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Qi,, {'00 HI.,.Ndneeef,Ttbees Tmieqqt Ltf- CI:Llndlil -{- ! *#{--}gNE-€-,R qi,, {'00 HI.,.NDnEEEf,tTBEES TmiEqqt lTf- CI:llNDlil u 2237 29 : MOI{AMMAD RAFFI sl. i',io: :.ICENSED STAMP VENDOR -'t:'Frit/o ).*L. e' L.No.: 07-15-02512011 sord ro: Ptr*t^' R.L. No.: 07 -15-03212017 i.ilDAT.'BI I'IAGAR. SANGADIGUNTA GUNTUR.522 OO3. totwnornfi,,fli FORM 26 Cell:995912S799 d- Gee4le4A) I I I Affidavit to be filed by the candidate along with nomination paper before the returning off6cer for election to PARLIAMENTARY CONSTITUENCY (name of the House) from td'eapATLA CoNSTITUENCY (Name of the Constituency) I, THUMATI RAVI Son of Thumati Nagaiah, Aged 46 years, resident of Flat No.104, Sri Venkat Residency, Sadhasiva Nagar 3'd lane, Guntur-522007, 6untur District, Andhra Pradesh (nfuntion full postal address), a candidate at the above election, do hereby solemnly affirm and st$e on oath as under:- IH E E (1) I am a candidate set up by ALL PEOPLES PARW. (2) My name is enrolled in VEMURU (SC) ASSEMBLY CONSTITUENCY, Andhra Pradesh (Name of the constituency and the State), at Serial No260 in Part No.61. Elector Photo ldentity Card No.UUSO327775. (3) My contact telephone number is 9550498084 and my e- mail id (if any) is [email protected] and my social media account(s) (if any) is/are (i) Face Book: raviblind (ii) Twitter : Nil iii) Whats app : 9550498084 (4) Details of Permanent Account Number (PAN) and status of filing of lncome Tax return: sl. Names PAN lhe financial year fotalincome !o. lorwhich the last shown in lncome. lncome-tax return lax retum (in nas been filed Rupees) for the last fve FinancialYears (as on 31.i March) Self : ) Nil AOMPTI982L Nil i) Nir fhuinati Ravi ii) Nil v) Nil r) Nil (i) Nil z. Spouse: (ii) Nir Bandi Mary Sowbhagya Nil (iii) Nir BEKPBO5668H (iv)Nil Rani (v) Nil Nir 3. HUF (lf the Candidate is \it Nit ) i) Nil (arta/Coparcener ii) Nir v) Nil z) Nil Nil Nil 4. Ihumati Missionary Nit ) i)Ni ii) N v) Ni r) Nil Nil 5. fhumatiHeman Honey Nil Nil li) lii) Nir liii) Nir (iv) Nil ,KU l'v) Nil ffi W o. Dependent -3 Nit Nit (i) Nil (ii) Nir liii) Nit [iv)Nil (v) Ni! Note : lt is mandatory for PAN holder to mention PAN and in case of no PAN it is should be (Tick this alternative if there is no criminal case pending against the Candidate and write NOTAPPLICABLE against alternative (ii) betow) OR ( ii) The following Criminal cases are pending against me: Not Applicable (if there are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give details of allpending cases in the Table below) Table a) =lR No. With Name and Nit \it Nit rddress of Police Station ;oncerned :b) lase No. with Name of the Nit Nil Nit lourt (c) Section (s) of concerned \it Nit Nit Acts/Codes involved (given n.of the Section, E.g.Section IPC etc.,) (d) Brief description of offence Nir Nit e) rflhether charges have been !it Nit Nit lramed (mention YES or NO) T 0 f answer against (e) above is Nit \it Nit /ES, then give the date on ruhich charges were framed (g) rVhether any Nit Nit Nit \ppeal/Application for 'evision has been filed rgainst the proceedings imention YES or NO) 6),' Cases of conviction i) I declare that I have not been convicted for any criminal offence. (Tick this alternative, if the candidate has not been convicted and wrrte NOT APPLICABLE against alternative (ii) below) OR (ii) I have been convicted for the offences mentioned below: Not Applicable (if the candidate has been convicted, then tick this alterative and score off alternative (i) above, and give details in the table below) Table a) Sase No. Nit Nit Nil (b) Name of the Court Nit Nit Nit (c) Sections of Acts/Codes Nit Nir Nil nvolved (given n.of the Section, E.g.Section IPC etc.,) d) 3rief description of offence fot Nit Nit Nit ruhich convicted Nil Nil ,e) Dates of orders of conviction Nit 0 Punishment imposed Nit Nit Nit (g) Whether any Appeal has Nit Nir Nit been filed against conviction rrder (mention YES or NO) h) f answer to (g) above is YES, Nit Nit Nit Sive details and present ;tatus of appeal (64) I have given full and up- to- date information to my political party about all pending criminal cases against me and about all cases of conviction as given in paragraphs (5) and (6). Not Applicable. (candidates to whom this ltem is not applicable should ctearly wirte NOTAPPLTCABLE tN VIEW OF ENTRIES lN 5 (0 and 6 (i), above ) Note: 1. Details should be entered clearly and legibly in BOLD letters 2. Details to be given separately for each case under different columns against each item. 3. Details should be given in reverse chronologicalorder, i.e., the latest case to be mentioned first and backwards in the order of dates for the other cases. 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying allinformation in compliance of Hon'ble Supreme Court s judgment in W.P.(C) No.536 of 201 1. (7) That I give herein below the details of the assets (movable and immovable etc.) of myself, my spouse and all dependents. A. Details of movable assets: Note: 1. Assets in joint name indicating the extent of joint ownership will also have to be given. No Note: 2. ln case of deposiUinvestment, the details including Serial Number, Amount, date of deposit, the scheme, Name of the BanUlnstitution and Branch are to be given No fi *t ffi;., ,fi, Note: 3. Value of Bonds/share Debentures as per current market value in Stock exchange in respect of listed companies and as per books in case of non-listed companies should be given. No Note: 4. Dependent means parents, son(s), daughte(s) of the candidate or spouse and any other person related to the candidate whether by blood or marriage, who have no separate menas of income and who are dependent on the candidate for their livelihoold. No Note: 5. Details including amount is to be given separately in respect of each investment. Note:6. Details should include the interests in or ournership of offshore assests. Explanation: For the purpose of this Form, the expression "offshore assets" includes, details of all deposits or investments in Foreign Banks and any other body or institution abroad, and dtails of all assets and liabilities in foreign countries": st. Description Self Spouse HUF Dependent- )ependent-2 )ependent-3 No. 1 i) lash in hand 30,000/- 20,000/- Nit Nit Nit Nit ) Details of deposit in Bank Savings accounts(FDRs, Term accounts: 1) S.B.r, Deposits and all other types Chuttugunta cf deposits including saving Branch, Guntur. Nit Nir Nit Nit Nit accounts), Deposits with A,/c.No. Financial lnstitutions, Non- 31 529543606 Balance: Banking Financial 92,000/- 3ompanies and 2) S.B.r, 3ooperative societies and K.L.University :he amount in each such Branch, Jeposit Kuchanapalli A,/c.No. 62205776660 Balance: 42,000t- ii) Details of investment in Bonds,debentures/shares and Nit Nit Nit Nit Nit rnits in companies/Mutual Nit unds and others and the rmount (iv) Details of investment in NSS, Postal Saving, lnsurance policies and Nit investment in any Financial Nit Nit Nir Nit Nit instruments in Post office or lnsurance Company and lhe amount v) Personal loans/advance given to any person or entity including firm, tompany, Trust etc., and Nit Nit Nit Nit Nit Nit cther receivables from Jebtors and the amount vi) Motor Vehicles/ Bajaj CT-100, Regd.No. \ircraftsl/achts/Ship s ^P07D3/.21 iDetails of Make, registration Vodle2015 rumber etc. year of purchase 3ost, 44,0001 Nit Nit Nit Nit Nir and amount) vii) Jewellery, bullion and Gold -1Ogms 3old -20gms y'alue ualuable thing(s) (give Value of of Rs.30,0001 Rs.60,000/- Cetails of weight and value) (Approx) iApprox) Nit Nit Nir Nit viii) Any other assets such as value of claims/interest Nir Nit Nit Nit Nit Nil ix) Gross TotalValue Rs.2,38,000/- Rs.80,000/- Nit Nir Nit Nit W B. Details of lmmovable Assets: Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated Note: 2. Each land or building or apartment should be mentioned separately in this format Note: 3. Details should include the interest in or ownership of offshore assets. sr. Description Self Spouse HUF Dependent-1 Dependent-2 )ependent-3 No. (V), i) Agricultural Land lnturu \mruthaluru (M), Location(s) Survey Nit Nit Nit Nit Nit 3untur(Dt). number(s) 3.No.580-2 Area (total measurement in acres) A.C.1-03cents Nir Nit Nit Nit Nit Whether inherited property (Yes or No) No Nit Nit Nit Nil Nit Date of purchase in case of self-acquired property Jan,2019 Nit Nit Nit Nit Nil Cost of Land (in case of purchase) at the time of Rs.15,00,000/- Nil Nil Nit Nit Nil purchase Any investment on the land by way of Nit Nil Nil Nit Nir Nit development, construction etc. Approximate current narket value Rs.15,00,000/- Nit Nit Nit Nil Nit ii) Non-Agricultural Land: Location(s) Nil Nil Nit Nit Nit Nil Survey numbe(s) \rea (total Nit Nit Nit Nil Nit Nir Treasurement in sq.ft.) W /Vhether inherited Nir Nit Nit Nit Nit Nit rroperty (Yes or No) )ate of purchase in case Nit Nit Nit Nil Nit Nit rf self-acquired property lost of Land (in case of Nir Nit Nit Nit Nit Nil rurchase) at the time of rurchase Any investment on the land Nil Nit Nit Nit Nit Nit by way of development, construction etc.
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