarh. Dadra and Nagar Haveli, Daman and Diu r rrd Lakslradrveep. 'FScore out thrs paragrapli, if not applicable +*Score ont the words not applicable. N.B.-A "recognised political party" r.neans a political party recognised by the Election Commission under the Eiection Symbols (Ilesen,alion and Allotment) Order, 1968 in the Stare concemed. PAttI'IIIA (To be tilled by the candidate) t I ) \\'lrciirlt tiri s:rnriiclatc .- (i) )ras hetr eonvrcte,.l ilr ol nn\'oiitncr{sJ unticr sub-scctron ( I ). or (h1 tirl cr,ittlrr,titiion oi arv lari'speciii.'J in sLrb section (2). of sce Lror.r \ oithc l{eprese ntlition rrl'thc i'eoplc Acr. 19-5 I (4i ot l95 1): or WNtr (r; t ir.is 1,1..:n conr rctcd 1i;i an1, olher ()ll!:n( r(t) ior- rvhich he has bccn anianra(l t(-1 irlrpniolltlanl iirr l\ti \!'uis or nlora. 3 ll iirc ansucr is "Yes", the candidate sltall tir ish tlre iirllou in!. irtforiration: (r) ( .rsr llrsl infbrmation repofi No s..'... ,. l" :,. -li.li()11{ >,,......... .lr ". ' l ,.;i \r.rlIr(s) of llie concern-ld cr(s) and brief description of the o tce(s) lor which ire h;,: i;;,.:lr convicted........ I1r'l[) r't >i o1- conviction(s ) (1) ( \),.ili{:)u,hich convic the candiclate.... .... r r i IPr-ri i:ir;ttr:t.it( s ) il.t.l ed Iinciicate perrod oi rmprisonment(S) and/or quantunr ol' irnt{:)I I r r;; i,rrit.i:l o1'r-elease 111 pISC)n......... .,. - I 'lrl )\\:as 1\:ere allY ilppeal(s)i revision(s) filed against abovf conviction(s ) Yes N',r (ir) Date and parti lars of appea l(s)lapplication( s ) tbr revrslon illed. t.{) \ arnc of thc urt(s) bcforc u,4rich thc appcal(s),applicat n(s) for rcvision fi lcd i.i.l ) \L.hether e said appeal( s)/appiication(s) ior, revrsj n has/have been disposeci oi or' lS lrri p ding (ul) Il the s d appeal(s)i app lication(s) fbr revision has,' ar.e been disnosed o1 - {a } Dat . r rr I tli.lru::l I (l)Na re of order(s) passed (2) Wherher the car-rdidate is holding any office of prolit under the Govermnent ol India or State Cor crntur'nt l. Na. (tElNo) -ffid-....-.,' i3) !\'hethrr the candidate has been declared insolvent by any Court? . .Il,b. .. ( )i*./nvo ) (4)\\:irlihc: tirc candjdate is undel allegiance or adherence to any fbreign i'r,Lrntr r .'..N9..t Ygi,'No) JPffi.i-i.-, r'-dElxl1s. ii ) \\ hur jrli rlrr cil.trii(irte has been disqrralrtied under secliol.i 8A oi Lhe said Act bl art orcle r ol' ilrc i)t,-'rir.i.rril NO . (\ENo) (61 Whcrhcr ihc candrdate was disrtrssed tbl comrption or for disloyalty tvhile holding otllcc ( lrlslir:o) Lrrrclcr thc (lovern:lcnt o1' Intl ia or the Governmerrt tll an y State'l . Al0. t71 \\hcrltci tltc Crrrriliri:r1t, ltas :iny subsisting contract(s) $'tth ll.ic (lovt:rnltlr'rrl eilh.'r in iprirr i.iiliiL liiltacirr or Lrl trrrsl or paltr.ier-.hip rn lhich tirc canilidate I::i. a sl.tzit-c lbr siippll 4 rrl an\ soods to that (lovenlrrrent or lirr crccttlion of work:r rtnrlcrtakcn bv that ( r()\.i rlll)ant.)......4r4.. ( YS, No) -it \cs. *'ith which (.iov€rnnlent and'details of srrirsistrrrry'ntlaelts).... .: ,/ /t./ '\i r' j r..l:-,cr the canciidalc is a Iriirri,virtg JScDt. \)r ttriirL,!ir (); Secretary olauy eompat;-y o: i ,' 1.,11,1i,.,,, (othel iiran .l cu\lp(rative \r( rct-! ) ur lht c:rpital of rvhich the Cerrtr-:rl (-r.,,: ir11]aiit or Stalc (]or.'ernment has not les: thrn t$cnty-liVe percent share?. ffi i'lr \\. i,.:titr lrrr cartirtlate ltas been ,Jisrlrialilieti by ihe Cor.:'rnission Lrnder section l0A oi ilr. rrtiri ,'\,-i N0 . .li*s'No) -ii , ;,.'h+ ilate r.i clisqualiilea{ion I) irrc r Signaturc o andidatc Drtc:&0r.?.:Q.01 t PART IV lTo be t'1lled by the Returnrng Oificer) Scrill \o. ol nonrirrlriorr paper .........L... -lhis nomination del-ivered at.. J.?5.f,wPt:,,rir r was -l^ to nre al my olfice 2 onlQ.:.03.:.I5....(date) by the *candifate/proposv. (nan.re of proposer....... ' ,,,.'..,..........) I)alc ')a'Qlrlj Retu lccr PART V Decision of Returning Oflicer Accepting or llejecting the \-ominatiolr Paper I htrvc examined this nomination paper in accordanoe with section i6 ol rhe I(eprese;r tatrr;r of the Peopie Act, I 95 I (43 of 195 1 ) and decrde as fbllows:-- I J ir1.
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