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A n ne%UI'C- 1 'G 9" BY CANDIDA 1 T11 TO BE FURNISHED AFFIDAVIT NOMINATION PAPER
Before the Returning Off-ice' of the House) Ivr A0 a tname, For election to^.iec3 •^G VVVV Q. constituency From ....g.,. (rtalt?zw• /r^ (Name of the Constituency)
e of Son'cl v1 ^ cat , 1, aged .....y.s" 14 ...... L .+P resident of .^/.i. Lt ' :, ruler: Candidate at the above election, do hereby solemnly aflirm and state on oath ,t
(Strike out whichever not applicable) ^ ch cog ¢aitce pan been i n WWh i n ( s) is/are pencg 34t/^ ^0 1. The following case 5 '72"3 VI / taken by the court :- U) 3Y/I32-13 9T F' C (n) vis II^yB//49f h cognizance fi) Section of the Act and description of the offence for whic
taken:
has taken cognizance: (ii) The Court which
Case No.: 3 5108 ,
Date of order of the court taking cognizance : >(
7 tiled of appeal(s) i application (s) for revision. etc. if any. against (^)
•hnve Order taking cognizance : x (2) That I give herein below the details of the assets (immovable, movabic. N u ll, balance. etc) of spouse. my dependents and myself:
(A) DETAILS OF MOVABLE ASSETS
(Assets in joint name indicating the extent of joint ownership will also have to he given)
SI. Dc c iption self, Spousc(S ) f Dcpenden t i Dcpcndcat- Depcuntaa No. Name(s) Name Name etc. Name
(i) Cash 2S, ►N^r k
(ii) Deposits in Banks , pr xa Financial Institutions #/c/Vb - 314548 F And Non-Banking 99 CO Financial_ Companies (iii) Bonds, Debentures and Shares in - x - - com p anies x
(lv) Other financial instruments, NSS, i postal Savings , [IC Y y^ x x I 'olicirs. clr.
(v) Motor Vehicles (Details of make, x etc . ) X X
(vi) Jexxelleiy (go^c details of ecig hl ,^ 7 rind value) ^,A X` -QJJo k k
(v1) Other sets , such v , Q as values ui claimy y uvescst's ^C X
Note: Value of Bonds! Shares / Debentures as per the latest market value in St:;ck Exchange in respect of listed companies and as per books in the case of non listed companies should be given. 1? Asst: fS B. i)F'I'Al1,s OP 1rs1MOVAIil , joint ownership will also extent of [Note : Properties in joint ownership indicating the have to be indicatedi -1 ^ D-pu:^tcnt-'_ ^ t 'N Spouse(s). Dependent Self hunt Description Mimic(s) Name I
Agricultural Land- - Locations(s) - Survey number(s) Extent (Total measurement) Current market value
Non-Agricultural land- - Locations(s) Survey number(s) )Ie Extent (Total measurement) Current market value
13uildings (commercial and residential) - I.ocationsls) Survey / dour numbers(s) k Extent (Total measurement) Current market value
L
I louses / Apartments, etc- - I-ocations(s) - Survey / door 5runbrs) Extent'(T`^ mcasuretiicf G'urretu uarkirf, lac I give herein below the details of IM, liabilities/ over due to public.lin;mciul
institutions and government dues:- ive separate details for each ttem^ [Note : P lease g Amuwt: Name k address of c^utstattdtng as Desoripuon Rank/Financial Insututtons(s) S.No. I - -li DepattmcntS(s) I o .. TWO (,^ (i) 1 uans from Banks .5^>t- 1 ^Cb
tinancial institutions (ii) Loans from
(iii) Government dues:-
dues to departments dealing with government accommodation
(h) dues to eteparunonts dealing ^t'ith supply of water
(c) dues to dcparpnents (Icaliog with supply of electricity
(d) dues to departments dealing tt'itIm telephones
ents dealing kith (U) clues to d ep uru» go.veinmcnt transport (including aircr4.lts and helicopters)
(\t) other oU s, tfany t Amount Nano R address of rwt\ mount it, Description Lt mk; Fin uteial Insutuhuns(s), on Dciailtn nts(s)
Income Tax Including surcharge [AIco indicate the assessments year I up. to which income Tax Retain 2< Account tiled. Give also permanent Number (PAN)]
(il) Wealth Tax [Also indicate the assessment year up to which wealth Tax return filed.]
(iii) Sales tax, [Only in case h proprietary business]
(iv) Property Tax X
- (4) My educational qualifications are as under :
IGIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATIONI University and the year in which the course ^^ ornplere'i Name of School / should also he uiccn d K„mq^e w ANwPNA NJ ^^^^^m^ .
v> 61e. r o VERIFICATION d 'are that the contents of tLis j^onent above named, do herebyof,my verify knowledge and ec and belief: no part of it is rrect to the best ' of avrt ate true an co froth m tterial has been coriaealed there fare anti nothing . Ol) ...... day of ...... tills t ie 4 y Ott -o °°'1
'^F9^1^` v 3 cjo ro37b 20, ooooo/. J/pIu1 M1A- t v h 3l Eft Ala ti4i;Rr tea wt^ f Ff5' -^4 Eft arty T Date of application for MCK Date of delivery of the Date fixed for notifying 9ng over the the copy. requisite stamps and the requisite number of > applicant. folios. stamps and folios. O y . fO-2°1' c-L- 0/7' 13 9^ ^31'^> oY E c - 272 f3R/ILI)0;)oa ;G tai-vim 3L _^ by ,._vv :-*rond^; ^- ^x^S 3?2r f T Toi of PaRW- 1 9 6 1 (ccFDT- f T 3Th 3TT 2T) r \ ^^ 2 ZT ' . J^ v^ (1 4 F ) -arm Wqw-w fi(r) ft w ffafu Po-Q^ BTIW 1 ZTT afFJI- 2, u4 &i i -ar Bt, 3aI c s air- 1 (3T1 T WW cpi c -9TZT Wh f4yU UTIZ 3T2,7eff gM 3g21ioT c, fu) , f4m--3 wSTf lcT ...... , ETT-of Tau we Z4 3T3lzi cc i tog -4 A c d l . I 3Ta T2i .7 ...... Qc-Tf/3Tf(iT /q% coif -.TM ...... 3-^T'Fic l sr ^T ...... ...... I...... T, 1T1 fc7 aT ual T f^ u' r tT N ZP W4-C^5 c-TT3g-y^7c c KW TO ...... TO A^ A(cT z' I ...... ...... fir ZT21T f^rjftlol & ? c am! ZT 0 ...... TTTF ZT O ...... AZ Aft I dt7 ...... 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' V=1 ZW sT T -ZTCTar 3Z F i7Im M-& B1RFi727 azWTqur Z, /" ff6w qZ Mfffff 3rrR3T , dctrlf* T 31k gTgd c5l3r/ Witt (f^5 T 2rcr2T S- /Q• 10 ^'^.. ^^•r,3 +:cSV icYoi ^Ico -v1^c ,^;c^Y^i 4^ si5ic t5 31'r ii f>i r:^ ;.1111 ^t-11 MT i3reM WO t 3TN Zae aTfkas arff RMr4T f 4 t w, y ..1 G _ 1 L - ...... " `','• ^•2f .... I...... Z +' TTt 3fT^T c7f^7ir I 7x ^,aiglwn,q- / aJ j^N.w-4.8-^^ KY^ 0.G1 /6LU ko, An nexurt FFIDAVIT TO BV FURNISHED BY CANDID'ATEhEONGWITH NOMINATION PAPER Before the Returning Officer For election to ... tha... L Sa i ?v't sert+ h.iT (name of the House) F. _ _ ...... ^ _ G-et,`rawt...... constituency (Name of the Constituency) 04$h...n^uk.h!...... Sorvdau$iter!^ e of ulkpmgi ,tvluVti...... aged ..^9 ...... Years, esld ru of .. L.r 11 a. - C--let`eju G - She 6^Y'^^l^S ,l-ltan ^. Candidate of the above election, do hereby solemnly affirm and state on oath as under:- out whichever not applicable)) g l a S t 0) .o /C t agaliSt lire (It WnuCn GogriIZalLGe flans Deen taken by the court:- (ii Section of the Act and description of the offence for which cognizance taken: NIL The Court which has taken :ognizannce: r i ! L Case No.: J\- Date of order of the court taiking cognizance N IL Details of appeal(s) apirf; above order taking cognizance N s L. That give herein below the details of the assets (immovable, movable, bank balan , etc) of spouse, my dependents and myself: (A) DETAILS OF MOVABLE ASSETS iAssetl in joie name indicating tie extent of joint ownership will also have to be given' Description Self Suuouse(s)p De endent-1 Dependent-2 Dependent- Name(s) Name Name etc. Name (i) -Cash (n) ^ Deposits in yanks, I 5 IL Scm ^ inanctal institutions 4jr_ to- 3I^4^4a9h And Non-Banking ^ S3} `-u-.ariciai ; (^ P.7 4-t cm , 1'D (iii) j Bonds. Debentures ana Shares in I companies (iv} ! Other finaticlal LIc -Rs3.at.eoo nstrutnents, NSS, - irp postal Savings, LIC Policies. etc 1 (v! t Motor Ve.hic-es Details o* qla Ke, iN I i.__ U--_>- (vi) I jewellery (give ?c nw,s stgri,4 j details of weight :.#' I,altia Si ^va-rAihaa, I and value} l,li L G'Sht^riec s 3ti, -Lv tttuztt i2j-ra t6 ', ! try-si lvtn Mwmec^! , Other assets, such as values ofeiaims' ;'interests 11 h+_l ( i vaiuc of Bonds/ Shares/ Debentures as per.the st market value in Stock I _7K Exchange in respect of listed companies 'and 'asp qtr ' ks in the case of non listed companies should be gi v,en. .Q `;per>endent here means a person substantially depend t^ktoneufthe candidate. . ,•J -;ft,. n B. DETAILS OF IMMOVABLE ASSETS Nc^e : Properties in joint ownership indicating the extent of joint ownership will also to be indicated] )es :ration I Self Spouse(s) Dependent-1 1 Dependent-2 Dependent-3 I Name(s) Name Name etc. Name i L t'rC sue, ^".ccia jEtl 7 tCU.SI^ tluur^_ r Agricultural .and- Locatibns(s' -.Survey number(s) - Extent (loin: X measurement) A Current market value (tt) Non-Agricultural Land-i - Locations(s' Survey number(s) Extent (Total ^CtL, measurement) Current market value iii) Buildings (commercial i and tiidenn a'.' x . tions( r ey'd -i uunibers(s, t\J 1 L. Extant (Total measurement) 1 -- X2unent market value Doses i Apartments, i etc- xanons(5: - . _rvevi doer m:u,bers(s•i Extent (Torn Measurement) - Current market value (iv) 1 Oihers ( Such as interes- prapertyl X I give herein below the details of my liabilities/ over due to public financial astitutions and government due :Note Please give separate details for each item] Description Name & address of Amount Bank/Financial Institutions(s) outstanding as Departments(s) L:aans from Banks liL (ii) Loans from financial institutions I A41 L-_ btI L_ t\,I r L. (b) dues to departments dealing with supply of water 1\G r L--- (c) dues to departments dealing with C supply of electricity (d) dues to departments dealing with r telephones (e) dues to departments dealing with government transport (including nrcrafts and helicopters) J a. Description Name & address of Amount Bank/Financial Institutions(s)i i outstanding as Departments(s) on ...... ncome Tax Including surcharge Also indicate the assessments year j up to which income Tex Return led. Give also pennan,_,.r Account (ii) Wealth "Pax [ Also indicate the assessment year up to which wealth k 1 L._ Tax return filed,] ;p[ oprietary business] N' L__ U1 L educational qualifications are as under :- L-kcs s3 fh ?a csei VE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] ie of School / University and the year in which the course was completed Id also be given.] Mi .1e School ^ufltcswa^ j}Sltwn, bkgnq VERIFICATION the deponent above named, do hereby verify and declare that the contents of this t a affidavit are true and correct to the best of my knowledge and belie:'.. no part of it is false and nothing material has been concealed there from. L. this the.. 54 .-06- ' %z: day of ... ^- :.....201C (t 4 Gov r: semi,,, „r "tole me DEPONENT aft r zaa aD m4a Date of application for Uffw g the copy. Date fixed 4,r notifyin raquU a s[anrys ano the requisite r •mber of folios. stamps ar otios. fRacf R1 a&,, Air 44w, Z4ft i i ffrOg Ak( iflcr zp,,- Eft f m7 gB Date of application for ariha Date of delivery of the the copy. Date fine' for notifying Date on which the copy Date of making over the requisite stamps and the requisite number of was ready for delivery. copy to the applicant. stamps and fohas. folios. A t S xl1D 0) (k to SIxI IC) 1Y Ile) S-jxIt0 df17Flo-/ C' g r1 AaT pqqlf^ 216 ft &4,3T 33i ^virlT.. TI ^ ?1^^JT f46 M f^ if mr 3rizT}aj u^rsfl } ^sTr 2Ta^f a man r„ fw^r z Jq a j ? of a z^F f Tarr f ?T T fT ..'^t.^^►^»^ ... zT^r zT; fTtff I fcTUra7 z7a7T ....^'... famar 2; 37r 3T^tr?ff I far - 2TfaUrr TRT ( 5) 3f T1?i T-rFcT Par " 07rW- f a fhi T r I (^) air ^r f^rf sTT*,T VTW a -1-,Zrr ^rrT^f7 fafuhr • Rr M qh-f 3T+T W TTcvwzsl GRAM - ELECCOM SECRETARIAT OF THE V UY : 23717391f2371732J NEW DELHI ELECTION COMMISSION OF INDIA TELE 237173912371732E #0 : 56/64/2008/;;2IT03j0_ I I1/ zTOZ03T^0 : 23713412123739944 NO. FAX ' 23713412123739944 Ul^: 04 T •, 85/40, 31T^i Tw >F R)-u, T - 800001, f4R I -Cvrw A c1 0. c $ 1951 4M 29i1i * 3T^fM SIT I .^ ^7 {YT3TT, ITT^ci ^rafiTT 3Tli T q ^n q T ' a i i9 18.032008f^r 3T ^' 3TTjZ^ ZTRt 3 r 3^T - f oT / ua^ T ATE ^17r^ a^? ^ 4 uf1ffR/u1 II 3TTi " ^T^•F.7 - ^'i 23. 01.2009 q4 3Tf4TT S ^Tqff 344ftz=T, 1951 ETTZT 29cP S 3TE T '4 t ZK tTTft 23.01.2009 % *I 1 ^Q III 2. 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Son/dwughteSLw-rfe of ...... aged ... A ^ C, ...... Years, 3 w resident of .ULli ....°°. .^ 7... al Candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Strike out whichever not applicable) 1. The following case (s) ,.q/are pending against me in which cognizance has been taken by the court:- (i) Section of the Act and description of the offence for which cognizance taken :() )l4V1 rr9/1471 ^f 3o 4&^3&o ^ c iS8^Pe ^'SV ^a7mrel+i, Of-, (111) i'7rP/r711^ I'^^reo ^j •C•a tf0 171 [ The Court which has taken cognizance : Case No.: C a'3 ^J0 No ; 7 ^', f^LY a 1 ^, ;^. S. r r_ L r/ n 9 1 L ^l t^ c ,f (iv) Date of order of the court taking cognizance : 71 3 0 3 , Z-J 7 ! e >k (v) Details of appeal(s) / application(s) for revision, etc. if any, filed against above order taking cognizance : X (2) That I give herein below the details of the assets (immovable, movable, bank balance, etc) of spouse, my dependents and myself*: (A) DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be given) SI. Description Self Spouse(s) Dependent-I Dependent-2 Dependent-3 No. Name(s) Name Name etc. Name (i) Cash 12 ^^ _ X X (ii) Deposits in Banks, S ni 11 :nL^o w.i Financial Institutions t _ And Non-Banking cJm mx/ "^-k Financial PS ' ^- 6 Companies ;1i3S (iiil Bonds, Debentures 1 D t3 ( lie 10 and Shares in j c . a o/_ companies (iv) Other financial L ; C hol ty instruments , NSS, tse 51211-r. 72- postal Savings, LIC ,C X v Policies, etc . (v) Motor Vehicles a 1-0 cyet , (Details of make, etc.) 7/i6S^ t3oJvro i \ ^ x 'Iq b786 N:N welleiqU7 ve details of In O and value) s cl ( u') Other a'ssets`? ( '. as ua)ucs oflclai iis/ interests X x Note: Value of Bonds/ Shares/ Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non listed companies should be given. *Dependent here means a person substantially -dependents on the income of the candidate. B. DETAILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] Sl. [ Description Self Spouse(s) Dependent - I Dependent -2 Dependent-3 No . Name(s) Name Name etc. Name (i) Agricultural Land- - Locations ( s) I'rN H&x 7JF<[- - Survey number(s) - Extent (Total L i c-L.o measurement) - Current market value (ii) Non-Agricultural Land- - Locations(s) - Survey number(s) - Extent (Total 6 N c d- o S CJ measurement) - Current market value (iii) Buildings (commercial p and residential ) PA IN - Locations(s) Y ^o r No - C 3 t Survey / door 2G. Z n s2 sg^ numbers(s) - Extent (Total ^GSJoao ^sY ^ measurement) - Current market value p4_ tom„. Lt3 ^'^ o a..^ 71^p I (iii) Houses / Apartments, etc- i - Locations(s) - Survey / door 'I / i IV O -3? i -_i nu s w `^^eno X xitc^t \ _ " , K l^ X"V O eajsurein Current marke e a r^ o t Itkers Sue as' it r;^ -- ---T ------^ I (3) 1 give herein below the details of my liabilities/ over due to public financial institutions and government dues:- [Note : Please give separate details for each item] S.No. Description Name & address of Amount Bank/Financial Institutions(s) outstanding as Departments (s) on ...... (a) (i) Loans from Banks (ii) Loans from financial institutions (iii) Government dues:- (a) dues to departments dealing with government accommodation (b) dues to departments dealing with supply of water (c) dues to departments dealing with supply of electricity /\ X (d) dues to departments dealing with telephones X ^C (e) dues to departments dealing with government transport (including aircrafts and helicopters) VT OUT if any W Amount Name & address of outstanding as Description Bank/Fi iancial Institutions(s) on ...... Deartnients(s) Income Tax including surcharge Curt TAx 0J'1`2ice [Also indicate the assessments year up to which income Tax Return g 0 kbP-PA 8818 filed. Give also permanent Account P14-N --(,eof t 2cb9-10 Number (PAN)] r ?s• )44,__,ZL^f (ii) Wealth Tax [Also indicate -the h' h wealth assessment year up tow is Tax return filed.] Fr 'U (4) My educational qualifications are as under c [GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] as completed year in which thQcouCse w P3 a5 [Name of School /University and the Uas h, ^ i 9 7 s^r^ should also be given.] VERIFICATION .G^ above named, do hereby verify and declare that the contents of this V/ 1 the A.epon l dge and belief; no part of it is and correct to the best of my know e affida vit,are ial has been concealed there from. 7Q^^ mater false ai?a'^Igt (a? ...._ ...... day of ..8 .... this the. ... 'V'Icrified,aI crif IC-I1\X huAar_,.p klentified by Srl' •• -» ••- ^_ Advoepte.: r=r•mn1v-.&¢firm ok-^, "a uoi've'me_. JAGANNATH SATftJ Annexure AGRICULTURAL LAND Mausa Khata No. Khesra No. Area B. K. D. K Ladho 54 71 0-10-10-0 P.S-Biraul 67 0-07-14-8 Dist- DBG. 47 105 01-01-0-0 127 65 01-06-11-0 Afzala 124/724 444 old 0-01-18-0 P.S- Biraul 445 old Dist.- DBG. 2695 new Adalpur 206 53 old/183 new 0-06-0-0 Darbhanga Valued Rs. 480000/- NON AGRICULTURAL LAND Mausa Khata No. Khesra No. Area C. K. D. K Baliya 31 628/629 0-04-08-05 PS- Biraul (Ancestrally acquired) Dist.- DBG Valued Rs: 250000/- Darbhanga 3333 0-01-16-75 NB. (Self Acquired) 77iis n Darbhangtr the Ch the last Forth m memiom Valued Rs: 810000/- by mean. Shall be : No fnrm i r IAbsri ^t ^ ^ ^^7 Cf Signature Candidate FORM 'A' COMMUNICATION WITH REGARD TO.AUTHORISED PERSONS TO INTIMATE NAMES OF CANDIDATES SETUP BYRECOGNISEDNATIONALPOLfCALPARTY. (See paragraph 13(c), (d) and (e) of the Election Symbols (Reservation and Allotment ) Order, 1968.) ...... (State/Union Territory). 2, The Returning Officer for the ,...6i!?&1...... L'?t 1 .....Constituency. may' Subject : General/Bye Elections to Legislative Assemblies /Lok Sabha 2010 n from ...... f ?1^C...... (State/UnionTerritory) Allotment of Symbols-Authorisation of persons to intimate names of candidates. In pursuance of paragraph 13 (;); (d)%nd (e) of the Election Symbols (Reservation and Allotment) Order, 1968, 1 hereby communicate that the following person has been authorised by the JANATA DAL (United), which is a registered Party recognised as State Party in Bihar, to intimate the names of the candidates proposed to be set up by the party at the elections cited above. District(s) area Name of person Name of office constituency/constituencies in respect authorised to send notice held in the party of which he has been authorised. 1 2 3 SAARAD YADAV President ALL OVER INDIA Specimen signatures of SWHARAD YADAV ...... t...... `.. ... ti' a' ^'1'f"y, ^a'.a s k t4 ...... ( H"o s-y 1 t.9, ...... :...... Yours faithfully, lEY.aasa ---it 4.4-" f NB (SharadYadav) I. This must be delivered to the Returning Officer and President the Chief Electoral Officer not later than 3 p.m. on the last date for making nominations. JANATA DAL (United) 2. Fonn must be signed in ink by the office bearer (s) 7, Jantar Mantar Road, mentioned above. No facsimile signature or signature NewDelhi-110001 by means of rubber stamp, etc., of any office bearer (Seal of the Party) Tel. No. 23368833 shall be accepted. 3. No form transmitted by fax shall be accepted. 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(Vi) -OM V -HgW 3ifgfcT c c WEIRn-6M -9M *cl5T '9/ Z Z i UM -9 ...... )(.'...... 42 3Tf1TTNTCff 3^T ^if^TT 3Tf9TNT4ff, W 1c Tfua AV lq^ zb7m/ w£cf f vzT 2TUZ^ g ci 31ac t *1 ii t 3T l all? f4cclM Z 3T iIT zieT 31fZ 1 'I AT icbI n a um Die * f 'b' 31T i ^ 2fffct c^ - a*ra r3AT ' I 4 f•bq ^•• ... `''Z taT 3ffvT arflri ..^^ /.. .4.C.a...... cS ZiC-4 i cl Farr ;^. ,,. at& SCFCr rllyalfkn s Annexure- (- AFFIDAVIT TO BE FURNISHED BY CANDIDAT NOMINATION PAPER Before the Returning Officer For election to - ^n4 ' ...... (nam of the House) From .?.? ,,.,. , z Sr , constituency (Name of the Constituency) ° ...... Son/daUgliw4wTfe of 1 s ...... : L ...... aged ...... ( C...... Years, resident of .t:? at/cam c •- 7, ( , 5 S / a` Candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Strike out whichever not applicable) a9^ t^ lowing case (s) is/are pending against me in which cognizance has Deep 7wnc11 aye-tne court:- G) S r On of the Act and description of the offence for which co gnizance taken: (ii) The Court which has taken cognizance: (iii) Case No. : k (iv) Date of order of the court taking cognizance : (v) Details of appeal(s) / application(s) for revision, etc. if any, filed against above order taking cognizance : y- s C That I give herein below the details of the assets (immovable, movable, bank balance, etc) of spouse, my dependents and myself*: (A) DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be given) S1. Description Self Spouse(s) Dependent- 1 Dependent -2 Dependent-3 No. Name(s) Name Name etc. Name (i) Cash (ii) Deposits in Banks, Financial Institutions And Non-Banking x X X Financial Companies (iii) Bonds, Debentures and Shares in companies (tv -,., filth rfi n4 ms[n vents, postal $avings, LI 2K Policiei, etc. X I ;^1 I (v) Motor f ehicles m , (Detai of in etc yc^ (vi) Jewellery _ (give details of weight and value) (vii) Other assets, avalues X X X Note: Value of Bonds/ Shares/ Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non listed companies should be given. s B. DETAILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] nP„P.„dent-2 Dependent etc. Nam Agricultural Land- - Locations(s) - Survey number(s) - Extent (Total measurement) Current market value Non-Agricu u ral Land- - Locations(s) - Survey number(s) - Extent (Total measurement) Current market value Buildings (commercial and residential) - Locations(s) - Survey/ door numbers(s) - Extent (Total measurement) - Current marl ct_value Houses /. Apartrbents, etc- - Locations(s) - Survey/ doo4 numbers(s) - Extent (,Total',, - Current mar I I give herein below the details of my liabilities/ over due to public financial institutions and government dues`- [Note : Please give separate details for each item] F§.No Description Name & address of Amount Bank/Financial Institutions(s) outstanding as Departments(s) on ...... (a) (i) Loans from Banks A (i Loans from financial institutions (iii) Government dues- V (a) dues to departments dealing with government accommodation (b) dues to departments dealing with supply of water (c) dues to departments dealing with supply of electricity (d)„dues to departments dealing with I 1telephones (e) ues to departments dealing with f^9vernment,transport (including aircrafrs anlhelicopters) X (f) otherdues ifany x Name & address of Bank/Financial Institutions^c TAmount utstanding as ^ Income Tax Including surchar Dpartments(s) ge [Also indicate the assessments year up to which income Tax Return filed. Give also permanent Account Number (PAN)] (ii) Wealth Tax Also In Icate the assessment year up to which wealth Tax return filed.] ) PropertyTax [GIVE DETAILS OF SCHOOL; AND UNIVERSITY EDUCATION] [Name of School / should, also be given.]University and the year in which the course was completed VERIFICATION I, the deponent above named , do hereby verif y affidavit are true and correct to the and declare that the contents of this bestknowledge of mu false and nothing material has bee concealed there age and belief, no part of it is Verified ate Sbyhe BntIn .... day of ... e doh,...... Y Add '00 b ..20^O s Swte Bank of India 0U it MAN! PHCOARI Acc7,;nt No . 314 5283 3053 i_1= I;l_nPi . Name: KHURSFEED A_.':_° E LECT S /D;''C/H/o:Idn AS'! ?SUE: °:d:: _ ss . VILL. BALI IA P .0 . AE'ZALA @sb:i..co..n VIA BIR2.UL Phone; I suo :04110/2010 Ena'i.lr 2020890 8127 n E (if Minor): DATE PLRTICULARS CREDIT E.=1'.,, _27CL IN ITIA.LS ( Control: 2020890 6127 31452683058-04/10/10)' 04/ 1 0/10 CASH DEPOSIT SELF - '. m' 11100.00 1110'.! uncl Hat! 0.00 C1r 5a1:11100'OOC;+uou sAL: 11100.9( ^ 1 'N'taA ...... -- 49 J ^$t iANM riaP42PT 1951 "• (OF fgw3T 3tt 3fT^2T) WNt iq- 2s PFEM 4 fg) ( ) f ^r err fit? cfta KM 1 ZIT aTM 2; v cprq air 4 Kw- 1 (dli clT WqT 1 & 4c -9RT so W9 OTU 3T34T2.ff -9RT 3L44dI i r ) f4EITaT W2iT t fWflui .:...... x ...... RtTrUT Tau f 1ICI el5F z4 3razr2tV Tu a9 1a^Fe1f a -lwDfftF- wea l 3ia 2ff zffr 1TDT ...... X...... tum „c,. rates ^r r ...... ;( ...... ,...... • 3W45T 3Tcf5 WIT ...... ^...... ...... :...... ^ uraT ...... 7...... faETrar wait f f- &m 4 f cp aliaiiccfi I aiw -do ...... A...... 9 ^FF 2{0 ...... :}!'...... 47 yR4 't I A-a raT ...... ...... fc^ETT T zTaTT ficif4 -1 el5r f cr airdiici fl I amir 7i0 ...... A -90 ...... w ufalz t i Mft ...... 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(ii) O ...... !}.•a ...... it (ice) ...... ^T...... ZT-T ...... :...... f...... (iii) -4CEm 3fid rar (3TfETFciciA) ci um (mzrd) 3T 3ZT 3TR2TET (3rLRTETI) iT-,T Z it i f T f ii (fvliccI) fcrg 3razTef f 3d{'Tcr RUM JPW t ...... ter, WaZ^ (i cW) -JM 3M W (3TTZW) tt Bair i u ...r ...... ,uT (d) Pawci^r 3rrzlu fR.f flrT ar2TT 2JT/ fz aTF ^} ...... -OM Taft ITT a c14TI fb ZTerar 3TrETcb7f lT c1Tc5 c4T cer TT -a4 M^ ...... 3 f i 3rtnrq (3rv?Tq^f) (S5 Ffc'1lf 1bcec 31f^i^ielar 1951 (1951 b1 43) r»1 8 3zrgrzr (T) err 3WM (2) at W, z11 atItipi (3) ,n (efft 36^$#f 3q chi Fiq f`ZTsi4)c7 Z&Zrzrr 3VIT AT Z31 %M DRTJ cT PdT- c sc4 i3TT^4T 7"g a `ezm) arraT^r/ A2jar Z^cTcTr f^U1; ZT7s^IT / sT?1TC' ...... /...... G JV1IeTtr, P u m a e u f th5 T ...... y...... ?C ...... f am ep iT (qo) ...... !\...... fUlrr l"') ...... ) t...... Z7- ...... (iv) qcr 3rfM aT (364P-4at d^}i eim (gTZTLJ) 31 32T 3TgZrq (3Z^r WMe f) W f & T t { r f zur Dr T ff a) f^fg 3rMag cTiaff 3TNT1ThcT P^i TT ar2TT t ...... X...... ...... ...... ( v) mtrw (dl1Zkjl) fowl 23au -,pdr urea eir/ Tuna ZTg 4 ...... X...... (Vi) ITT ; @T air 3TfET^Tfi crr c WM T -gM Si t/ ZYcS aTLJ 'a .... x...... dTZTB( :- deati f' BJiJ^untt. r, ?'ZMi TE rw trCerm-al U 41, 3^q'Z 3TfZTZTr^ff, el rfcfc 3rf t d ccb cc1T/ Cicc11 45 21A .^;s q5r cWi i 3rc1 rr ir xdfwai ' r r 3117 f 4,-a z S 3 c - i 7TT r AZ Wt t 3?tZ Vz1cbI or if iVdVM. w w^ w w S^/••. ty .. Z qZ 3Tr3T -dr after f ood by .Sri ..:. +w rr w w N,,, r .a So'emnly ftirr0 r^ s^It x,v I befo'c m dentVP, rzi / 1Tn^^1C , YiS ^e,.c it1k)f•^m 4 ? ' ' SAHU 3^, ?^^ Advocate ALL.,.,,; „ 3rf`7fW4 Si cTT$TZ n ote(v Public. Beniur_ Oarhh.or► I AIlI1CXl11 C- A AFFIDAVIT TO BE FIIRNISIII ?l) Bl' CAirJW NOMINATION PAPER Before the Returning 011icer For election to ...... '... «^..4 .' -:z•ti1"IFz`x`JL...... (name of the Housc) From .... constituency (Name of the Constituency') 1' z ...... Son/dau« ' e of . aged ... 3 G...... Years, resident of Y^,^..-oa:.'.:•. and state on oath as under :- Candidate at the above election, do hereby solemnly affirm (Strike out whichever not applicable) which cognizance has been 1. The following case (s) is/are pending against me in taken by the court.- f the Act and description of the offence for which cognizance (i) Section o j-ly a^s71J4L7 Ve- taken: All ^ I^7) ► 4 ff/ ► (ii) The Court which has taken cognizance: Date of order of the court taking cognizance : against petails of appeal( s) / application (s) for revision. etc. ifany, filed above order taking cognizance : [Abstract] hat I give hefcin I)elow the dclaily of IIit' a.^scls (nnnIuv,tl1lt Irnl\,IHHlr, hail, ,talancc. C I O of spouse, my dependents mind myscll'l: (A) DETAILS OF IINIOVABI,F: ASSETS (Assets in joint name indicating the extent of joint ownership will also hove to he given) Description Self Spouse(s) . Depui(Ieui 1 )epen(Ieui-2 1)epcudcW-3 Name(s) Name Na.... etc. Name ^^/ 7C K De osits in Banks . ) 1 L I fZ w61^ Financial k-f I „ Institutions 3 1oJfm6 X And Non-Banking Financial s ^+ 5 6W f Com )anies (iii) Bonds, Debentures and Shares in companies /K (iv) Other financial instruments, NSS, postal Savings, LIC S_ Polici es, etc. (v) Motor Vehicles ] ^- s (Details of make, AL SeMS-^f? etc.) / F t^t/cy f1^^^ v S A Lea (vi) Jewellery (give ^1. r details of weight o f j 5 a and value) i ^f' 2e, an;-c J` ^ I c3-+srra-a J ` I ^I (iii) `E3i r s;€^^t As-values of clamsi intcrests >( L - - L - - i \ It Note: Value of Bonds, Shares/ Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non Iisted'Fompanies should be given. *Dependent here means a person substantially dependents on the income of the candidate. (Abstract] AI S OF ININIO It DG ► will also Note : Properties in joint ownership indicatin}t the extent of)oint ownership have to heindicatedI I)ehcnilent-2 Dependent-3 SpouSe(S I)ependcut 1-- Sell Mum, eir Nniue )cscription N:uue(s) Nanic cultural Land- ocations(s) ,urvey number(s) extent (Total measurement) Current market value oI,Agricultural Lm Locations(s) 1 f`,^la - S3 Survey number(s) Extent (Total qf- measurement) s Current market value ,i) Buildings (commercial and residential) Locations(s) Survey I door numbers(s) Extent (Total measurement) Current market value 11 (iii) houses / Apartments etc- - Locations(s) , doo r I - Survey /\ numbes(s) Extent (Total j ' ur^nsNr^im^tl Caxrrent nt^alalue (t l i)thcrs (Such as interest K iil proper it x tr T th e dCIdIIN 01 uiv II,IIuliII 1 give IICrCIII below institutirnts and government dues:- I Note : Plcasc give separate details or each ilciui Description Nainc \ Iul lrc, ., 1 ni;,ui^i Bank. manual Iustitutions(s) oulstendin^ as Dclmrtmcnts(s) on _-..-._-_. ---- t (t) Loans from Banks C 1 e 1 13 "---K rc 4 MC , r .i Loans from financial institutions •i'' lay(=^ wx^^^r 4^vf, (iii) Government clues:- , (a) dues to departtlients d eali ng with government accommodation (b) dues to departments dealing with - - - - supply of water III I ___ r (c) dues to departments dealing with supply of electricity 7C (d) dues to departments dealing with telephones (e) dues to departments dealing with government transport (including g is and helicopters) K I ------t * trt C 4 v,, p rod/ ^rySah^ - ^ Allli lillll I )I' I ip1 1(111 ^nII;InIJIn1' .r. Mm Income 'lax including surchar ge [Also indicate the assessments year up to which income Tax Return tiled. Give also permanent Account Number (PAN)] 1 (ii) Wealth Tax [Also indicate the assessment year up to which wealth 5< Tax return filed.] (iii) Sales tax [Only in case of 5< proprietary business] (iv) Property Tax (4) My educational qualifications are as under i- 9 0-0 3'n _[ IVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] completed LName f School / University and the year in which the course was should a be given.] / ` . _ e r ^ ) ue KI )i v /C Identified by Sri tden,,f,- - DEPONENT Adv,C1Cc ,, n .. ;^ Cil d°Clara h, ,_.^.. "IV f fCn p V.FRIFICATION I, the deponent abos tttWtObp hereby, yeri y and declare that the contents of this affidavit are true and correct to th knowledge and belief; no part of it is false and nothing material has been concealed t t IT from. a^Qr 2000 this the . A . clay of A'l 4^ dent 1'v ;ilr,r (1[^'^^^r^^^r^5^. 6igria i ,. ; V FORM A Communication with regard to Authorised Persons to intimate names of Candidates set up by recognised NATIONAL OR STATE Political party or REGISTERED UN-RECOGNISED political party. (See paragraph 13(c), (d) and (e) of the Election Symbols (Reservation and Allotment) Order, 1968.) To 1. The Chief Electoral Officer, ...... (State/Union Territory). 2. The Returning Off cr fozthe ... J!.?$1.gla...... Constituency. Subject:- General Elections to Legislative Assembly from Bihar (State/Union Territory)- Allotment of Symbols- Authorisation of persons to intimate names of candidates. Sir, In pursuance of paragraph 13 (c), (d) and (e) of the Election Symbols (Reservation and Allotment) Order, 1968, I hereby communicate that the following person (s) has/have been authorised by the Samajwadi Party, which is National Party/State Party in the State of Uttar Pradesh/Registered Un-recognised Party to intimate the names of the candidates proposed to be set up by the party at the election cited above. Name of person Name of office District (s)/area(s) authorised to send held in the party constituency/constituencies notice in respect of which he has been authorised. 2 3 RAM GOPAL YADAV GENERAL SECRETARY Entire Bihar State. U 5 5 I t- z db A w N CD y m -' 1J r n ! z N ^' n CD lD O N i 0 A C ^a, C7 O CD n A T, CD O C i a C ct _, y CD N O C 0 O h C SI < C j G O C C k fki^ Date of application for cil(Rr Date of delivery of the the copy. Date feed for notifying Date on which the copy Date of making over th€^ requisite stamps and the requisite number of was ready for delivery, copy to the applicant. 31 1 °5 stamps and folios. folios. f7 r71'y / ' e n/ c En C ( r r t' AI 1 %C ^-- ^ ,2 1-^::) `^I1^7/ aF !m/ P^^t/ail eff 10 tr i trJ18La r ,^^ -•-(' ^ 'f i 61 cll^Cd ^f^^^?l Pd^Yf '^^i df^d Date of making ove+ Date on which the copy for dfi^Ci Data of delivery of the the applicant was ready for delivery. copy to Date of application fixed for notifying requisite stamps and the copy. Date the requisite number of folios. stamps and folios. 7Jq q ^l(C; y \ 1 dl c--Z(Ti q-F -Sq A /tom 1l$r "60 \I CAI ^O^cun40'M^j ,^- 1961 'Tai 3M 3fr'2T) p 28 4 -) /a. mw aTm- I 7JUr a - w 3T3zi &RT^ (i T Wca aPcrm Uf ...... 7.!7 .. g ...... 0. ^7c e7T^T 2i3iT ^'' c CT ff -C ,i' f&Elm ET3iTol 3T32T ...... ^.u. l .....y^^ .• 3T3ET co-arm ...... ^I ...... : iuaTT 3TW u^,•ii+f_1i^^ ...... {^^^ yea - ql<< zfm ...... ;...... a•^'rs'i` 14 1 C) 0\...... ° ...... ,...... 4)-5r a"T Ro 3.6.....-4 "am R0 :...... yS^...... w I /Lr/ 2-00 f- 2 (m ...... f ...... ziaTT fa ...... YaZFe4l V ...... v ...... fqm/-J, ar A . r6r ...... :...... ay pair r air -A 45-F xo...... aM Ro ...... 3i^£ fO55 ZTWFF a-g f45 R(a fia VFW 3a S zr Arr2r^ 10 I A.. `7 C 'f c^i I o WaV4 aiidil^i 7 Sit z^) a eufj 3razreff ^zT d2TaT A aTrar i i R M 2 ( t , 3T £ cT^£c1T f^- c i r& 3MZff 3T _Aa (c15) ...... (t Tsr (i) ZT 77s (ii) v aw^ c 3z ) ... ^. ^ ... /...... 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TcTc]Z°T IVIK1cp / •• ^3 ^') ...... ,1:...... ^/...Qd.^ ! '.+....^^.S.r... .6. Sr... .^ ^r...... ^.,- . ^ 1...... fir...... -....g...... A9 ..... > " fTX&-t .k^C.. T , ' ") 1ZT (3TT?1 .. . . t^ c (iv) 2T, 47 WaT arr[T 4 .t/..l.? ... (v) ;2;r ( ) ? wft Rau ?4T/ FqW- M ...... o $Tai 3i Tfif^ciT ^ T Z (vi) -am W SIT 44 a t',* ZT -t/'t ...... x...... f ( ) ( 3ddT 1951 (1951 t,1 43) t' £IT2T (3) li^ 3iUafaf7 311 W 8 3>r£TT2T ( 1) SIT 3gVM (2) -7T 37 JT2I1 ^ Well AT 3TUZT£T (3luzreii) f i TgAlz f45M ^r^Tr $/ 1n ar^Tr I I -IT 3d f' ozrTm (7 _ 3TrT2i14ft 3Vkff Z32rU J T 3h R M WIT - c p4u--^ wamt V ay , fT) X, / N TT7 ...... B1TdraT/ vet r err zmwr w, f zF f rr ...... x...... tam ...... x •• ...... k ...... (iv) 367fizfaT (3i p^^) ' EiTtT (r2TL^ 3h 3N 3M7K (3^ 3iAZTc ) fi ...... ^'°i ') cal 31&'t 45A 31x2 T MM x (v)OfU^r^sr^/ ...... F3^1 ^ RTr-r^i (vi) aFTr isr sr ^reTaT 3Tf ► c Ted 3 > juz cTT cT 3ira1 n , 3 £ N 3N 'l 2c1rA C 3i 3 3Tr zt1a ..5^..../-19...... 7jyl.A z Idenritipd by Sfl . •••.:.- Advocate, So1smn h' rtfllm & t . a b,*nrb -40. ik *ATH SAHU Advocate *10tawv Public. Baniaw. flarrbb®s i'7re C AFFIDAVIT TO BE FURNISIIEJb '^qi fTE ALONGWITH NOMINATION' Before the Returning Officer For election to .^ ^l ew.. ^ ...z.. 4...... ^' (name of the House) From ... q,... G a...0...... -. ..A. ...?' 0-k .:. constituency (Name of the Constituency) I, :..... f (l;r °4 Ut Y...... YCL ct d ...... Son/daugirterhv-ife of o...... cQce v ...... aged ...:.:.6 .... Years, resident of .^t`((f e- .Rctoc c ccrc 7role !4'^cf iw3 S Jctnlak hwv Gish - b0vv6 &a.^ a Candidate at the above election, do hereby solemnly affirm and state on oath as under:-nder:- (Strike out whichever not applicable) 1. The following case (s) is/pe'pending against me in which cognizance has been taken by the court:- (i) Section of the Act and description of the offence for which cognizance taken: l p-o, i 6 4 6 e, ((ze / / 2-0 Ld 9 P C yr- ' (2) ----c if 7Kc P e Courtwhich has taken cognizance : r,/. jccd -€ t 9 So-u/!^ / G R. C Caa c ti--v se No. : J^ C'a.z A's o ^l LB N n ^c z r g R Date of order of the court taking cognizance : ti /J1V(^c`tr7 (v) Details of appeal(s) i application(s) for revision, etc. if any, filed against above order taking cognizance h T 0 0 0) It n' O N 0- C N '< 3 0 I I 1 I n 'T'Z5'm p 0 w a - •a w n CO ,.. ao O n o ff' Cn'jJO72.°' aaaaaDOl p a CJ p w C o w 0 0 0 0 0 0 O N w 7j y[J Co Q.O O r --^N -nom CA^O^D ^O'O'O ^O vi" c < A W 7 0 0 0 O Uj W x 'JJ 0 CD 0^ C) C ro J 4 O w , C) 0 O a 1 rn -iy 5w O O N w N - NW n 7 00 sn C. v W N O O w Dow ^ py 00 w tr 0O- aua O 0\ C n O w 0 D\ OW ^1 N G O N N 7 0 7 O^ aONN N ^1 y' O O; O O p ^7 N O ^D 00 0 7 N "' 00^ 4 a 000. 0 C N O ry 3 n' m ti a v I w p D I rn rn w n ^D 3 y 3 ^ ^. d O O C v N 3' '* a p w o o ^ o o 7^ o v D w rn r o o n z a N oo Q x.00 J NO • S c O- N -oo o 3 O c] [ V c 3n' NO 3 W cD N 0. I S. ? T. O- C ry O I 1 I I A tr" w n rnv r2 n mcn r2 n mv r y G < C o _ G Y. y o C 'f. C O / .z O o O W .Ni d A^ .Ni W o r w w 1 CD C CD P a r m a a c a v 3 3 3 C - C -i V N C C -, v a m o a cao ro R ^• ^, 7 7 7 7 7 7 7 ^^• x x x x C C C y a 7 7 2 z z^ X < k X 3 c z x N_. I l 1 7C Ca I I z= institutions c here in below the details of my liabilities/ o^vcrdut', [o public Financial v :rnment dues:- r c: please give ,rpsrate details for tcht tell ^mouut outstanding Name & addr ^s of as on l'oetJ0111 ^^- Description SI.N I tBank/Iinaneiat titution(s)/Dcparunent(sl Ills NIL l it (i)Loans Ciom Banks (u) Loans innn Irtstltat1pns NNIL IL (tu) (oveuunent dueti dues to departments dealing a. dptiOtt with C)V eCNllent al'COmmU X b. dues to departments dealing with su Iv of water - x c. dues to departments dealing NIL with sup 1 of electricity. NIL d. dues to departments dealing with Telephones e. dues to departments dealing X with government transport (including ail-crafts and NIL helicopters) NIL NIL Assesment year I other dues, if any including i. income tax 2010-11 (b) surcharge [Also indicate the AFQI'P115513 year upto X assessments i tax Return income which also permanent field. Give Nil Account Number (PANIC _._-- ii. Wealth Tax Also indicate the X w year upto assessments which Wealth tax Return NIL Nut atpplicablc Yield es tax [onl se of NI L io rietary business]y "I propcrty Tas--_ C 0 0 G Cf y N S O 't O CJ (^ G 0 C) N M c ^ a ^ n v C S 'D 00 J O\ J 00 W `O O. S v, O+ O A Lh J y Q' F O) Q1 O O0.^ o r, m Q a .^ °OO 0O o0 o p p V U O N ^ h w M Ol a N w r V O w 41 Cl m 'oo 00 ° °' ° °A ..0. S VJ V, O, J O A Ol '00 O O O Vl O W O y z V, oo J A 0 0 OJ0 W b O U J O J O -^ i ut 0o J J A O\ y G ti W J O O 00„ v 9'+ vwi J J O1 A •^ ^ ^ O C. N J Cl- J G W r, NJ o X Q0 O'J ODD J (o A' J NA U. d O 00 N W O `O „ w A W Q .V O p p0., S N H p^ W 0 a C `" (^ A J OO W 00 0 C Zo w W D\ 0. 'D ON (71 00 .J A 00 OC N < O C^p U \ 00 \O J w C z Cl) G G N 00 J A W DO ON ty0 a. W O A 0o O O' v W D1 O O P p„ X00 J A W 00 'p ^' (10 o A 00 O < O• CCD O A A A 00 = - ^,' v .p a, oo a, oo v. O w- N `O AO A A O0 N O F O -- N fJ 00 00 3 S Oo ] A 00 00 Or 0. 7 w N o 00 J N 00 w O (1C O0 U J W 00 J "O. Ct Al O.. 00 c © J' .A • C W •0 O - i O Oo J O\ J W D\ < o A O A W O w w J W N 'O 00 . O O O A N A A O p In J Vl N (r J P O O C.J - W A O A -^ W 00 .^ J GO ° o Le aa' °ArnJ v ^ "' /^ Oo O. A A N w N 00 a1 Ol J •00 A t A Q O A C 'p V` w V+ A N A J Pi O ^ S y N y d^ w s tj s W G S N Cl wS O O m - m w 0 w N oc CD 3 n. v N O m Ci y y+ < S 7 C w O' ^ • ,b• d x r..^ N 3. G Ci7 Q S N w 2 y N C w, > O rn o N o p w 3 0 - `-C N w p N v O v O W C S C IJ - w 3 - C N a D O 0. o < o A a. C N O Z 41 S N O 6 O S 3 O d N a w N W n O C w O C b O s O O o [GI` E OF SCHOOL A°:l) l r.1 IQSH l.l)UCAIIONI [Name of School / Univ ersity and the year in wcl h the course Pra completed should also be given.] it 'kw tl tu' yevCc ,z t/vvrwr- /94 x r9 -A 'Ilp: v LI Cu't(PYk VEIZI CAT!() L I. the depotlent abov J 11a 111cd, dtl her eb `-'fll1 and u :.:6., e in;lt th ''Olllil ,. 1[ tins ttmhda vtt are true aml c onTe ct to time best o - nv hnowl 'd Lc 811.1 bet eL no 1" o f ;L is also and nothing material has been concealed there how. i l+! c`G^r±. l^+ . ^u1 -1 cd et this the ...... L av ...... '. (111^^) ica -o /gxw,44r-lam JO g AdvO=ts If ts;,{ . a ttcea. me, I daolare g; 9n t eJn'my prye 117 a'x e+, L. 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(iii) 24c 3r6ETfPar (34M i 1&1i1) it1 UM (M ra) 3TRT 3Er 3rtftTET (3o 3NR?TETt) 4 f wr f a u r , R (f c ) f rte 3i Rai -1W z6r'rr aTZrr EIT ...... ...... ...... ...... y...... ...... . 7.1 ...... ...... ...... (iv) aN%ft ( ~) Ci eFrft 1(a^) ...... ?T (^c) DTI 4ICfzT vf`f£i ( a) 3TaZTef c rTe.1T arc 2 ...... 3 ...... 4 ...... 5 ...... x...... (VI) 3ifi cT (cci i uoi2i ( ) -Oft 31a% AZ / znT (i f'f) ci}i ZTf2T 3Af2fcT c ) ...... (VII) WZTUTTT z4 P.FdDff ca drft (Mfo) ...... x (VIII) cjz i 3U hi ?)qftft (aq%W) 4i c > a 3Tdc7 (3iag)/ $wi M Wu ZTU t 4T / 49t (I X) i ei cri Ur^ iii f (3iiScif)/ g4g&M 3iR (, {iac if) c t 1T%TT ....k...... (X) 3Zi mfr A (3ar ) mi (a) nar, RticcFi `U c ) 2Tdi$T 3it i (3T c ) / CTW 3Tf4i)PF JTL ...... ...... (XI) cf^ 3c r 3T6f & (3 MW) / 8WI 3TTca (3TTc^) ThT Tc I LI UFUT 't Zfl 0-6 / cr cFRO -9 ...... 3cFir 3idl ct (3i rfl) tgfl t°T 3-Tcp47 .(3if4il) c1iT ti jt URIT 9, ct (c N) fw^Tt cei cdI (ii ) ...... (u) gfta 3Tf*2T (3Tt2Tt) z a vcbft ...... 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Z i - { 2T M c cf W2J 1 car 4 -t L f 45* of ka wpfc it Rr M, ZIT Nf405 -C i -Cl5m 7TZT Z4 iTgft f ft 3TVZT£T (3MUE4) riir/ i} 3&g-cf W' 4 f 2i is 3TfF^. off c c c.. ei o zr -9'M 3TTmAtic chi rT Jf2lf '9 JTLT 't I (1 3TfaraTf L* r 3M T£T (3MUE f) $hT/ aR 3faTSEU 't ch 4T UiIC40lZ uegc-f / col) (i) 3if¢,.-fM/ A2pf 7 K Z ^f M * W / ...... x...... (ii) ^1 iei eTM (2*) ...... x Pam W) ...... ZTuZr ...... t (...... (iii) Ziar 31fT raf (3Tfgf 3i) c>i}i E7>tT (£TTZTd) 31l 3ZT 3M-,M (3fq ) W ZiftT^T i ZQr f ( ) i 3Tazr2f 3Tthf f 1^52T i PTT'9 ...... )( ...... ...... i U4 ...... :^( ...... (iv) c i1^c m, f i 1ci (fWWi ) n 3M M (3TTa) Z} f T i t (v) dI&c ( ) feral 3Ttz^Q f a f lT err 2^T/ f zm 4 ...... /.` ...... (vi) cM Waft zJT S ctieiaT69 fcIffi Zieiai 31940ifiar c r am-cm m Z ZT^ -9/ 19 ...... rn 31V7T4 ( j1) (C ' 3 3f 1951 (1951 f5f 43) ti WU 8 c7^fi 3VEr1Zr (1 Zrr UgWU (2) a %fZ 21r 39MU (3) Zi 3M* 3rr -aA f* 3rWM (31tR1EuI) Z farms c, fc^tl f R'!f Jiff ',/ di Tz11 ar ' 317 t zO err 3Tf11w a f wrzram * cc fir ar n V/ di ihrr aril i' 1 (Z[ft 3634W4ff 34d4ff Ziq f Tyr arzrt 3rt£ c3rf f rr arzir fl^ ? PGrr a jrff wzgff err) 3fT3rM/ Air f tj ;TTW (1r/ 1IC ...... 1C...... a2rrrrr 1 , f f rr $ ...... X...... Pru I(1) ...... x ...... fir (f ) ...... :x...... r ...... ? du r a4Z[ 14 (3>fi 'f) aR WU grZrl) ( 3ih 3W arrow (3c^ 3razr4I) hT tj fgr fR (Ptrc) f'rfI 3TWT4f Safi 3ligft W M W M t ...... x ...... )...... ( v ) r ( & 0 ) f dsr rdr aria ejr/ ru art? 4 ...... A ...... (vi) azrr psi Werai 364Wf3ar MW&W cc $,rZr z?jr ^'F/ z arty ' ...... 3rf^alZir^ wezrrE al Sara 3rfarare #i,Zr6 za a 3N mar/ 4, i. fk VF si4, rf-jr " 3^ffft WW 3r f'c{s . c'i 3igir= t 3N 'rarfi f^urrftar dft n1V 4 ).. - 3rrvf ssf ... ..4.. .Cl. ..j.l. c q Annexu AFFIDAVIT TO BE FURNISHED BY e-A$DIDATE ALOTGWVITI NOMINATION PAPER Before the Returning Officer For election to ..LSietzye.!)gs 1?).... (name of the House) From ...rf • constituency (Name of the Constituency) .. .,..QcJ ...... c Son cjaa$liter/wi-fe of ... . 4.5 ...... Years, ...... aged resident of . Candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Strike out whichever not applicable) 1. The following case (s) is/are pending against me in which cognizance has been taken by the court:- X (i) Section of the Act and description of the offence for which cognizance taken: (ii) The Court which has taken cognizance: (iii) Case No. : (iv) Date of order of the court taking cognizance- (v) Details of appeal(s) / application(s) for re sion, etc. ifany, filed against above order taking cognizance (2) That I give herein below the details of the assets (immovable, movable, bank balance, etc) of spouse, my dependents and myself`: (A) DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be given) 1. Description Self Spouse(s) Dependent-I Dependent-2 Dependent-3 Name(s) Name Name etc. Name 1)7)Lt hCrmCi . t\laxc^.^ c^ Cash ^,CZZc2^ )Q ErC ^CZ^ Deposits in Banks, Financial Ct, tract Institutions And Non-Banking Financial Companies Bonds, Debentures U-1r . q _ ^C tg6a and Shares in RelZe^ce t^ companies Other financial ^DS{a I R instruments, NSS, 931, elm -e-a postal Savings, LIC M 1,S- 1,So,Urv c _ Policies, etc. K, V, P4 r,M,erz -^x tJ•$ga20S.0-M - M G I' C a 5,c2, &n =ev - - 1 Motor Vehicles M/CcPass;a.v, fi (Details of make , etc.) vAlue-2,Se,trea>. Jewellery (give Geldtti. tie, oQ QeJCe ,Je.Oelle details of weight Clsov ti - 2 e $rn I o o ga rvn^ and value) mta4-3S,ert',ae value-1,9Q, ii) Other assets, such as ralues of claims/ interests t -- - Note: Value of Bonds/ Shares/ Debentures as per iihe latest mi cet value in Stock Exchange in respect of listed companies and as-.per books?,in the case of non listed..,pan co hes 1ds ou b e given. *Dependent here means a person substantially dependents orr, the income of the candidate. B. DETAILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] Self -- 7--spouse(s) Dependent -1 Dependent-2 Dependent-3 Name(s) Name Name etc. Name 1J el'r^Y ec t, Agricultural Land- - Locations(s) - Survey number(s) - Extent (Total measurement) - Current market value Non-Agricultural Land- - Locations(s) - Survey number(s) - Extent (Total measurement) - Current market value Buildings (commercial 3 2oIn HG } ^{; _ckenq Sc and residential) , - - Locations(s) ct, )<,D,3 't A Survey door I ^ re) t^z shr7 ,umbers(s) Q,7f C7z) ' o-z - Extent (Total 13tJct Houses / Apartments, ctc- - t ocations(s) - Sut-rcv d001- numbers(s) - Extent (Total measurement) - Current market value (iv) Others (Such as interest in property) (3) 1 give herein below the details of my liabilities/ over due to public financial institutions and government dues:- [Note : Please give separate details for each item] Description Name & address of Amount Bank/Financial Institutions(s) outstanding as Departments(s) on ...... (i) Loans from Banks X I i) Loans from financial institutions ta r (a) dues to departments dealing with govert$nent accommodation 2' Y (b) dues to departments dealing with supply of water (c) dues to departments dealing with supply of electricity 7 x (d) dues to departments dealing with telephones (e) dues to departments dealing with government transport (including aircrafts and helicopters) r U) other dues, if any Description Name & address of Amount Bank/Financial Institutions(s)/ outstanding as (i) Income Tax Including surcharge Deartments(s) [Also indicate the assessments year PAN. Nt -^ H PP 0 41F41 92,4 up to which income Tax Return ^ c 4 . 31 C3.2o10 filed. Give also pernranent Account PIIN•No -413lPN 4893E ea y3 ; C-7) Number (PAN)] PAN >Jc -AAD^I >1•t^cs.7 9.320 Ct QC,[ "^' - .31• t! (ii) Wealth 3.2tto Tax [Also indicate the assessment year up to which wealth Tax return filed.] x (iii) Sales tax [Only n case o Proprietary business] (iv) Property Tax y (4) My educational qualifications are as under :- N(' ^3 s M°cdl. tccu vr,s; .j [GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] [Name of School / should also be given.]University and the year in which the course was completed VERIF'CATION I. the deponent above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of m false an othing material has been concealed thereknowledgege and belief. no part of it is Y, ,"'TYY from. erM^ 'ec aI' . r he .fj by SrI ..,, Acl,r, 't 10 ..".. dayof.... 1.0...... 200 9 064, "" s n9 sue"" 1tceclar 11 . r r' Tr^ h/ThS bc;urB mA. 14R t. tr a Lit e ^^ °^11 8Js^terv A I U ^l^ 11 tlb(iY,. R9nrUlrr ,. P \ _ E P01T'D r i^7. FORM 'A' COMMUNICATION WITH REGARD TO AUTHORISED PERSONS TO INTIMATE NAME OF CANDIDATES SET UP BY RECOGNISED NATIONAL PARTY (See para 13 (c) and (d) and (e) of the Election Symbols (Reservation and Allotment) Order, 1968) To 1. The Chief Electoral Officer Bihar. 2. The Returning Officer for the ...... 79-Laura Bauram _...... constituency. Sub: General Elections to the Legislative Assembly from Bihar - Allotment of symbols Authorisation of person to intimate the names of candidates. Sir, In pursuance of paragraph 13 (c) and (d) and (e) of the Election symbols (Reservation and Allotment) Order, 1968, I hereby communicate that the following person has been authorised by the Indian National Congress, which is a National Party, to intimate the names of the candidates proposed to be set up by the party at the election cited above. District/Area/Constituencies in Name of person authorised to Name of Office held in the party respect of which he has been send notice authorised. PRESIDENT, BIHAR SHRI MEHBOOB ALI KAISER PRADESH CONGRESS All Assembly constituencies of COMMITTEE, PATNA Bihar The specimen signatures of the above mentioned person so authorised are given below: Specimen,signatures of Shri Mehboob Ali Kaiser : 1...... 2. Yours faithfully, (MUKULWASNI General Secrets Indian National Congress Place: New Delhi Dated: 27'" September, 2010 NB: 1. This must be delivered to the Returning Officer and the Chief Electoral Officer not later than 3 p.m. on the last date for making nominations. 2. Form must be signed in ink by the office bearer mentioned above. No facsimile signature or signature by means of rubber stamp, etc., of any office bearer shall be accepted. 3. No form transmitted by fax shall be accepted. ro_ FORA W 'NOTICE AS TO NAME OF CANDIDATE SET UP BY THE POLITICAL PARTY [See paragraphs 13(b),(c) and To 13A of the Election Symbols(Reservation and allotment) Order 1968] The Returning Officer for the 79-Gaura Bauram Assembly Constituency. Subject:- General Election to Vidhan Sabha from 79-99'Ira Bauram (Name of the Constituency UnionTerritory) - setting up of candidate in Bihar (State/ Sir, In pursuance of paragraphs 13(b) ?!!otment' order 1968, I hereby give notice on, (c) behalf and o,'and 13A of the election symbols (Reservation at INDIAN NATIONAL CONGRESS (Party). of the party(i) that above the personnamed, whoseand particulars are furnished in columns (2) to (4) below is the approved candida (ii) the person whose particulars are mendonc' ; columns (5) to (7) below is the substitute candidate the Who will step-in on the approved cancJk-:te's nomination beinc rejected withdrawing from the contest, if the substitute candidate is still a contesting -candidate, at therensuingr e h election to vidhan Sabha from this constituency: g ghr r; 1. Name of the Constituency 2. Name of the approvedcandidate 79-Gaura Bauram Dr. Nageshwar Pajiyar 3. Father's/Mother's/Husband's name of approved candidate 4. Postal address of approved candidate Late Sitaram Pajiyar Vill.+ P.O. Pohaddi Bela, P.S.-Ghanshyamn!!r Distt.-Darbhanga. S. Name of the substitute candidate who will step-in on the approved candidates nomination X being rejected on scrutiny or on his withdrawingt from the contest if substitute candidate Is still a contesting candidate. 6. Father's/Mother's/Husband's name of substituc., candidate.: 7. Postal address of substitute candidate' X X 1. Inserted by notification No.56/97/nual-III•• ^ d-ted 15.12,1997. - 2. The notice in Form "B " given earlier in favour of hri/Smt./Sushri ...... As party's approved candidate/Shri/Smt/Sushri .. hereby 1. Inserted by notification N 56/97 /Judl I, datec -sS.1'2.1997. 2. The notice in Form "B" given earlier in favour of Shri/Smt. As party's approved ,/such. I.., ...... As party's substitute candidate is he, aby rest; - 3. It is certified that each of the candidates whoa name is Mentioned above is a member of this Political and his name is duly borne on the lolls of men-.'5ers of this party. r 176 d't l L,( 67 6-1 ^Cq ^ ^ ^/^f3^rl^t ^^ alp C^ a, vai* ' a uflS^ #^ ^1 ^tdf^H 3fdfla ^ ^ ^^ -q"4R'kR t fftw Date on which the copy Data of making over the Hied Date of delivery of the copy to the applicant. was ready for delivery . f ap^lic p a[fion^for Date fined for notifying requisite stamps and the copy. the requisite number of folios. stamps and folios. c1 cam' ^ y ^ r W ary t' ice dV7 . ii 79 20 0 3oS3 .f4^it ^a^ fiq;ni ) rtr la4$ip a4*i 4" . ... afid' Co J iftd ti.i T ^a1 =zrrzrrWtr, rfgTrIF qwgrftia^ti fi Qtir ; i tn, w(kr& Safi r$-a^, fluz 1 9f g d-g^ ,ft" M apt 45 a4, ^. 4 1 T gfi M7 aTiT tt*ttrT,3;1 1nr, qtF - flTfol- qt dt -Qtrr'9 iti N ftj r- tai7lr r -f$Tzn fwi tt j5, *n i!i ol. 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Lk - \ o - 'i-o b wcerrq^R •rr, ^A►enttfie c19aT aT rr^ff, tc JR4d 31k 04a WZM/ b a (f sTUZr Advo y rIR rc T' r 331k f42 ni c i 3TgTrt d 3T } aft i7 4: dec rr+nty tr^ aft zbw arfkw arr I 1 4. CA I :7Alh ,§ ' ...... 10 Z2{TorZ7Z 3rfiif arfl Zo 7 Li.... 1...... RcFiT 2iT I P,r]v^., Rokr !n.. Syr ry g r r ^w^2t1_'i- SiA de-PoL&r k P4+ n Lam, ' A- V9\-o 1.a9 S^ q,,." l QYt^' t. -. 2r nr,y p^racb-,GZ 311 aT4ff a; rreTr 1 A! AFFIDAVIT TO BE FURNISHED BY CANDIIA TK A GWI NOMINATION PAPER \ Before the Returning Officer Qi^Y' Lo.^i3b*tV^ ASt n-b\^ For election toM...... 2^Mber.l...... (name of the House) From ...... ^la^! constituency (Name of the Constituency) I, lclb l r^tl s .....P4 he e^ ...... Son/dqughter/wife of ...... 5hQb1...... aged .....L.4 ..... Years; resident of .v t-L( .a IQn...,. Q R.:. $e iia ., Pq'sel4t? :..^4$^ i° 2 Pau*i Q $ l7\ ► 4^Sl yov. p^^r t3\oe^- \cCL^a rc n r • 1^1S1F - 73>0-*P '4 Candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Strike out whichever not applicable) 1. The following case (s) iys/are pending against me in which cognizance has been taken by the court:- (i) Section of the Act and description of the offence for which cognizance > P ^. Q+- ^j QTI'r% 9 c\c^- taken: \Q) 3 \ , 3 a 3 , 1 i o O trk +^- ^b) cb L1 9 p .e_ q,_p! 3 L1^ ^x^ Se - S-v. i) The Court which has taken cognizance : `q_) S , H , pia 4v^ t^e^ 4Vnr l\5 ) S • D • -J'' M , (j i'a-9 u-l `^ et i pw - Case No.: `q) k-jx ,.q,,Aky°, prr p ,g.ca^ye^b - ^ ^ fib) ^l q^s^ ^vM QW( p,S •csua_ 1 5 41 ya-Q-$' Date of order of the court taking cognizance ^^) \;-• o; - X009 (v) Details of appeal(s) / application(s) for revision, etc. if any. filed against above order taking cognizance : That I give herein below the details of the assets (immovable, movable, hank balance, etc) of spouse, my dependents and myself: (A) DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be given) Si. Description Self Spouse(s) Dependent- I Dependent -2 Dependent-3 No . Name(s) Name Name etc. Name Prcy""`^ Cko • (i) Cash tab p a^ ^_ 6-0 2 2 Gov = s° '^ x >C (ii) Deposits in Banks, Financial Institutions `mkt-^S?°'Y And Non-Banking Financial Companies Bonds, Debentures X (iii) ' / and Shares in 7 ^ X J` companies (iv) Other financial ^OOp00=^ instruments , NSS, `p Lsraa (s t US, postal Savings, LIC L • t• C X Policies. etc . Pot'1t-t t'40 - X 533^^'St3z 18 ^^e1 (v) Motor Vehicles .> g1-3 (Details of make , tae1+-^ X X X' etb jewellery Oive s details o f we ht Q^ and val ue) (vii) Other assets, such as values of cWHis/ 7- X X X ^' interests - --- ^ - Note: Value of Bonds/ Shares/ Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non listed companies should be given. *Dependent here means a person substantially dependents on the income of the candidate. 4 TI `` ,4^ MMDV A01.E ASSETS g SET ML S OF I( C A 9^ L CU. ^1-rc1L \.a^°nl! Q rn^3 Ngnt\'Jobe V, \, k ^! mYo 8216 3^9 %4000O _ of 1S^S 5oB\ S O $^- ^119 b ^b 3aa-5 Zo 5b 80 99b 9o^b 0-0 - to 7-\ 13 1 \ooooo =oa yon 626$ LNI-0) I - vA - \"l- In- b s s(tts) - 5000oe=ov 38 %93610\1) (32b9 LNcw-) i rloh- R eics^lts^rQA l.4*s Sam K4. a-L4^^-4 K^\nt\,4 N0S00'0 =I'll \9'4 lo\d-) 0 -1- 0 1-arou 4 Sub- 300000 = 0t -Two T tm 6LL;1o)i a} vt\\ 9-4t p•s-\s.L r9", 2ps--D°nW4 ^p0Ott -00 ^'W O 'T tna sui\d.i '- \.k eztd n, D I AILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] Self Spouse(s) Dependent-1 Dependent-2 Dependent-3 Name(s) Name Name etc. Name c kY Agricultural Land- - Locations(s) - Survey number(s) - Extent (Total V. measurement) - Current market value P° Non-Agricultural Land- - Locations(s) - Survey number(s) K Y - Extent (Total measurement) - Current market value Buildings (commercial and residential) - Locations(s) - Survey / door numbers(s) - Extent (Total measurement) - Current market value ! 4ocations(3) ^, x Survey / doo'l\ 1 x I x iumbers(s) mcnt-(¢ otal ! Mt, measurement),! 'Current market alue UttytHo- p^ by lh^ ns ta* os ti \_ocL'4 ^c1nK 0- . ira t D as " 6xsooo =ov Dom" 3o \s \ t v ^ 1 qK G -"y -^ H T Lcsv•, A tesQ ^'D, tT"U 106 - I give heretn• oeicw the uciai13 V . ---, --».•---____ institutions and government dues:- [Note : Please give separate details for each item] Description Name & address of Amount Bank/Financial Institutions(s) outstanding as Departments(s) on ...... (a) (i) Loans from Banks ^2ai)a ^'t'c4c^• J L&Z le- (i ) Loans from financial institutions (i i) Government dues:- 2< (a) dues to departments dealing with government accommodation K K (b) dues to departments dealing with supply of water (c) dues to departments dealing with supply of electricity x IC (d) dues to departments dealing with telephones Y (ekues d % epartments dealing with \ nt transport (including `/ y^ove X ^m r f airc rafts y nd helicopters) x ,. \ ( (f) oth^r du es, if any ,a^VOGa ^4-) E 6 u e. O^A o r q- , c^ -,Lc i 6-L o'4 , S ^a^t^c^ 10,a,.$1 .a¢S.K ^ •' r^ave9,ti, e 1% p 19 ^ -- b4 ("jo*mLO- - - \b 1 ^y^Y rno^ lj ) ^qs a te - ^M- 0) . »; -1 1, ^. ^,j Name R address of Amount Bank Financial lnstitutions (s)/ outstanding as De artments(s) on ...... (i) Income Tax Including surcharge Also indicate the assessments year Tn P4~1c6o up to which income Tax Return filed. Give also permanent Account u,^W p ,Ao Number (PAN)] AP^pP4^1 t, 3M (ii) Wealth Tax [Also indicate the assessment year up to which wealth Tax return filed.] (iii) Sales tax [Only in case o proprietary business] jE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] [Name'6'hoo1 / University and the year in which the course was complete s}touldlsq$ given.] 2p^ DEPONENT VERIFICATION identified 4y,Srl .- R (^ryg 0' (}`Ta'bl" named, do hereby verify and declare that the contents of this off' 1'd,f° `^E"trW-and correct to the best of my knowledge and belief: no part of it is false and nothing material has been concealed th ere from VNh.yTH SA HIJ Q)0 ...... day of ...... 1.0 . 201^^ Verified at FJGtaw.PubliG, $eii, ui. L040** =4 9 ices '^6`1-'^ c^ Rq b. o 3 t `^. y „Sp ".cam. DEPONENT OH ^\ e`^.ojD `llal ^r T 7 I 4-t ail 1 I ' . 'eji 46C ,LW. I-r r- _ e ^-#/(c r Idlcf - C I! I ... +SQf) w ,^,. 1 rr,ilt 5. 1 7a^ ?? a7^7a..-,. \lpZr-` \ tr:^+r,7Meii•I ^JI. 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F)ND ^c ca ...... :...... 9.1 2Tr 3iaazTTZ^ m f lw 4 @) ) ...... 2 ...... }^ ...... 3 ...... ...... ...... ( ) ci T ( ( ) " 3TcZf£T 31ft / Zff (yj) 3Tf 2 q^ ...... 3g2^cT ci) ...... ) ...... ci c-iTa"Ffs (cziT (VII) ^ZTaTr£^t ( ) c^i ff^i a 3141@ (34c )/ WT @ (Viii) ^Zn 3ZR^cfti GlwlcIWA f4yc Zrt 4 : ear' / 3TT (3TT) 1 faf2Trr.... (ix)ff 4 U 3T(r (3T)/ ...... 'M, :gW,-T 3TMc (3T> cl) / (X) 32i rrcT^T (31F -JTU ...... (3T1^``) " f4i1ZTZT 'A Urzff Z1Te (Xi) c^iiT 3cci 3T>Tr (3T) i3""'^i°T 3TT ...... {.}...... pl l 4'c^ (39kcT ) -03 f74 1ZT ig""'4M 3ifc^ (Xii) ZA '3ZFii 3TMc (3ia^) ) ...... (,T5) WgZr^ cfi (cTf ) ci VE& ...... 74 ...... (:uf) t Ty a 3TT^2T (3TT^2T c ca r c^ ^y n, i^ ;' C4 Qy.^/1 3T2 2 c-h'r $iZ KW- 4 (R^' T 31T 1-£ &T T 2RT WUUU ) I1W f 2T T-ter za ;f 5F z TT- ... ..t J ...... 2r^ a 1i ,Me4fcje4 a ...... :..: ...... ( r:r) 1 ... iti^ a.:'°!° ( ) *3T32T g^* E15 R u1kci f45 1T URn I UT7tT ...... :...... OTW- 5 2Ttf- cTi} > c7 -ZIT Z W M -M JT 31T is I5 %r T 1 2TT-v5 Z1 pPdROT -T 3T%1RTaF, 1 9 5 1 ?Ii ETRr 3 6 c 3T iR Vf1Rfc f cTZi ICI41 ' 3TA2 39 ftd,^ d9 fcf%2V2T cC T 4 I :- cA ...... ftd r 344511 f) ...... (f) ...... (f1 T) ...... ctr S. Arm ure- i .- "^ AFFIDAVIT TO BE FURNISHED E ALONGWITII NOMINATION_ i Before the Returning Officer For election to .. 13;,^r(r, ,Li 2 1: S' Lcz re.. l kf.-. f44ame of the House) From ...... 9.n.. t^r4....!3.Ur`?+??.. constituency (Name of the Constituency) I, ...... L_^f?:r".^^'...... ,...... Son/daitgkYer/w,i€e of Glian ra... G'.t? .....^1^. lts? ...... aged .....3.... Years, 5. Pj s.euf...7^; il resident o f. Yil1.-...M..tt.Il^mm.. ^..1'y...3 .0.41.1A...P : - !)UYb^OL• Candidate at the above election, do hereby solemnly affinn and state on oath as under:- (Strike out whichever not applicable) 1. The following case (s) is/are pending against me in which cognizance has been taken by the court:- (i) Section of the Act and description of the offence for which cognizance taken: Secf^ e h - 193 ; 19,6 , L1 20 , P- C . (ii) The Court which has taken cognizance : g. 1, _7M • I3 i r Ltx / a^ /3c,h ` .: P.Nols(aeie (iii) CaseNo M jM Fc +3i (iv) Date of order of the court taking cognizance : p 12' 20 e7 (v) Details of appeal (s) / application( s) for revision, etc. if any, filed against above order taking cognizance : That I give herein below the details of the assets (immovable, movable, bank k2) balance, etc) of spouse, my dependents and myself*: (A) DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership wil l also have to be given) Dependent- Dependent-2 ¶ Ption Self Spouse(s) Name(s) Name Name (i) Cash Q,, 1v,eooj X >C (ii) Deposits in Banks, S I Financial Institutions p And Non-Banking F Financial Corn anies (iii) Bonds, Debentures and Shares in A x I x companies (iv) Other financial ze Rs l^-a,oc^j^ instruments, NSS, tI F . RS:1 se,eoc. postal Savings, LIC X Policies, etc. (v) Motor Vehicles sole-rb(r3R'",1P (Details of make, U s-o i') ly) ke u:e etc.) p (vi) Jewellery (give C vbt- _ST 6t1c e rr> details of weight I 44. C qw i `(( ta (I K and value) (vii) Other assets, such as values of claims/ interests Note: Value of Bonds/ Shares/ Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non listed companies should he given. *Dependent here means a person substantially dependents on the income of the candidate; B. DETAILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] Dependent-3 Spouse(s) Dependent-1 Dependent-2- Description Self etc. Name Name(s) Name Name 4 o. (i) Agricultural Land- - Locations(s) - Survey number(s) Y_ - Extent (Total measurement) - Current market value Non-Agricultural Land- I fl-Ca ^ - Locations(s) meuzc.^ Mt-^' - Survey number(s) - Extent (Total trr14 -D [ o- rli. M.V-U7 Y 6 measurement) . Re in, so;oQa( - Current market value tZg. j„eo ooe^- (ii Buildings (c Uw ercial 1 1k4t'(g f "^ and residential) - Locations(s) - A-M w,4 - Survey/ door numbers(s) I X K - Extent (Total measurement) - Current market value R S,ve;oer,] - Houses / A ents, etc- ca - fn e^•-t^ - Locations(s) A - Survey / door A numbers(s) - Extent (Total measurement) - Current market value pa.^ee1 tbj (iv) Others (Such as interest in property) A I give herein below the details of my liabilities/ over due to public. financial institutions and government dues:- [Note : Please give separate details for each item] :Name & address of Amount s No Description Bankinancial Institutions(s) outstanding as Departments(s) on ...... (a) (i) Loans from Banks f ^ ^I () Loans from finatution I -J (a) dues to departments dealing wish government' accommodation (b) dues to departments dealing with supply of water (c) dues to departments dealing with supply of electricity (d) dues to departments dealing with telephones x (e) dues to departments dealing with government transport (including aircrafts and helicopters) (f) other dues, if any Description-, Name &address of Amount Bank/Financial Institutions(s)/ outstanding as Departments(s) j on __ (i) Income Tax Including surcharge [Also indicate the assessments year up to which income Tax Return filed. Give also permanent Account Y, x Number (PAN)] PAN0e _,j:0PCe9$(.L 100 Wealth Tax [Also indicate the assessment year up to which wealth Tax return filed.] (iii) Sales tax [Only in case of proprietary business] (iv) Property Tax (4) My educational qualifications are as under :- !--.^ --a-x,^^ 110aTI^ ;^4e - iC+-t e ^. ivet , < uaoaL ;'A-4AR. 33RouL.(bp^v) SCNatL ExAM7NJ m' FON 'nc^q- rj r>I t>A-r&iq . JY4r_ 14Bi`. [GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] [Name of School / University and the year in which the course was completed should also be given.] 3^cy' fC4a'igt C'c -, ry yc. VERIFICATION 1, the deponent above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief: no part of it is false and nothing material has been concealed there. from. Verified at ...Gr^ti^ :a,y...... this the..... 3.c.I.C...... day of .. ^ TM^ ^ rY.20 0 ...... wbn is identified by Sri ^/1^, 1tel a C ^av Advcc.toSulemnly aWrm•d and dccGs,cd nckre me. DEPONENT C.u G -t+AY In{ rfaiao, isc,a 1 4r'v 1 Data anon for ^' Date of delivery of the Data m which the cc of ranng o'er Date fi.ed or r tilting req6< 9 v c/• c/./f^ 07-77 °t G Y C/ C yavo /1 T c) r I I`-/ FLT-4 a 'X^ l'fc suT * -3i4it Aia o, NIrV 3 T'ttiifc^^NT ttft€, id's vii T,.^lr I it!^i4i ti kF''l ei& ^l =i: -ItNd Amu A 'p, fifi^cf r^FW Afi^P ^u L I alata i cdT Date of application for Date of delivery of the Data on whic the _cb^ Date at mak i ng over th u the can, Date fixed for notifying requisite stamps and wa r read! fu I,ery . iopy to the aptllcant, the requisite number of tulles. stamps aid folios. (7 7 JAK -/, / *W -e Vff o-1-/ rt 7}77 1)7Vj7 '7 1' ;a i 014112 c ftrZW 4 `5 tfZ97) ...... 7-!...... : l ^:S^.. ^.>?l.! ...... F.ICIFQi elx -9 ftmfzw j abl rraT) L ...... 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SHAM-IM r1,T7 0 ,; c 3Tf4NT4ft -TZ , ZrF Zinc T^ci 3117 E) T ci d i / c i ^ i^l % VA 2Tg2T q c^i 3M4-,g A' WUTffiaT .RM A7 ft!NM cz?i 3Tff7TTZ WC74 3Tt7 at t AZ Vd45T A7 3TTJT DTP-UT WO -t 3?yT MPMcTi -aU %4141 W&t 4 t I ...... i...... -,R4 ^ W 3TTuT aT IiT ...... cr W,;a lfc 4, ti' Addfa l.;o by 8#1, ... : . C gt®, Cecla,o ts0 tS .trr ., 1. _I CANDIDATE ALONGWITII AI I II)A\'IT T PAPER Before the Returning Officer For election to ...... ^ (name of the House) From ...... constituency (Name of the Constituency) soll/dauei /wife of ...... aged ....^3 i.....Years , el .... ^u. . resident of ..... aY^ and state on oath as under:- Candidate at the above election. do hereby solemnly affirm tStrike out Mhichever not applicable) case (s) is/are pending against me in which cognizance has been I . The following taken by the court:- of the offence for which cognizance (i) Section ul' the Act and description taken: ^a Ihe Court which has taken cognizance: /-rv Date of order of the court taking cognizance 1-4 0 Details of appeal(s) / application(s) for revision, etc. if any, filed against above order taking cognizance (2) that I give herein below the d, )ils of the assets (immovable, movable, bank balance, etc) ol,spouse, my depen( .tits and myself: (A) I)ETAII,S OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be o iVCI1 endent 2 Dependent-3 - I De p Spouse(s) Dependent il SellI S Name etc. Name S1. Descl-II)tW Name(s) Name No. ^r.cJ'a1A{^ Deposits in ILinks. I^ Financial Institutions And Non-14anking Pinaneial Contpal1tc, 4 M)1( I )chenlus. ,,c5 .. 04 I SOIO'^D-L Shares in V•-1 Ct"D•-UD com panies (fiber tmoneia l insl nunenls. N55, post al Sacums, I.IC Policies, etc. Motor Vehicles l I1c tails ,,I - n akr. etc.1 lei) IcvicellerY details of tnd Naluc) - -i (vii) ^', Oilierasse as Nadu; inter er the latest market value in Stock Fes/ Debentures as p of listed companies and as per books in the case of non xtld be given. candidate. tantially dependents on the income of the 'I)ependenl here me ns it person subs U. D4: MILS O F INIMUVAI3L1': ASSL I S Note . Properties in joint ownership indicating the extent of joint ownership will also have to be indicated) JI. Description Self Spouse(s) Dependent- I Dependent -2 Dependent-3 No. Name(s) Name Name etc. Name 1) \ illld ti. ) I' l)l: atll/llsl( - Slll-Vey Ilu nl her(s) - Ltent (Total -^'-' measurement ) C^^ pb^'bfi: ^^^^^^ ^ ^'^ (^e^[5^5^ Current market value / (u) I. N.m-;A-ri:uluu»I I.Inll - - I. I lial i^lns(s) _ - tiurcc^ nanlher(s) . I(\Ienl (ruial^ ^ nleasuremeni ) ---- - Ctuienl market value (III)(iii) RU Ildilli-Is tl lllerellli - (.ro l l rc< id el mah I_ocillions(>) SIII ACV' door nll)))tiers(s) - Event ( total i nleaSill e ) nent) Current market value r^151S11 (iii) I Urn's. A}nliilllellly -- -- - rlc- - I iu- t.' lnl,e(s) ^ -.tiunr \ illlllr nulnhers(s) - I>xlrnl (lo)al nlei s u r\nlenl) - l uirel 1 Illurkel A;lIne F V) 111 Iei,s (Such q ,^11110 eJl Il plopcil\') / over due to public financial 3) I ^icc herein below the details of my liabilities institutions and government dues:- I Note : Please give separate details for each iteml Description Name & address o Bank/Financial Institutions(s) outstanding as Departments(s) ou ...... (,il , (i) I o:uts tium BmIks (u) t_oans from financial institutions `9 V (iii) (KSYinmci t ducs:- N (a) ducs to dcpartmQnts dealing with government accommodation (b) dues to tlrlwrtnients dealing with /!o supply of water (c) dues to departments dealing with supply of electricity d) ducs departments dealing with telephones O dues to depar nients dealing with government transport (including aircralls and helicopters) I other ducs, it any Name & address of -Amount Bank/Financial Institutions(s)/ outstanding as Dartntcnts(s) on ...... Income Tax Including surcharge [Also indicate the assessments year up to which income Tax Return filed. Give also permanent Account Number (IAN)] Wealth Tax [Also indicate the assessment year up to which wealth Tax return filed.] III case of pnaprielvv business) (4) My educational qualifications are as under :- ^CVL Jk: Gl^S^ [GIVER DETAILS OF SCHOOL AND UNIVERSITY EDUCATION] [ Name of School / University and the year in which the course was completed should also be givven.j 5Hgn1!M DEPONF.iN I' VERIFICATION IV f, deponent ,iltove named. do hereby verify and declare that the contents of this kfarZ;t^ it q rc auc,aei(1 collect to the best of' my knowledge and belief; no part of it is '11 W nothpng }tareMtl has been concealed there from. 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(iii) O ...... ^.?...... frr (f) ...... :...... °..'...... 1, (1V) ZTefEu 3Tfwf tai (3TfYT%TA) c7a Um (F ) 3Trz 3Li 311ET (3ci 3TgZTQl) E5T ?Tfkt?T f&zur f-ZT (fffr-) f 31azieff a a^ 3M,4t- T R,7 T jr iM t ...... ...... /...... ...... :...... (V) c-i f (M&41) ftiO SSl T TAT JTZIT e4T/ -gZiiU uTL7 .. . °. . ?..J.... (vi) iziT 2T zrerfT 31fef TfZar arcl 1 rzr z r / z C^ '^.. ^ Z elm 3TfaTZTTL'fl -9, U5W WPM 36Tai4ff, ZT 7R;M q 3?rZ iflfw r Tzar/ f AZT 2rgel vw Z A 3iuth eft ZTc7 di 5-T7 i 3Tyz %Q-4M Z'i 3%f WT 9 Z -3tIZ --,ZTFFT Wai FTRe TT Wi t A7 01 MPccTcT5 W fBmzft EA ZT^ ^ ...... 3 . L ! ...... Z e T F = f ITT 3 T R R - ? r ft . t d' P...... ^ ZTcSTfgc-i f5m I 3ifaTZiie#PiTeTr AFFIDAVIT TO BE FUI(NISIIED I3Y CANDIDA I 'EALONGWII II NOMINATIO ' PAI'L;R Before the Returning Office Fo election to :E2v? SSeo (namc of the Mile PUT '0y) Lt.\ (N,-me ol'the-Constituenc)) resident of. 1..°r'.C:.0'-.N.0 .!r? .r...S ..1 y3 ^1^ c. .lst-^ po bLq^ Candidate al the above election , do hereby solemnly aflirnt and state on oath as undeF:- (Strike out whichever not applicable) 1. The following case (s) is/are pending against me in which cognizance has hr taken by the court:- 0) Section of the Act and description of the offence for v. hick cognizar,: c taken : 02) ,3 ,$`(, j•P C (1I) 143 3ti1, 32 4 ?, 3S3 c l.P C 011) 7u 1 5^ ^Te.veM-+zoVt )P1-n e n.I41.; c (ii) The Court which has taken cognizance: C..1 h, 90'0hhc, 6)tI0i 0 (iii) Case No.:(i ) 7^ ( 2Ca0S (II T3jrwoL, QiQ I (iv) Date of order of the cowl taking cognizance . (t) C I, tab ^1 t) id b yo (trt) I?, e-9.3oio (^) Details of appeal(s); application(s) fur revision, etc. ifanv_filed agaist above order taking cognizance:W^7^^Yoe ^^tI^SrE ,2 V1 I lovt-1^hle ali3 Czcuil-,Pcx.~ A ,S;kG-' V cIQ 00._.3' [Abstract] That I give herein below the details of the asset (imil,i viable, nnnova I) c balance, etc) of spouse, my dependents and myself': (A) DETAILS OF MOVARLE ASSETS (Assets in joint name indicating the extent of joint oMdetsltil7 will ako lw;i'. c Ic I): given) SI. I)epcndrnl Itcltcu lcn^,-, No. N'arte(s) Ism4- SVy)2i ^t.t} ^i'7a 1 ©t)0 od qS_ S ooa J Rs- 1 1 NO 7_ Deposits in planks, c) S 131tM17^ihi^ x Financial Rs- 21?.Li1 1`11 L._. Institutions ^,i^it^SQ•^ g csv1-+`i And Non-Banking Rs- Joc Financial 0117 ^^'l tJrH"^I 4.Sr , u Companies _ IIV p,>.r. 13 c . W. --T Bonds, Debentures TI Qi - 7000 -'D ana mares in companies ^I 2 L 1`I IL Other financial instruments, NSS, postal Savings , LIC ^I I 1 L^ Policies, etc Motor Vehicles WCt o I-Ioj )f (Details of make, etc.) Pnsslot,l '+ Ni t- NIL t, 7, oao^v Ix jps- Jewellery (give 110 6ky L9014 pr LSO lc^ details of weight J/ '197 ruCIO and value) ^S - SS 000 ko3-n' sllvfit ( ^+ I T Its- 2(^^000 Other assets. such as values of claims interests Y Note: Value of Bonds/ Shares l)ebenulres as per the latest market calve in Si-,:k Exchange in respect of listed companies and as per books in the case of iron listed companies should be given person substantially L{el?ell. _ ai tltr ip,'nntn of tb ' ,- int11 r1aL B. DETAILS OF IMMOVABLE. S. " hS f I /ownershi p \vIll also [Note : properties in joint ownership indicating the ex have to he indicated] Scli Slurus 1 ) I)kpatdenl-I u I)cscaip1 on \:unu(j Name i .u , < < n, (j) Agricultural i,and- L2 I - I.ocations(s) Survey number(s) E :tent (Total measurement) ^,{ .- .j Lam? >^ ^ - Current market value zht ^Y^^ (jj) Non-Agricultural Land- I poki-ci QA^A - Localtons ( s) '3 Ah 5 } i A! - Survey number( s) 2S^ 2 ^c S CJ hn L- ^, li l t Extent (Total 3ok ?Ss ^ nieati;It eir1l:71I) S rY^^^^+}" - Curran ncukcl caluc^, Rya! O JL ^^^ 1^,_c, Ma,lort!,1ot fLl+-f /n5 (iii) Buildings (commercial I i and residential) - I n,^ahnnsl S) Survey ! door H! L numbers(s) Extent ("fatal measurement) - Current market value t--- j iii) I louses Apartments. etc- Locations(s) N O Survey / door numbers(s) Extent (Total II measurement) i Current market value (jv) Others (Such as interest in properly) give herein below the details of my liabilities/ over due to public linancntl institutions and government dues:- [Note : Please give separate details for each item] Desc ription II Nantc & address (I I G;urkil uianeial insiituii^ iiz(^l -DC.-a!tmcrtts(s) la) (i) Loans from Banks x - (ii) Loans from financial institutions \XI (a) dues to departments dca:lin„ with gove(timent accommodation (b) dues to departments dealing with supply of water (c) dues to departments dealing \w ith ,upply of electricity ^) I 1 V ly (d) dues to departments dealing with telephones dues to departments dealing with government transport (including aircrafts and helicopters) Y J same K address ttt moon Description : Baik-Financial lnstitutions(s)/ outstanding as Departments (s) on ...... _ ., Income Tae Including surcharge Also indicate the assessments \col" ap to whic'n income 'I ax Return tiled. Give also permanent Account N umber (PAS)] (ii) Wealth Tax [Also indicate the !. assessment cear] up to which wealth ax retutr^ fi':cd (iii) Sales tax [Only in case of proprietary business] (iv) Property lax • S L' "r . Lv;)ctr ^c5$ eo& (.;) \lv educational qualificati011; are as under LL,13j L.nv,rsr.u,l^ca•w6ti^^ e0 jGIVE DETAILS OP SCiiOOL AND UNIVERSITY I'.DUCATION] which the course was completed [ Name of School / University and the year in should also be given.] DEPONENT VERIFICATION 1. the deponent ajink- named, do hereby verify and declare that the contents of this - % onnect to the best of my knowledge and belief; no part of it is affidavit are true and C false and nothing material has been concealed there from. .)G?7Fi^z1 h this the...... Q.Ci...... day Of ... j.6...... -, .;, Verified at i It 4 n at idq c'fTw Date of making over the copy to the applicant, i 1 n 70 - 1 .. ^ C6 C l.' Z 11 { j1 fir` `l< S Date of making over th copy to the applican t a e^ pd/ ice(/H' 7 7, r /a y ^^^ ^^7 . 7 X10 f+^^i sa faaa^,gc'^ EPt:lot clo 41,3!;A! Iii , .. ... aiid ?Y f Si f •» ' V+c! %..3 . 4a o < "\4- 2,1 ' ar Ig..`.^j^ 7 ^tfE^3^=il^tt^clf m I 194, CA 2 , it . TUiTIT vaTa -. pto 414Tc T STRT'T-'f' tqi ^S^tf10 f;jfq 27/ ^^/1 aTiE7iZ4i ! Sr+TT1aTT fgruT 7, en q f7i gal,frEr fwrtr n 4irr i 9r nt FORM A COMMUNICATION WITH REGARD TO AUTHOR1SED PERSON TO INTIMATE NAVIES OF CANDIDATES SETUP BY RECOGNISED STATE OF NATIONAL POLITICAL PARTY OR REGISTERED UNRECOGNISED POLITICAL PARTY [See paragraph 13(c), (d) and (e) of the Election Symbols (Reservation and Allotment) Order, 19681 To The Chief Electoral Officer, BIHAR. 2. The Returning for the n ....._ /.1...`;i .A.U-F-A NAa .1 .. Constituency. Subject : General Elections to Legislative Assembly-2010 From BIHAR State Allotment of Symbols - Authorization of persons to intimate names of candidates. Sir, In pursuance of paragraph 13(c), (d) and (e) of the Election Symbols (Reservation and Allotment ) Order. 1968 1 hereby communicate that the following person has been authorized by the JANATA DAL (Secular), which is a Registered Party to intimate the names of the candidates proposed to be set u b the at the electi ons c ited ab ove. Name of person Name of office District(s) area authorized to send notice held in the party Constituency/constituencies in respect authorized. 2 3 H.D. DEVE GOWDA PRESIDENT ALL OVER INDIA Specimen Signatures of Shri H.D. DEVE GOWDA L e. .--.? ...... ^.... :...... Yours faithfully, Place: New Delhi Date: N.•..l5-.Qr..20 10 (H.D. DEVE GOWDA) President JANATA DAL (Secular) N.B.: (Seal of the Party) 5 Safdarjung Lane, New Delhi -I 1001 I I This must be delivered to the Returning Officer and the Chief Tel. No. 23794499 Electoral Officer not later than 3 p.m. on the last date for Fax No. :23010288 making nomination. 2. Form must be signed in ink by the office bearers(s) mentioned above. No facsimile signature or signature by means or rubber stamp, etc., of any office bearer shall be accepted. 3. No form transmitted by fax shall be accepted. FORM A TO AUTHORISED PERSONTO INTIMATE NAMES OF CANDIDATES COMMUNICATION WITH REGARD SETUP BY RECOGNISED STATE OF NATIONAL POLITICAL PARTY OR REGISTERED UNRECOGNISED POLITICAL PARTY Reservation and Allotment) Order, 1968] [See paragraph 13(c), (d) and (e) ofthe Electi6n Symbols ( To 1. The Chief Electoral Officer, BIHAR. 2. The Returning Officer for then etq Constituency. ...7../... . ()..A.(,AA..l3 AG.4RAM...... Subject: General Elections to Legislative Assembly-2010 From BIHAR State Allotment of Symbols - Authorization of persons to intimate names of candidates. Sir, Reservation and Allotment) Order, 1968. 13(c), (d) and ( e) of the Election Symbols ( In pursuance of paragraph by the JANATA DAL (Secular), which is a 1 hereby communicate that the following person has been authorized f the candidates ro osed to be set u b the party at the elections cited above. arty to intimate the names Registered P District(s) area Name of person Name of office Constituency/constituencies in respect authorized to send notice held in the party Of which he has been authorized. I 2 3 ALL OVER INDIA H.D. DEVE GOWDA PRESIDENT Specimen Signatures of Shri H.D. DEVE GOWDA Yours faithfully, Place: New Delhi (H.D, DEVE GOWDA) Date: .^.t . i Q. c ..2010 President JANATA DAL ( Secular) 5 Safdarjung Lane, N. B.: New Delhi - I 1001 I Tel. No.:23794499 I This must be delivered to the Returning Officer and the Chief Fax No. : 230 10288 Electoral Officer not later than 3 p.m. on the last date for making nomination. 2. Form must be signed in ink by the office bearers (s) mentioned above. No facsimile signature or signature by means or rubber stamp, etc ., of any office bearer shall be accepted. 3 No form transmitted by fax shall be accepted. z n 2 L S) 3 (^ JS lA z t s C n^ b D y N d^ S 3 w=d ^ i r y wf w^0 6 \ a,. L W 1^ n 6 A 6 1 V ^ ^ ro B s r r ^' 0 O O w y Y 3 s o n 3 c N ^ o-o n r. y S o_ O S •' d` Y £ n 5' 1 Q c c c w n a 6 n o ^ " ^ n 2 0, n o ; c 3 a OR n v w Y O ^ O .r 1 c o- e P O y Y ^ d O1 a 6 w H' A Q p ^ n d r d Y n CDn m9i if 9 V-# r tl3ll-a1 a107^r1 ^T ABBREVIATIONS , USED IN THE PASS BOOK pun)ab national bank Clearing DARBHAI+GA , C . f ItA GHAT Di,R5HPqq Transfer ACC^^ ^ ^^ODNT5 PARTICULARS' ur. C heque Commission Interest "h HUs]-k 1 Ud A Dis count I 3^a^ I S\O LA E t1An r ti;rit C CujA wft w-* Tr^ f * g^ lja VIL+PO-POKHRAM p,,; -r,IRAUL Outstation Cheques/Bills Pur DO ^f9c ifgf DARSHANGA Dividend Warrant car. In BIHAR pd[,IA WM* D/W Pin 54'20 Returning WIgTft wit7ft VW Rig. W. A. Incidental Charges Date o 0:10 anf c t -.qf TM I/C Carned Over 3iT/-I" C/O g -), 7irm Ti Jf Brough "Coulputer generated entcliu t Forward ; shown in the ; tatemei B/F Af account do not requi Lc . re any au th'rnf l r'afinn / i nit.. Local Cheque /Demand Draft L.D.D.D. Y'r"' I ^O'"t^ ^'^fiA''a flip [r31.1: Idly9a ,1 y4T11(la I "^sd g0lgrour6taS"kmltdgglcopeetonM Draft Iiii acthanU&i n t Dft. TER Cash TER 3 fr/*F Cash .. (d^/ DATE 5 _e " / MANAGER Outstation Bill/Cheque 0. B. 3TfrT.F g 3Frm *h" BRRRI& ll aYlo `ilo) U4M 3ir O w0l; 3rI'i.T^Trl.t?. ff i T ;A aaiRi 3iZ T Tl1 a-ra a; , , i n f * ytel ^zrr Inward MailW Ttranf. r I.M.T. z i f i f a e f if arh rl afro vfafte aT Ulm TT rti Under Centralized Banking Solution System , Bank shall only honour or pay Foreign Outward+ the cheques of the customers against clear balance up to the previous day y`Bills Purchased pF.O.B.P B.P .m, I'+R7n tf+ fM and having regard to the drawls of the day already made in the account. LtiF.31}. .27f. Foreign Outward Bills Collected F.O.B.C. Page no. 1 fwx m f it*rfto *q 7afTf?r ar.W,- Particulars DR. Amount CR. Amount Balance Off. Intl. &v CASH 5,000.00 By CASH 10,000.00 15.000.00 By CASH 17,000.00 32,000.00 C To SELF 25,000.00 7.000.00 C aml-A -r¢1yra*t Carried Over Page no. : 1 f %M1 To M am Ift T j Twq vls err Tft Off. DR. Amount CR. Amount Balance Intl. 5; CASH 5,000.00 By CASH 10,000.00 15.000.00 C By CASH 17,000.00 32,000.00 C To SELF 25,000.00 7.000.00 C 3m1 A fn# TWR Carried Over c/ J /U - // 3^1c^,'1 dc1\V ^^1 \ ..c ^^ In l 1 Mca^^ ti l©DOO_( ..loaao ^^ MAO 144 L1 4. Tc c ©c /0, 16 W" _ ` -- 1 9 61 rf^ ' f t s r} FGRW 4eUFU) pogrz ( ) za f% waif ii^ f %,f "i I -'Ell RM 2, vim} Zrr% ur et, 3 f WRY '46 c ^1 ZT W c i r JTC 3?2^T2${ R7 3U^I^^ c ) a^ f4m2T Rani f^ i .....` {....aU. J...:..^ l_ '...... f^err^ ziarr ^^ e^x ^ srazrz #f ^z^ ^ f^ ^1 ^,^ ^ ^ i WaZrzff W ffw ...... c^I r ii5T r ...... ^P.....3:^! ...... 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ZO Zft 3 I:kft -cT)7 f (t• R-sr (i) zTT -,UT (ii) U1 374 Zff^ ^) m r %7,rr urzu t, u T zrur a9 I W I k1 T ;&9w arr r 3ff )cm T 3Trzferu vft ag1, 3Tr r %5zaT u rt7 i () (ii)a xf al a4 ...... RE UTs, f45-"TT aWWti t, vi zi ^r sTaTr r^r zr CD I * zr f oI ecici-A 3Tazrz7f ;Nu a4 a-g T6r an 3 -^) Az *a u1 uft ga tit 3Tf ZfTF a (i) ...... (ii)...... J i (ar) a}1T r 3r r a fear r ^r ...... 7..^.:z ...... ((TrWr T aTaT) -4 t T,u -4 pdTn arzTT t I () 3ruMi z a, Amcor; 3r £ f42am ii^ 3fgwrr A x uuzr aR fay 2TaTT 5T zmv Kza f ga AT f 303rrr faz aft a ( I *aA wu aft Fr1^ zff T " f45 ...... * *ArfaiA a A rn it ...... 7rur 3-a d w 1 a 4 ...... () -r 39F * * *ATf^/v^ATf^c^ '^ ^ a Zri a f t E r l ^ z f P 7 I f45 a o fia;TZ Z 1 T f P W Tau f zT eT-2iT22T Z15 AT * agUlli ?TTErRT faafac1/3u-%aia-a a z a1 -4 3Tf fay 2TaTT Daf e al 3Tazre#fii^ -,^;ia a * * * *arw WRTff wre %m ara1T 9 3rd .r 9t f zrr ATcj-jIT 1 T .... ' -..1...... 1.C...... (3TazTeff 15T Z-aU417) *** cr% - I ZqT £?1T 1 IZ :- "mac Iwr1d f^ZINl 3rFdM -JnT f ^( cc , (3n ur 3Tt1 3i i d c c i ) 3fa2T, 1968 c t 307 ZTatIT?T ?T 1 30 --91 RT PTT b 34a7 cf t I MW- 3 "IV' ( azreff -iris air urru) 4;m 3Ta f za :- (I) yti, 1 i u cU 3TTETf-7M- 1951 (1951 ZI5T 43) cA UM 8 i - (") 34ETRT (1) Z. Srth r % 31UZ (3iTM ) S f u; ITT ( W ) 3 1 4 U M (2) 3 4 c ^ r WET i 3c ^l f2 W URMT JTUT 't : ZIT (11) L3iw 3iwuET (3muETf) S fc^fC7 ft^aq dT ap 't', fvRi fT.T&) frIU 324 ift 44 SIT 3TfETZf5 -& WZMM ftff fkzff JTZTT 't I Zft 3r-I7 "e' 3T{ 't, c3h 3TaWe1f f^c ci air : 3Idjc'1T / gem 2 T oco ...... lf^ru 2Ttc7T (2Tt) ...... fifc1T (a) ...... ZIT ...... (iii) 36lf di (AiPozoif) cf am (EITZILJl 3iA£ 32i 3mzTEI (3a7 3i42TEIh) c'Tii *fri1FT Razw, `f ^ (1tf Tcj'i ) fw 32 m JTzTT ant ...... ...... ...... ...... ...... :; ...... ...... ...... ...... ...... (iv) ( 4) Z-A M ft /(cii^) ...... / 3T3zI2f 'TT / ,..-. ...... ...... :;...... ...... ...... X...... '^}i 3TeEET 31 Z / SIT ( ) z a 7Tf2T (Vi) 3rfUifCFcT I (WZTaM (WjUZt) c 3V 'fr Ti) ...... (vii) , W f arfr i i 1 m z t ( U T ...... K ...... c i 3rcf}& (3T c )/ 3"rftf WT rT (Viii) q4T 3 ( ) f, aTL7 TT '/ W X (ix) W- cl }i aft 3T T (3T crif)/ $TDT 3 (3171) ...... ...... zT T4T 3T (aT ) / cfii (chi) Olaf, chi (Fvf^l ) (x) 3a n ci ( c c T^) 4M 3TT °T ^ aTC+ :- ...... ' t...... ...... 3rT ) ?5T gt ai2IT % ZIT ZT3 ) /p4fUT 3Tf ff ( (Xi) ca21T 3EFTc 3T c (3T rT -ii^aTcf ' ...... / c^ c (3Tfc^ ) ZM ffgZRT aT2IT .(xii) 3Ui 3T c (3r") ig lei°f 3TT (r) ...... \J ...... (^) i^rzT3 cTfZsT ...... 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KOM 31uZTQ (') 1 951 ( 1951 '^51 43), (1) '4T 3 Zr (2) z1r 3 rETRT -^L (3 3 cT 3T 3MM (3 1) Zl farms f TZff -,,If 44 - 'UT XRTCW RTT aTZII Z7 X31 ^ Jf2/f ' / (za 3T^aiRr* 34zyq al ly ^ J1 1 41,? 4^ ZF6 ^ R5M JTM Alpf f"r Zijr/ G') ^r1^11- 11L7 ...... `ter, f ...... ('el) O ...... WURT ...... (iV) WCT 31 (3) r ( 7 Ar31 32r 3rv r (3^ 3r ) 15r tDr 3ra^2 ZUaf 3irjlfda pc,5m um -g ...... ,.Y...... ...... (V) ...... 4g*eT / ...... ,x (vi) ^r ^sr R+ ...... S i ...... C E^ 1 Ip) b wmqar 35W 40W 3rf'WM4f, Zr6 nfucT 3rk glfa ZUrav } W 31aft 3 a^f^ 3T 27TH ^' " .sli 2rA2^ 4 aifdf f3r2 r 3k 4"^ c^1 Tai 3 3r a5l ^(d 1 , tY` ! "JrtY Ai 3rruT mga^ p m , ^41c i^ ►dr nt-ftm by Sri - t .,. Akl r. c.aF3,r!^mnly aflrm.d r fJ €^nrc v .-C^a. i/C,^ 1 % Annexure- I 'AFFIDAVIT TO BE FURNISHED BY CANDIDATE 1^ fQ ?GWITH NOMINATION PAPER I 11 /' Before the Returning officer i_ For election to .. k! 2• l E s l afi^ j s E ...6 t (name of the House) From . ,ri 9....G)r. constituency (Name of the Constituency) 1, ...... 1.. ! Y,1 q ^i^1.`1 ...... Son/d ...... j^^^^.^> ...... -.. ter/ of resident of...... aged ...... Years, '/ fl cc t . 4itl: ^?; Candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Strike out whichever not applicable) I. The following case (s) is/are pending against me in which cognizance ihas been taken by the court:- (i) Section of the Act and description of the offence for which cognizance taken: (ii) The Court which has taken cognizance: (iii) Case No. : X (iv) Date of order of the court taking cognizance : V (v) Details of appeal(s). application(s) for revision, etc. if any, filed against above order taking cognizance : X That I give herein below the details of the assets (immovable, movable, bank balance, etc) of spouse, my dependents and myself': (A) DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be given) S1. Description Self Spouse(s) Dependent- I FDependent-2 Dependent-3 No. Name(s) Name etc. Name T Y,Yhr1 4M klvA f1 etn% rE ka i j (i) Cash f r n t_ w TIr I 8%^^^ ^c ^ Ni L Ni L- (ii) Deposits in Banks , [* T. t , L N 1_ - r N L Financial Institutions i And Non-Banking N I^ T^ I L 1^1 N L N L Financial Companies (iii), Bonds, Debentures NIL and Shares in N t N t t N 1 L fit L companies (iv) Other financial instruments , NSS, L N t L N^ L Ni postal Savings, LIC Policies, etc. (v) Motor Vehicles (Details of make , N N1? lY ^) N^ etc.) (vi) Jewellery (give ' t L G,t4(1 details of weight IV' "^j1 ^r.s-o-t- $. l^" (\1 t (JiL and value) :pct. ;vii) Other assets, such as values of claims/ interests Note: Value of Bonds/ Shares/ Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non listed companies should be given. *Dependent here means a person substantially dependents on the income of the candidate. B. DETAILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent Of joint ownership will also have to be indicated] Description Self Spouse(s) Dependent-I Dependent - Name(s) 2 Dependent-Y] Name Name etc. Name j^l,al9 E y^ Agricultural Land- - Locations(s) - Survey number(s) NIL NCI - Extent (Total measurement) - Current market value rO,TrlD .^ Non-Agricultural Land- - Locations(s) - Survey number(s) - Extent (Total measurement) - Current market value Buildings (conmlercial and residential) - Locations(s) - Survey/ door rvmt1Zn. Rc^rnr- j numbers(s) - Extent (Total measurement) - Current market value Houses / Apartments, etc- - Locations(s) - Survey / door numbers(s) - Extent (Total measurement) - Current market value Others (Such as interest in property) I give herein below the details of my liabilities/ over due to public financial institutions and government dues.'- ^J t L [Note : Please give separate details for each item] .No. Description Name & address of Amount Bank/Financial Institutions(s) outstanding as Departments(s) on ...... (a) (i) Loans from Banks (ii) Loans from financial institutions X (iii) Government dues:- (a) dues to departments dealing 1 with government accommodation /X\ (b) dues to departments dealing with supply of water X (c) dues to departments dealing with supply of electricity (d) dues to departments dealing with telephones (e) dues to departments dealing with government transport (including aircrals and helicopters) X (f) other dues, if any x Description Name & address of Amount Bank/Financial Institutions(s)/ outstanding as De artments(s) on ...... (i) Income Tax Including surcharge [Also indicate the assessments year '7 up to which income Tax Return filed. Give also pennanent Account Number (PAN)) (ii) Wealth Tax [Also indicate the assessment year up to which wealth Tax return filed.] (iii) Sales tax [Only in case of proprietary business] 'x (iv) Property Tax A (4) My educational qualifications are as under [GIVE DETAILS OF SCHOOL. AND UNIVERSITY EDUCATION] [Name of School / University and the year in which the course was completed should also be given.] `JDEPONEN-T VERIFICATION I, the deponent above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief; no part of it is false and nothing material has been concealed there from. Verified at .. k ..! .I , this the , .....b...... day of ...... 200"x) ...... WN is td, nt+fied by Sri AdwLc..;c ;okmnfy »f8rmed C ud I,,r.I30^IENT ^^y 7- A',. -i-q 1 -q-zcilz^ ^ iii-q G 131- F--`-t 1 - J; - ^- LM D6y7172- / 7 9 'FORM B Notice as to name of candidate set u b y the political art fSee Paragraphs 13(bl (cl and (e) and 13a of the Election Symbols (Reservation and Allot ntl Order 19681 To The Returning Officer For the 72, GAMAA l arVR sutuency Subject Avel"I :- General/bye Election to '-+ S. PoA O Ai from •...... (Name of the Constituency) in ..fSt. +.Q.1.t.....(State/Uni0n-Ter6tery)_ candidate. setting up of Sir, In pursuance of paragraphs 13 (b), (c) and (e) and 13A of the Elecfon Sym pl (Reservation and Allotment) Order, 1968, I hereby give notice on behalf of--N_ L47IRSt Coy) (i) that the person whose particulars are furnished in columns (2) to (4) below is the (nt cP) approved candidate of the party above named , and (ii) the pe on whose particulars are mentioned i columns (5) to (7) belo is the substitute candida of the party, who will step -in on the proved candidate's nom'' rejected scrutiny or on his withdrawing from he contest ation being , if the substitute candidate is still a con[ ling candidate , at the ensuing general /bye election from this constituency : Name of the Name of Father's/ Postal Name of the Father's/ Postal constituency the Mother's/ address of 0 substitute other's/ address approved Husband's approved m c didate who sband s bf candidate Iname of candidate t°v wii I step-in on r name of substitute approved a the -approved substitute candidate candidate candidate's nomination candidate Ca- being rejected r aI Q Q Ot ')4 on scrutiny or on his J Q 0- LoZ Q < withdrawing ® 4 from the contest if substitute candidate is still a contesting candidate 'Inserted by Notification No.56 /97/Judl-111, dated 15.12.1997 22 2 4 en. favour of *2, ^T,he notice in Form B given in_ Shri/Sm'tw/Sushri ...... as Party s approved candidate/Shr ^Smt./ Sushri ...... as Party's substitut'`sandidate ...... is hereby rescinded. 13. It is certified that each of the candidates whose name is mentioned above is a member of this political party and his name is duly borne oli the rolls of members of this party. Yours faithfully. asue (MORAN LA.[ AGARIWM ) ame and Signature orthe h ised erson of the Party) 11^ ^ Place ..)...0. \ \.. W Date .... .3 /.l 9.I.l.P * Score off, if not applicable 1. This must be delivered to the Returning officer not later than 3 p.m. on the last date for making nominations. . Form must be signed in ink by the office bearer (s) mentioned above. No facsimile 2 signature or signature by means of rubber stamp, etc., of any office bearer shall be accepted. ll be accepted. 3. No form transmitted by fax sha 4. Para 2 of the Form must be scored off, if not applicable, or must be properly filled,if applicable. ------ .12 2000. 'Inserted by Notification No.56/2000Uud-III, dated 1 23 -1 FORM A Communication with regard to Authorised Persons set up by recognised to intimate names of Candidates NATIONAL OR STATE Political party or REGISTERED UN- RECOGNISED political party. (See paragraph 13(c), (d) and (e) of the Election Symbols (Reservation and Allotment) Order, 1968.) To 1 • The Ch1iElectoral Officer, °•°••°•••.••.N...... (State/Union Territory). 2. The Returning Officer for the /J`..3A.U.€ 1;g % Ugn ency. Subject:- General Elections to^...... from 1 ;.:.^. (State/ Allotment of Symbols Union Territory) - Authorisation of persons to intimate names of candidates. paragr ph 13 ( and (e) of the (Reservation andlAlotnent ) Order, Eection 968, 1a hereby communicate haw been authorised by the party that the following person (j) as/ , which is National Party/State ...... --Party inPthe State of- /Registered Un-recognised Party to intimate the names of the candidates proposed to be set up by the party at the election cited above. Name of person authorised Name of office held in the District( to send notice s)/area (s) party constituency/constituencies in respect of which he has I been authorised. 2 3 P^res i j t ^^ ( ! (3 i k O-s` r{^,^tci es i, E ;,I a'r S-fa+e Na.--iona isE Con real Parr 'Inserted by Notification No.56/97/ Judl-III, dated 15 .12.1997 20 2. The specimen signatures of the above mentioned person (s) so authorised are given below:- 1. Specimen signatures ofShri...M.0.H. N .).'sa..P.CAA^ll/#^ (i) ...... (ii) (iii) , .. ,...._ 2. Specimen sign tures of Shri (i) ...... it...... 3. Specimen signa ures of Shri ...... (i) ...... (ii) ...... (iii) ...... Yours faithfully, T_P.PEETHAM ARAN MASTER GEN^PiF iS1^ (SR Y RATIO NAINSMOJIV RMI PARTY #flONALISST--E9NGRF 'S PARTY I^,DrBlshamb-har Da-. .hug. New D 100 (Seal of the Party) 1. This must be delivered to the Returning Officer and the Chief Electoral Officer not later than 3 p.m on the last date for making nominations. 2. Form must be signed in ink by the office bearer (s) mentioned above. No fascimile signature or signature by means of rubber stamp, etc., of any office bearer shall be accepted. No form transmitted by fax shall be accepted. 21 Generally used abbreviations I A/c= Account dep = Deposit Pr = Principal Adj = Adjustment Dft = Draft proc = Processing Charge Amt = Amount dish/dsh = Dishonour rd = Recurring Deposit Ar = Arrear DR = Debit ret/rtn = Return bal = Balance DoB = Date of Birth Rnd = Round of Capn = Capitalization eft = Electronic Fund Transfer sb = Savings Bank chg/ch = Charge Inop = Inoperative SC = Short Credit chq = Cheque ins = Insurance SI/So/SORD = Standing Instruction Clos = Closure int/in = Interest S/D/W/H/o=Son/Daughter/Wife/H usban dof coil = Collection Ion/In = Loan tr/trf/xfer = Transfer comm = Commission min = Minimum TT = Telegraphic Transfer COR/CORR = Correction os = Outstanding txn = Transaction CR = Credit P & T = Postage & Telegram Wdl = Withdrawal csh = Cash Pos = Point of sale +MOD bal=total balance (SB+linked MOD a/c) LTIkdlg FEZ State Bank of India Satiin-;, Bank Account SUPAUL BAZAR CIF No S583$1 11 PG : B.1RAUL Account NO : 3145466--0l Customer Name: Mr. TA.LNNA S/D/5G/H/o:MAIIA^1UD ALAbi Address:S/O- ,M1AFI IUD A1:ANl Phone: '132 -1-1 ' VILL- BARDAHA, PO- Y„\LRAM Einai I : sb i . 030 LO(sbi. co. in VIA- DIRAUL. DISf-. D_ALRBHANGA Branch Lode:BO10 Phone: Date of Issue: 05/10;2010 Email: 0 /1../2010 326 {; I, 010 D.O.B. (If Minor): FIRST " MOP. : SLNGLE Moot. Reg. No.: Nomination Name: