ANNEXURE IX-C I FORM 26 B ( See Rule 4 A ) BEFORE THE NOTARY PUBLIC : BONGAON

AFFIDAVIrT TO BE FURNISHED BY THE CANDIDATE BEFORE THE RETURNING l OFFICER FOR FbE CTION TO WEST BENGAL LEGISLATIVE ASSEMBLY, FROM bh 97- GAIGHA+A4ABsEMBLY CoNsnIuENcY. Bc1 I, ,Son of Late Pramatha Ranjan Thakur, fl aged about 58 years, resident of Village & P.o. - , P.s. - Gaighata, Dist. - North 24 Parganas candidate at the about Election, do hereby solemnly affirm/ state on oath as under :-

a 1. I am not accused of any offence (s) punishable with imprisonment for two years or more in a pending case (s)in which a charge (s) her/ have been framed by the court (s) of ' competent jurisdic tion. I] Contd ...... If the deponent is accused of any such offence(s) he shall furnish the following information :

CaseIFirst Information report No/ Nos. Not Applicable. Police Station (s) ... Not Applicable. District (s) ..... Not Applicable. State (s) Not Applicable. (iii) Section (s) of the concerned Act (s) and short description of the ofcence (s) for which the condidate has been charged .. Not Applicable. (iv) Court (s)which formed the Charge (s) .. Not Applicable. (v) Date (s) on which the Charge (s) was/ were framed .. Not Applicable. (vi) Whether all or any of the proceeding (s)have been stayed by any Court (s) of Competent Jurisdiction. Not Applicable.

2. I have not been convi cted of an offence (s) other then any offence (s) referred to in sub-section (1) of sub-section (2),or covered in sub-section (3) of Section 8 of the Represen tation of the people Act, 1951 (43 of1951) and sentenced to imprisonment for one year or more. I (i) Case / First Information report No,/ Nos. Not Applicable. (ii) Court (s) which punished Not Applicable. (iii) Police Station (s)...... Not Applicable. District (s)...... Not Applicable. State (s) Not Applicable. (iv) Section (s) of the concerned Act (s) and short \ description of the offence (s) for which the 1 candidate has ever been charged .... Not Applicable. (v) Date (s) on which the sen tence (s) waslwere pronounced .. Not Applicable. (vi) Whether sentence (s) has / have been stayed by any court (s) of Competent Jurisdiction .... Not Applicable.

Date :

VERIFICAT

\\ b. I, the above-named deponent. do hereby venfy and declare that the contents of this ? Affidavit are and correct to the best of my knowledge and belief, part of it is false and nothing I' material has been concealed thereiun . Verified at Bongaon, ------_-- --_. I _L.