<<

FORM 28 (sE rule 4) I NOMINATJON PAPFR Eh\hoa,",h. l.ti.trt^, A\)atbq ODISnA $aet E'

STRIKI OFI PART I OR PART II BELOW WI{ICHE\ER IS NOT AIPLICABLE PART I

(To be used by ceditlate set up by Gcosnised polilical party) I nomin,te as a cmdidate for cldion o rhc Llgislaiive Assmbu Aom rr'"..l&Q. .Srrna

ny *.. i' namo-.chorcl,rr".da.xrre.dd ir is entered at sl. No.3a5..in pa.t No..1.73....oftleelcdomrrolforrhe..laq."^SLeEcde...... Assembryconshtuency. ( Pon,, ov.^+'* ?-ia trq, o", a1$,/aotq s po.rue ofrhe Proposer '.- n

!, c d,darc ro- elecriol ro 'lc lcEi"lortre Asembly rrcn

i{ nafre is e.lcred al Sl. \o '1PsnNo...... ofrtc.ecor.l'ollfor :\\ A"..mbly We declaie that we re elecion .f ihir Itc eec\,| rol. lor fih A-erbl) -orrirucl,y ^ ird'.rFo belo( alo !e,ppend our 'ierdMe"be}l. hbkeno,

l 6 l. 2. 3.

8 9.

N B.- TheE snoudbe len electos ofthe constitumcy as prcposen.

PARTIII I. t]re cadidare me.lioned in Pan L/Pan ll (Srrikc oul {hich k n.r apFlicabl.l assent to this nomination and hereby declaE th3! l!) Im acn'Tei oll1d.d dno nJre I or d.qnr.J rne c. /en\1rp otd I tor gi 5rare. (b)rhd I h,!ecomplekd..:r6 ...)em;f aaei [STRIKI OUT.OOR c(ii, Brl OwwH]rl l\ 'c lS\Ol \PP lrABll-l ,c' ' ) | dm rd up d, 'hn e'e...or t'\ r\eerlilb/'a1,Gb"i'. rhi-1 F re.oEn:ed Aksnt+34 \rare Par.) 'r .'i. s d e rr-d tar .Jhool '..ened l.' rhe dbo\e '1e party be alloned to me.

(iD oEised pohical party/thal I anr conte$ine this election as indep6d6t candidhF.{Slikc out whicn is nor applicablc) and rhar the symbols I hale.hosen, iD order of prclc_i

/d\ n\ 0are nd n)',rqnt slhea h!-!4G nin e h,!\ bt rn..n.. .r \pe' ou, abo\e ir L^9 L4i..L .. . rnaineor,.e alsudge.. and /e) nd ro rhe beslbl m) Lnos'edte.no be ie: lar l q r ilrcd mr al.o o .qJal \d " 'o for beins chosen lo nll lne seat in the LeCislaiive Assemblyolrhis SraG . | 'unhe, de.hre Ltar mdmenF or r.el

PART iIIA (l) whdh{fie mididde_ (i) h6 been conlicred_ ra)oJ ] otkoco\tuds sub-rclbr ll) tr iii:lil;;r,i:il'::' ;l';'ii;:i:ili:'^:i'i:1t' +*n"" '1" [T,::::.":#HXHfi ::i."tuG),o,.r,,"r r," r,u, u"-

of$ermemed { Ac,u) &d or.r r.**;;;;;:"J;*;i;j ;;;;;

.r,he counrsr berore Nh,ch tft aor."\ry"oriii"ii",r"ir", i ornot'u J''n ,)ir)ft4h1rc.mddd?' :T#dn sL-co\!-r"- .,, NA ---: ;/ * ola'"u^ *'"' I).;J';:"."".:1.:Jr,,'.,,0,''

r'' Ib''i'''e "r ;'i"'""""''''^ " "'' , il:'.:-:'::,.:" "' ";' er(!d.n,' .l)rdrNoi N+ F.nd.,"al,td "' L\ .,.,..nod o. .o,,,, ,\F. -n"!J9,r - :,,;:;.:,lil:";:: ;:l""TT::;:';''!'\' r\".,f.drcoru.hr'.m''-1 "",n.uo.-dn- .,.n.'.",n1i"'d-'l ";;::" - T.^ :;::;;:::;;,-:"""' lIi-;'"'"' ;y :l':: :::l;:":;::::::r:r1" :i:;iJ:r: : ' "'"'=Ji r- ",:':;.. ." *** . ;";."'.--." :' :'-.;"".:: "". ==***l**i*r1;::J.llT";::;i:b\ dlc (omr ",-. *' 0*' dRquahficd , * ntn" """t'0"9"" ", on .- w.F 'nsK J'{ ',,:l'"d'o_ ' '(' r'{d'co' .J* ' . . \ *"0'u"" a^*, Swr:aAof da"y't*5az Kiu-' ""n' Dd.: a5/o3lolq ,.. .:""i"t.\;,^"",..,, -i:[:it' "'" T;i'i""i',lli1ll'l 3""1"i,-',j*t"i:;frS:ffijt'E$

D.,," z=1a\r,"'\ -^.a;;bt'ons'k0ei'Y,-"f:i,'.',ffn:""., PART V D..lrion of Reiumirg Odicer Acc.pting or Rejeting tte I nave exmined this .oniraiion papo in accorddce wi{l secdon 36 oI the Reprerqknon oflne People AcL la.' dd decd. s tollows: -

PART !'T Receipr for Nomimrioo Papq lEd Nod.e of S.rutiny Go be nanded ovq to lhe p.Mn pGcnting lte Nonri.arioD Plper) Sdial No. of nomination papr...... -..... Tle nonimtion paper of...... -.-.,-,..,.a candidate for €lecrio fron the...... -....--...... Ar*nbly comtituency ws Celiveed to oe at my ofnce ar__...... (tou0 oo.,,,.,..-...... (dale) by 1ne ..ddidadprcposq. All noninari4 pap6 will be raken u! for $tutiny at ..-.....-.....(tou) or...... {dlte) ir...... (?loce). Et-{I , TEN 5qn RUPEES s.10 10

BEEORETHENOTARI PUBL]C, SURAD,\ CANIAM

AFIIDAVIT TO BE III,ED BY THE CANDIDATE ALONCWITH NOMINATION ?APEII BEIORE THE RETURNING OFFICER FOR ELECIION TO LEGISLATTVE ASSEMBLY (NAME OF THE HOUSE) FROM 129 SURADA AMMEBL1 CONSTITUENCY (NAMtr OF THE CON5TMUENCY) PART A

I, SRI PURNA CHANDRA SWAIN "son/dtu6hrer/*U. oI SRI MAHADEV SWAIN, Age.l 46 yearr rcsi.leni of SARUA SAHi, SURADA N.A.C., IO,/P.S, : SURADA, DIST. : CANIA, -61103 ODISHd tuJ oJ.rJ dddr", r. .M.Lo. k . d e pt .oon. oo he,"b. 'Tmbon " "bove Nerun! arrirm md liate on oaL\ asrolotrs -

I d c .ldaie set up by BrJU IANATA DAr" ODTSHA (rinane o1 drd potiticat lalb/)/[email protected] 8?s,nn:{ftte?sdenrfrrdrd,t€. ('rstrike out whichever is nor applicable) fti. ->12) My .ame is etuolled h 129 SURADA ASSEMBL1 CONSTITUENCY, ODISHA (Name oI the cotutitueuy and the Staie), at Seiial No 357 in Pa* No. 173 (3) My .ont .t telephon. nunbe(s) is/ aft 993n867s,9fiabas7s4 and my enait id (it dy) is [email protected] and my sGial mc.tia a.conn(E (iI ay) islme (i) Puna Chddn Srrain (Ia.cbo6r) (i, ,Nil Fot ,I,rn ol.. ,...,i"l.il* J, ' , ,1t r. _ 4"9 o#9'? ls's"'t07 eE -.7.f.5....

K u-fqq";q' s.v s.R'o' Bhanianagar (Gm'l (4) Dehils oI Peituent Accout Number (PAN) and sbtus oI litin* of rncore Tax retuin

a.r\tli I /_.*7'"** i\ PA '9 tB,lt. rRd ccQPs274rP *#n tsrrrr y'C. s^**--* w{9 CQUPSIISI]I L Nil NiI

NN Nil

5, NN Nil MI (s) Pendingoiffalcases n\ | d6 li."'}dl thqb \nope. dDg,'iJrw .6p J8zr.ne. . \I nit ttr\nltltrrrtttttE,? | ohr \,..n*p dagrBn\!),? ;nd,h oad tunp NOT APPUCABLE aB|,Bt itt htdtilE (ii) tElaat

(ii) fte f.Iowing criminal .ases are pending agaitur me i (U fiere are pmding cimiml cases agaitur rhe candidare, fien tick this dteftatiwe an.l sore oil rlrematire (r) abov., and give detaG ot an pendins

rrR No. with nane and addres or Polie siation

Case No viil] Nahe or the

G) se.honG) of concehed A.ts/codes involved kre N. aJ ur s{kbl, e4. sedior

wnedE chare€s have ben -13 frme,r (meftion ]Ts or

i0 ff answer a8aind (.) rbove a YIs, then Srve rhe dtu on ,hich chr36 i.ere

G) whethcr any APPeal/

b@n filad agairei rhe Procedinss arrtrriD, Yas (5) caesolconvichon , tl rL - (i) I d(larc !hat, I have not beon .onvicted for Ark tuk nltermtue, il E ndidnb las nt bd .o ricted ntu1 tutit NoT i'! r ats\ APPLICABLE rgnnd nkenlnhle (ii) Md|) t have b@n convicted lor the oI /s (|ftutdndidatctnstu canlnkd,tha n&nnsnlk nnun n s.oft afaltettutiry (t) nbat, ntu|Ei@ d.tn 5fi it Toble beLo ) xy,eNa. NN NN 4D^ t ry Nil Nit Nit G]

NN Nil

(.1) Nit Nil

G) Nil Nit Nit

(0 Nil Nil

(c) Nil Nil

(h) Nil Nit

(6A) I have given tuI and uP tGdate information to ny political part, about all pending crminal .ases agajnst me and alout ail cases oI .onvjction s Alven in p agraPns (5) ard (6). IN [Cnndidntus to tula this ]ten ls at applic.'Lne sllatld.karlv tunE NOT APPLICABLE []=: t'IEwoIE T/IIES IN 5(,) o/d 6 iiii.--r-,Is,a[; { t- aAlDt??', I ' D. tou' tnrltllx?nPro Do trrdrytbt! , 2. Details ta}! iwn epnnbl! kr e&.nP detdifrtont@Latnso\ntsten hitu t. I Detuih 4loin W fi d'ttv .htonal%i t adzL i e., a ttust .r* ta b ltst i. Snpn 'Enrion?'i nndbo.Lmnts ir tE atld nJ drt s lar E ottet dvs 4 AdAina ol s|@t nybndde.iilreq nrd. jn.onqlirna is sibte nrypluitlgt ih aJdan'hte s Ptnecowt\ 5. cintlid.te re4n fu 'atid idsnnt i'1w.P.tC) Na.536 of2011. Fd lP.r or. ikJ.F .4'v L ....- ..l,- ^ (.4i__. r^r^FYsoRAoa {GM.,ill i llr q (7t fl@t I gif tld bttor, u@ d.tnik aJ lp nsers On@ble nntl ihurahbte ek ) af vyL t1\

.tails ol nubltastPb:

A$ets in joint nam indicaring rhe e*ent ot joinr own€rship $iI arso have ro be .N. PATR mr{ In r6p of d"po.n br'e,mmr. Lhp Frd L m. tudi,t c4,ijt \umo. An oL. drp oId"pGn. Ge,.hemp. N n" or be B"jJ Lrb-rlbon rad B,tu,I cF.o De

v.lue olaond!/Sharc Debdtures as per.uirenr marl

D"penden/ r.ft pcr- <..on.{. oru8n.q,n ot th", adNa"or.pob"dno rr' orrp' oqso- b Lhe dnle kh.,}lF 'd,ted lrt bv b,ood o, tu,ii"8". *.o have no se?aEte neN oI ituone and who aio depeiile.t on tho .adidate for fienlivelihood

\o." : r DeL'l.r. LdDS ano, .r.. ro bp givrn.epcr4r. i,1 rp.prt I or ec., r\psmrnr

) K' ["-","...",

.1.:

I Pad or...."r-1h.,.0s J ) Nil

r€Fd.s. n%,!i6*\ R

4 IJ I l

, Part o1.....A;l-L J*.1 (:- _) t-

H&{sE !!.

("ii)

(,iii)

ns 20o2rtr turA7l7b/- B. oetaus or rmova[re;GEi Prcperiies injolnt ti"*4-._!r-l owneNhip tndicadrg thd ext€nr ofjoint ownerstup l,il a]$ h.ve io be indi.al€d. r Ii,._r-"JJ:_!/ r/ rme.--.rrr..+,iiJ,{ Nob ', Ea.h land or building or apabnmt should be menrioned setaratety in For- )p€rrot...A. .i.f -f, - F . l-.. ffi (,4 -"X+\\-or\r / B.tr. Pr' fiflHlJ.,, \ xorA uffSzl*:s,",

(o I Bhat,inipur _r.lauza

r5r]1. rrat No

K.rN WW DD!l.t ni 1j:r Nit

/5) ttlila

I. PAT, lg{,1i-P"',yrr" F,\ IOIAR' ifftiffiili::[: lol tu

NLL (,) /)i (q) m kI:g!AD^ lY :.(3) I give herein below tho debils oI liabiliries/.lues to pub1i. find.ial irohruriore and 9"" -'l-;Ili J-*_:.1 I (Note : plea* give sep ak details ol nme ol bar*, institutioa entiry or indiridual and mdDt belore ea.h ittm) Fo paaor,.d;.fJc,..\ q- | r f."'-" a* .'.:^e . - ()

@ K B.tt. l \NO ( @

(ii) (A) H6 thc DepdEn' bpn h c.upation of a(o modation provided lry &e covenheni .t any iime durnE &e ra* ren yea6 befor rhe dih

(B) Il srver b (a) above n \'Es, Lhc followinB d{lararion may be

(i) the addrs or re covem Qla er No DS 03/03, Unit rV, , Pay,bre u resP{t of above covermenr a(onmodatjo4 6owards - (a) refc ,a)< (b) Ere.ftniry.halg€sr-Nn, G) witer chqer md Nil q "u"^\ (d) Teleplone dEr3a s on Nil (dd4 +d \ Idp date should b€ the ldt daie of ihe inird mon$ piioi to thc ,h-L '7, honih in whi.h ihe ele.tion i5 notiried or any dab iheEalierl ffi Note - 'N. Du6 Certifi.are for &e agen.ies.on erned in ftsped of rmt, clc.bi.ity .har3a, nsci charge and ietephone .hr8es for ihe above covehh.nt akommoda (ijj)

.: For Prrror A-l,,L l - I l. -I, (')

I a.rrtl (-e .'{.bx4$1, r[a.M$, r.r. P tq'RrraU . IOIi \ uff##.'"* (9) Details oi prolession or (a) Sell : So.ial worker (EX-MLA)

(9A) D.tails or soures oI in ohe l

(a) sex : Honorariun (b) spouse : Busin6s (.) Source oI in one if my, ofdependents,: Nil

(9B) Conhacb a i& appropriate colel]r]mn. d any public compmy oi .ompanies

(a) Deta s ofconka.tsmtered by ihe.ddidate : NN (b) D.tails oI .ontracrs mtered inro by slous NN (c) Der.iL oI contracts mtered hto by dependents : Nil (d) Detaib of.onhacrs entered into by Hindn undi'ided Family or trrst in $ni.h the cmdidate or spouse oi dependents have inre rcs t : N'I (e) Dctails or contracg enteidd into bI Paftie6hip Fnms in whi.h cmdidate oi sp.usd or dePendents.re ParhPE I Nil (l) Details oi.onha.ts enreEd inro by private compdies in $ hi.h cmdidaie or spouse or dep.ndents have share : Nn

My edu..tional qualilLation is as mder :

Oass Ix& Pass (Govi. Hig\ School) lvledl.al Cmpus, Berhdpur, (cive details ol hiShest S.hool/Universf, edu.atim mentioning tlr Iull form oI dre ce*ilicate/diplom/deSree cou4e Gne oI theS.nool/Cologe/Unile^ity rd the yed in which rhe coure $Gs conpleted)

pi( Fo' or....t..Ll . d ." - I *o,^"', ,, "o"^*iJ,fi /, 1 PART - B (11) ABSINACI OI THE DETAIIS CrVEN IN (1) TO (10 Or PART - A : Name ol tie .andidab l-fu PLINA-HA\pR,A s .Vost\t t AT : SARUA SAHI, SURAI tr;- \ t. ro. G !.5. : 5uae, u,sl : , oDrsHA / rs \ 'I\lrmber d rome oI the otubiutu.y i5lI,T. 129 SUMDA A5SEMBLY coNsmUENo PAT] l#re;?rGP.l,ftil,ilh"h,rD \., N,,ry(; ,lie red'dale 1otr,e,",* -"ti: B,U JANATA DAL ODIS}TA \<3DA (q Total nmber ol penthg cr;mimt rc 2. Tot l numbet of c6es L whtch Nil

filed ccoPsr44P cQUrsrrsoF Nit Def.ils ot Assets ad Liabijities nr tupe4

Nrl

B, Nir Ni Nit

MI Nil

I

ZFi; Nir (: ,f":"Jn N I )j D.l Fr !1.:

Fo' ) Palt or....1.+1,.J.* t tt l. ii) &N Nit Nil Rdj N"R! /- ftioau'"" \ QlaG Y NN (ii) Nil NN Nil Nil Nil

High{ €ducarion.l qualifi.ation : class Ixth Pass rrom cort, liigh s.hool, Medi.al CdpB, Bernmpur, (G!rian).

(Ci!e det.ils of hlgher s.hool/Univesity .du.ation mcntioning tnc tuI lom oi lhe .eruJi.ateldiplom/deSree .ouNq mme oI dre s.hool/College/Unile*iry and ine vear in wlncn tne .ourse was .onDleted)

VERIFICATION

l, the deponent, alove named do hereby verify and declare thai dre conicnts of thc allidavit are true and cotr{t to tne best oI my lnowledge d beliel and no pait ol it is labe md nothing mlerial nas b*n .on e.led there fion. I tuithd d(l e tnat :

(a) There c no case ol convi.tion or lending .ase against me otner urm thole meniioftd in item 5 a.d 6 orPart A and B above. (b) I, ny spo6e or my depmdenE do not have any asset or lialilit , ofier tlm thoso mcntioned hilem 7 d8 oIPartA md item3,9 d10oiPartBabove. $c...... LJ L..l dayof 1l ia.+,4"1 ,. - f.,_- ....-=.- --(!. #I't"" DET'ONENT t n"*-.L:;-- I ,n.,uu.lffi**iff.,,,,n,r-hir..*r4rtudior,l.., D r'"._....5J__lq1",-- l..4L 'i j.fl !riIq ,!bai[ D dtini.d tdfl n. r[! ,t].h! ,, oUl.e+m.Lx.rrtd! rte ttoh* J_1,J" !E.eej. /C+ R.!d o" sd;-br",;;; !.pd!.i ,]n pe{k4 b rdili,t rJ ri. or,.dr iid'srd rk EF! !t ,tio rflidddr , , ""TJf^:y:1,*Xeffi ;ffi /,., FOltNl_'A' C:,nmMicdion * ith reeard ro Anthoized P.^ons to intimak nancs ofcmdiJits s.l up trv EcogniT'd N!ln,n,l or Sralc Polillcll Pa6'or ltesnFrcd un{coeolzed loliticaL P.r)l

l. lhc chiclLlcclorul Omc.i

2 Thc Rctuming oticcr lortlre !?r,ivM.DA.ASSE!.ALL -...... cons,iluenc) lo H LUls-Al \c \s\lVB Y (uhi.rr u.,.orlr ..' r . .'o...... odhha Slate Allohcnlolsrmbols_ urhorizrrionofPersonstoinlimalcnanresolcandidales

ln|u6ua.c.olparsEphs ll(c) (d).nd(e)olrhcEleclionsrmbols{RcseNationand'4lld_ mnl)Oider- 1968.1hcreby conrmunicale thotlhe lollo$ing peso.(s) has/have been lufiorked b] th' pallr lvhich is 'knrimlra4/Srarc p.nI in the Sutc olOdish,/'Regislcrcd un{ttqlnisln pany ro ;ndmrtctheDd'ns oflltcandidalcs p$po*d to be sd up br thc Panl altheeleclion cncdubovc

.orniruren!\/Lonnnt enc Ls I rts.ect oJ {hich he hls

I I'RESIDE\T \\.HOLE STAIE OI

-l hc specime. si-{DrluEs ol$e.bo\..renrioncd peNon(s) so lutho.ized xr. !i\en belo\' I specnDcnsignafur.so|\AVEENPATN^IK.Prcsident (-.--<-. (i)...'. ------..-:'... /.\ / +(, \ii)... ""';4,; - - f'--'--=:.( , (' r)

Y. ariri'l?l! L.

BijuJan!t,Drl.Odisha

BI]U JANATA DAL t L; 'E;3 I l{ -- "= O riE=.!t!ts ea= "r E.r:a:AtF ;I t : a; is' - ":= 6

: !:c lza

;;1, 2 z F'aE:i= ! - ta a P;. \ !. =?.

V69Ai e : .E;E i <6'- rsG dZ -".14. zz l 4i tz

a ll :.

: .=1= =: = j = = .: l= ,-3"9$,33"oo

s,'r,atuq,?F[+Sffi;;&nrub.,,' iiiri{^GA

oGPlFoNl01P.2!7.s0,000&9'02\2201j

ooa or g6er oq l61610 a6uFo sg6eo ry1 (e)/eeqr (e)t ,i qr

16,aac,q6r6 66Q 6n66 e5s,rF16,616 eg6 €o riron.r qoEo 6aaa asuno66' €lce 6qre o Be 6rEe {a. ( a -:r- S.\, RL': (q d$a ql€a s qeF a6666' 6q') ' o! a!s6Er6r oB ar66z9 rca...... "). ".,."e. ^ ?/ .. ^ ot+o...?-qrrg r!:... -r.ti ".* 7.f'1 r; + @-1.r. e, e-" ...... c,6, q{'. '* ?L:..j,q:r'.. aq€o6 bs!c..{6 00, !26. oo,is, Eb.6 affi c6.6. r r'.,eed'ffi"J' '--/ De.laration by candidate/EHiMgat/ PrPlrc while sutnittirg tle ptotoghlh

5,br"' re,Lior *Ls,,.L!t. , n en- on thP ran" o' rrre hou'er rror '.el^\ha.Lrl,l(n.re or rhc rr' P--,)/"lPc .ol to t o-r.' oi ('are'/ ...1.4q. Sl,&r.eclo ...... 'on 'l Legislative Council by Assembiy Menbere.

.:;-"/"i!Eh'- /",r. r Dran..Cho,rd,m.Sanco .,. Suoada.,4n a"^" "' d dddF. '1 .Mataodot.,gOrtLio... nor,rur"oalcanoidarero-Lr"abovcrelr'onpoele' o ^st,, an subrnitting he.ewjth ny photogEph for the purpose olPrinting the saDe on the ballot papexl declare that tbe photograp!has been t!!€n durine th€ last 3 nonths befo.e the date 6anotili.ation of election. .t signaxtrc ofCbdid.le

photograph]. [nll up ths partwhen lbe candidata hihs.lfis sobmjttin8the OR

of shri L...... - ...... '' ''' '' '' '-' " (name), eledidn asent/proposer """ "" -...... (nane and address oatbe candidatel, son/daustter/ uile oashri ...,,,,,,,,...... ,...,.,.,...... , a candidate for the abovementi.ned election, herehv submitthe photogmph olthe said candidate lor !he purp.se ofP.intingthesame on the ballot pape.l

Sigoaturc ol Election Ager! Proposer

[fi]lup tlis part when t]e election as€nt/proposer is subhitting the PhorogEphl. Dzra:...... ,,.,.,. Namei.,...... ,...... -.--, Addre$,...... -......

Tel N...-...... ,......

T \,, t s^|...... ru. t:-1--.4:-a-!:1....::3:......

l-/ 12r BhanjanaEar/ 123-aska/ 12s-surada A$em6ry coniituency,

The Returning offjcer,

Sub: A.knowledEemeniorReceipt

l,the above iahed cand date doackiowledg.lh€ re.€ pl of tene6, Notires, Form.,

fE edon Comnis5onas dera ted be tu.

\ 1. ReceipiiorNohi.arionpap€rdeliveredandNortceiorsnurny{parlVtofrorm2(B)

2. Duplicate check lhi

3 Oath Acknowledsement

4 fstrud on regardine photosEph ofcand date

5, Fom ol dedaEtion by endidate/ Ekcuon agenvpmpo$ruh e strbmitrins phdosDph

6. Fdrm No 3 Appointment olelecrion agent (Taocopie,

7. Inltruc(on regard ngprintingon pamph elsposteEerc.

3 tistoflreesymbol(iflnd.pended.andid!tel

9, Notice aboutthetime, date and p a.e forallotmeff olsymbols. (irindependeni cndidate)

c--cl* shzrtanas 9q4\4^'44\ 7* ':-> adr-: 25 o.2oi9 sisndure of the candiddes