Zsl2jll'} 1,31 P-Rn ; ~ J ~Co~ ~ ;

FORM2A (See rule 4) NOMINATION PAPER Election to the House of the People

General Elections to Loksabha-2019 1S-Warangal{SC)P.C Date Time ROlnitial SI.No. ,...... ZSl2Jll'} 1,31 p-rn ; ~ j ~Co~ ~ ;,.-.. -

STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PART I (To be used by candidate set up by recognized political party)

I nominate as a candidate for Election to the House of the People from the 15-WARANGAL(SC) PARLIAMENTARYCONSTITUENCY.

Candidate's Name CHINTHA SAMBAMURTHY[Father's namejlate Chintha Bayanna. His postal address H.No.16-1-295/2RT, Srinilayam Apartment, Near Last Bus Stop, Saidabad Colony, Opp: Charminar Function Hall, Hyderabad His name is entered at Sl.No.69 in Part No.52 of the electoral roll for Hindupur, Nalgonda Town, Telangana State Assembly constituency comprised within Nalgonda Parliamentary Constituency.

My Name is ~j~'\)/g~ 7O.kJ::ctI/

Sl.No. I Z 9 in Part No S~ of the electoral roll for the

10~ - t,,_jG\Y~Y\Otl \ 1~eS:.+- Assembly constituency.

Date: 25".03.2019 2 , !

PART II

(To be used by candidate NOT set up by recognized political party)

We hereby nominate as candidate for election to the LOK SABHA, 15- WARANGAL (SC) Constituency. Candidate's Name CHINTHA SAMBAMURTHY[Father's name] late Chintha Bayanna. His postal address H.No.16-1-295/2RT, Srinilayam Apartment, Near Last Bus Stop, Saidabad Colony, Opp: Charminar Function Hall, Hyderabad His name is entered at Sl.No.§.2__inPart No.52 of the electoral roll for Hindupur, Nalgonda Town, Telangana State Assemblyconstituency comprised within Nalgonda Parliamentary Constituency.

Particulars of the proposers and their signatures.

Sl. Electoral Roll No.of No. Proposer Full Name Signature Date Part No.of S.No. in Electoral that part Roll 1 2 3 4 5 6 Nil Not Not Not applicable Not Not applicable applicable applicable applicable

N.B. There should be ten electors of the constituency as proposers 3 , 1

PART III

I, CHINTHA SAMBAMURTHY the candidate mentioned in Part I / Part II (which is not applicable) assent to this nomination and hereby declare-

(a) I am a citizen of India and have not acquired the citizenship of any foreign State; (b) that I have completed 65 years of age;

[STRIKE OUT b (i) OR b (ii) BELOW WHICHEVER IS NOT APPLICABLE}

(c) ( i ) that I am set up at this election by the BHARATIYA JANATA PARTY (BJP), which is recognized National Party and that the symbol reserved for the above party be allotted to me. (d) that my name and my father's name have been correctly spelt out above in English (name of the language) (e) That to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State.

*1 further declare that I am a member of the MADIGA-31 which is a SC of the State of Telangana in relation to Nalgonda in that State.

I also declare that I have not been, and shall not be, ****Nominated as a candidate at the present general election/the bye-elections being held simul~aneou.sly,to the House of the People frol more.9it I.antwo Parliamentary Constituencies. ' '~

Date: .03.2019 SIgnature ofCa ' 1

*Score out this paragraph, if not applicable. **Score out the Words not applicable. 4

PART III A (To befilled by the candidate) Whether the Candidate - (i) has been convicted - (a) of any offence(s) under sub-section (1); or (BIG and BOLD LETTERS) : NOT APPLICABLE

(b) for contravention of any law specified in sub-section (2), of section 8 of the Representation of the People Act, 1951 (43 of 1951); or Not applicable

(ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. Not applicable

If the answer is "Yes" , the candidate shall furnish the following information:

(i) CaseiFirst information repOIiNo.lNo Not applicable (ii) Police station (s). Not applicable District(s) Not applicable State(s) Not applicable (iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted Not applicable (iv) Date(s) of conviction(s) Not applicable (v) Court(s) which convicted the candidate Not applicable

(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of fine(s) : Not applicable

(vii) Date(s) of release from prison Not applicable

(viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) Not applicable

(ix) Date and particulars of appeal(s)/application(s) for revision filed Not applicable

(x) Name of the court(s) before which the appeal(s) /application (s) for revision filed : Not applicable

(xi) Whether the said appeal(s) / application (s) for revision haslhave been disposed of or is/are pending Not applicable

(xii) If the said appeal(s)/application(s) for revision has/have been disposed Not applicable

- 5

(a) Date(s) of disposal Not applicable

(b) Nature of order(s) passed Not applicable

(2) Whether the candidate is holding any office of profit under the Government of India or State Government? (No) -If yes, details of the office held.

(3) Whether the candidate has been declared insolvent by any court? (No) -If yes, has he been discharged from insolvency: ....

(4) Whether the candidate is under allegiance or adherence to any foreign country? ili2l - If yes, give details ..... (5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the President? ili.Q}. If Yes, the period for which disqualified (No) (6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State (No) -If yes, the date of such dismissal. (7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of nay goods to that Government or for execution or for executing of works undertaken by that Government? (No) - If yes, with which Government and details of subsisting contract(s). (8) Whether the candidate is a managing agent, or manager or secretary of any company or corporation (other than a cooperative Society) in the capital of which the Central Government or State Government has not less than twenty five percent share? ili2l

(9) Whether the candidate has been disqualified by the Commission under section lOA of the said Act (No) - If yes, the date of disqualification .... Not applicable

Place: Date: 2:5':03.2019 6 , , ., PART IV (To be filled by the Returning Officer) Serial No. of Nomination paper ~t This Nomination was delivered to me at my office at.. t.~.l..p.:.Y.1.. (Hour) on 2-s.j.a.!.'.1.., (Date)by the 'candidate/pioser. ~~' I

Date:.2:5·J·~·l·~q·,. ~

*Score out the world not applicable

PARTV Decision of Returning Officer Accepting or Rejecting the Nomination Paper

I have examined this Nomination paper in accordance with section 36 of the Representation of the People Act, 1951 and decide as follows:

Date . Returning Officer ,I I, AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG WITH NOMINATION PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO THE LOK SABHA (NAME OF THE HOUSE) FROM 15- WARANGAL (SC) PARLIAMENTARY CONSTITUENCY (NAME OF THE CONSTITUENCY) PART A

I,. CHINTHA SAMBAMURTHY [Father'S name] late Chintha Bayanna. His

postal address H.No.16-1-295/2RT, Srinilayam Apartment, Near Last Bus Stop, Saidabad Colony, Opp: Charminar Function Hall, Hyderabad (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under:- Form 26 (See Rule 4A) Please affix your recent passport size photograph here

AFFIDAVITTO BE FILED BYTHE·CANDIDATEALONGWITH NOMINATIONPAPER BEFORE THE RETURNINGOFFICER FOR ELECTIONTO THE LOK SABHA(NAME OF THE HOUSE) FROM 15- WARANGAL(SC)PARLIAMENTARYCONSTITUENCY (NAMEOF THE CONSTITUENCY) PART A

I, CHINTHA SAMBAMURTHY[Father's name] late Chintha Bayyanna. His

postal address H.No.16-1-295/2RT, Srinilayam Apartment, Near Last Bus Stop. Saidabad Colony, Opp: Charminar Function Hall, Hyderabad (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath "ATTESTED"

~.~~____....., K. SURYAN RAYANA a.Com. B.A. LL.B. ADVOCATE & NOTARY H.Mo: 1-1-336/10, Vivek Nagar. Chikkadpally, Hyderabad-500 0.,'.... Telangana. (1) I am a candidate set up by Bharatiya Janata Party (**nameof the political party) / **amcontesting as an Independent candidate. (**strikeout whichever is not applicable)

(2) Myname is enrolled in Hindupur, Nalgonda Town, Telangana State (Nameof the Constituency and the State), at Serial No. 69 in Part No. 52 (3) My contact telephone number(s) is/are 9346821171 and my e-mail id is [email protected] / [email protected] and my social media account(s) (if any) is/are

(i) Face Book: Chintha Sambamurthy (ii) What'sup No. 9346821171 (iii) Twitter: Nil

2 { , , ,

(4) Details of Permanent ACCOlnt Number (PAN)and status of filing of Income tax return:

Total income The financial shown in Income Tax year Return (in Rupees) Sl. For which the No. Name PAN last Income- tax for the last five return has been Financial Years filed completed (as on 31st March) I 2014-15 \ (i) Nil I 2015-16 (ii) Nil 1 Chintha NIL 2016-17 Sambamurthy (iii) Nil 2017-18 (iv) Nil 2018-19 j (v) Nil

2014-15 (i) 432010 1 i (ii) 388870 2015-16 2 DrB.P. AUWPB7097E 2016-17 I (iii) 412870 Pushpalatha 2017-18 , , (iv) 435300 2018-19 (v) . 460160 3 Dependent 1 I NIL NIL NIL Chintha Nithisha~1 . ." :[ I r . , . Note: It is mandatory for PAN hollier to mention PAN and in case of no PAN, ~t

should be clearly stated "No PAN ~lotte.d'" . .'. . '. ,'.' ..I,

(5) Pending Crim~al ca.ses:.1IL_ . .

(i) I declare that there is no pending criminal case against me. (Tick this alternative if there is no. Clir!iminalcase pending against the Candidate and write NOT APPLICABLEagainst alternative (ii) below) OR

(ii) The following criminal cases are pending against me: NIL

(If there are pending crtmmal clses against the candidate, then tick this alternative and score off alternative (i) above, and give details of all pending cases in the Table below) \t .s .,~. . <:,'"'~:~Tei;~1~~~':Ai::: , .ATT!."P:~:\!~,·;;·,.r~.'~o: 1-1-336/10,'Vlye~;~a~a£:,'lJh"':~. :: v TE . :~.;; . ",' ::":',,:~!,i<:'."..ardPaIlY' HYdefa~'II"""O~j)". ' ',. " I _lt~ '"~~~J,;~;;:;i,.Telangs(i ~~ ..

, Table

(a) FIR No. with name of land address NIL Police Station NIL NIL concerned NIL (b) Case No. with Name NIL NIL of the Court (c) Section(s) of concerned Acts NIL / Codes involved NIL NIL (give no. ofthe Section, e.g. Section ...... of IPC, etc.). (d) Brief description of NIL NIL offence NIL

(e) \Whethercharges NIL NIL \havebeen framed NIL (mention YESor ~O) (f) ~fanswer against (e) above is YES, ~hen give the date NIL NIL on which charges NIL -- Iwereframed

(g) iwhether any !,Appeal/Application NIL NIL for revision has NIL !beenfiled against ~he proceedings (Mention YES or NO)

(6) Cases of convtcttorn NIL (Q I declare that I have not been convicted for any criminal offence. (Tick this alternative, if the candidate has not been convicted and write NOTAPPLICABLEagainst alternative (ii) below) OR

(0) I have been convicted for the offences mentioned below: NIL (i) above, and give details in thr Table below)

fable

NIL NIL Case No. NIL (a) I .NIL NIL (b) Name of the Court NIL

(d) Brief description of NIL NIL offence for which NIL convicted NIL (e) Dates of orders of NIL NIL conviction NIL (f) Punishment imposed NIL NIL

(g) ~hether any Appeal NIL NIL ~as been filed against NIL conviction order (Mention YES or NO.

(h) ~f answer to (g) above is YES, give details NIL and present status of NIL NIL \appeal

(6A) I have given full and up-to-datI e information to my political party about all pending criminal cases against}e and about all-cases of conviction as given in paragraphs (5) and (6). - N0l APPLICABLE

[candidates to whom this Itenr- is not applicable should clearly write NOT APPLICABLEIN VIEW OF ENT ES IN 5(i) and 6(i), above]

Note:

, " ,

columns against each item.

3. Details should be given in reverse chronologicalorder, i.e., the latest case to be mentioned first and backwardsin the order of dates for the other cases.

4. Additionalsheet may be added if required.

5. Candidate is responsible for supplyingall information in compliance of Hon'bleSupreme Court's judgment in W.P (CINo.536 of 2011.

(7) That I give herein below the details of the assets (movable and . immovable etc.) of myself, my spouse and all dependents: (8) A. Details of movableassets:

Note: 1. Assets in joint name indicating the extent of joint ownership will also have to be given.

Note:2. In case of deposit/Investment, the details including Serial Number, Amount, date of deposit, the scheme, Name of Bank/Institution and Branch are to be given.

Note:3.Value of Bonds/Share Debentures as per the current market value in Stock Exchange in respect of listed companies and as per books in case of non-listed companies should be given.

Note:4.'Dependent' means parents, son(s), daughter(s) of the candidate or spouse and any other person related to the candidate whether by blood or marriage, who have no separate means of income and who are dependent on the candidate for their livelihood.

Note: 5. Details including amount is to be given separately in respect of each investment. Note: 6. Details should include the interest in or ownership of offshore assets.

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 details of all assets and liabilities in foreign countries';

·ATTE·8TED"

\~.~ . ~ .v, SURVA A·RA"AI~ .,.,:

a.Com.B.A.LL.B.' L ," OJ ADVOCATE & NOTARY . ~ ;~, H.No: 1-1-336/10,Vivek,Naglf, : j '. Chlkkadpally, Hyd.rabad~500020(· .': . t Telangana. " ;. ,"

~:..." Self Spouse Depen S. No. escription dent-!

Rs.l,OO,OOOj- Rs.50,OOOl : (i) Cash in hand Rs.l ,oo,booj- 1) Rs.2,OOOj-· Details of deposit in 1) Rs. l(DOO/-in 1) Rs.I0,OOO j-in (ii) Savings/Account of Current Account of savings Accoun ank accounts SBI, Safthosh Nagar, ndhra Bank, Kothur, of Axis Bank, (FDRs, Term HYderaiad R.R. Dist. anjara Hills, Hyderabad Deposits and all 2) Rs.1900j-in Savings2) Rs.28,600/-in other ~es of ccount of Andhra Current Account of 2) Rs.500j-i I deposits including Bank, l¥ampally, HDFC, Shadnagar, Indian Oversea Hyderabad. Mahabubnagar. Bank, ML saving accounts), Quarters, Deposits with Hyderabad Financial nstitutions, Non- anking Financial Companies and Cooperative societies and the amount in each such deposit NIL' (iii) Details of investment NIL NIL . Bonds, Debentures/ Shares and units in companies/Mutual Funds and others and the amount. 1) LIC assured (iv) Details of investment . NSS, Postal NIL LIC assured sum of sum of Rs.2 Saving, Insurance RsAOOOO/ - lakhs. Policies and 2) LIC assured nvestment In any sum of Rs.l lakh Financial instruments in Post office or Insurance Company and the amount (v) Personal loans / NIL NIL NIL advance given to any erson or entity .ncluding firm, company, Trust etc. and . other eceivables from debtors and the amount.

·AT·TE'STED" ~. S, .0-

, ~. . ::.,...'1<\';&' 'i"'~ a.Com-"."",'". B.A. LL.B. ADVOCATE & NOTARY H No' 1_1-336/10, Vivek Nagar, Chlkk~dPa"y.Hyderab8d-5GO. 020. Tet.ngana.

<, ", (vi) Motor Vehiclesj NIL TATA Indigo Manza Honda Activa IAircrafts/ Yachts/ car NO.AP09CC 3906 No.TS lIEN Ships (Details of date of purchase 9412 taken on Make, registration 3/2011 loan of number. Etc. year of Rs.8,00,000/ - Rs.80,000/- purchase and date of amount) purchase 2018

(vii) w-ewellery, bullion 30 grams 100 grams 200 grams and valuable thing(s) Rs.90,000/- Rs.3lakhs Rs.6,00,ooo/- (give details of weight and value)

(viii) Any other assets such NIL NIL NIL as value of claims/interest

(ix) Gross Total value Rs.l,92,OOO/- Rs.12,78,600/- Rs.lO,32,500 /-

B. Details of Immovable 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.

S.No Description Self Spouse Depen dent-l

(i) lAe:ricultural Land NIL NIL NIL Location(s) Survey number(s) IArea (total measurement NIL NIL NIL ~n acres)

IWhether inherited NIL NIL NIL tproperty (Yes or No)

Date of purchase in case NIL NIL NIL of self - acquired property

-ATTESTED"

\.L_, .-..---....~.. -c:-:t~ '-/~."...., '~'.;' J . (' .I. Ii. SYRYA ARAVAN I.Com. B.A. LL.B. . ADVOCATE & NOTARY ," . '...)r;-l'l ..' ' ..~ H:No: 1-~-336'tO, Vivek.Nagar, .~. \ ', Chlk_lIly. Hyderabad-500 020. ·:":l.:t~l"~; Telangana. $

NIL NIL Cost of Land (in case NIL of purchase) at the !time of purchase NIL NIL NIL \Any Investment on the Iland by way of development, construction etc. NIL NIL !Approximate Current NIL hnarket value I NIL NIL NIL (ii) lNon-Ae:ricultural Land Location(s) Survey number(s) NIL NIL (Area (total measurement NIL ~n sq. ft.) NIL NIL IWhether inherited NIL IProperty (Yes or No) NIL NIL Date of purchase in case NIL of self - acquired property NIL NIL Cost of Land (in case NIL of purchase) at the ~ime of purchase NIL NIL !AnyInvestment on the NIL ~and by way of development, construction etc. NIL NIL \Approximate current NIL !market value I NIL NIL NIL (iii) Commercial Buildine:s (including apartments) -Location(s) -Survey number(s) I

NIL NIL !Area (total measurement NIL ~ sq. ft.) NIL NIL Built-up Area (total NIL ~easurement in sq.ft.) - . ~~ ~ " ~ " ..,0-rL ~~ , ,> .. -~ TTESJ~'I","'j~\,l... '/ .'" ::,''ii_ r..;*, L_~\"'C1lCI&lAlU- " ;'O~~~ 6.co",.6.,.~~ -1:"':;',' _,_':< ,Gl~. ADVOCATE' ),~, . =- ~O"~ A' : 0 '·~Ik""'IIy•..,.21 -- .".:; - '.~;,lL~~, L :TE & . ~ ",.9,*'t>, .-:/::!i;,~<",:~.£~:\l,~~i.~.\""G(J"s:\~ ·.~_'N· :,fiJ .!~··L.:~J.

,}~~~~ ~'t.'S-rt'(~./;~..,: . . ,"_ '~'.; !Whether inherited NIL NIL NIL jproperty (Yes or No)

Date of purchase in case NIL NIL NIL of self - acquired· property

Cost of property (in case NIL NIL NIL of purchase) at the time of purchase

Any Investment on the NIL NIL NIL property by way of development, construction etc.

~pproximate current NIL NIL NIL market value (iv) Residential Bufldfnzs NIL NIL NIL (including apartments): -Location (s) -Survey number(s)

~rea (Total NIL NIL NIL hneasurement in sq. ft) Built up Area (Total NIL NIL NIL hneasurement in sq. ft.)

!Whether inherited NIL NIL NIL IProperty (Yes or No)

Date of purchase in case NIL NIL NIL of self - acquired property

Cost of property (in case NIL NIL NIL of purchase) at the time of purchase

!AnyInvestment on the NIL '·NI!). .' A ,> NJL i and byway of :p~. development, " ~. construction etc. .. !Approximate current NIL ,NIL ~ ,NIL lmarket value .. " ";,-~:':~~i0- " ~~. ~:

.( NIL (v) Others (such as interest NIL NIL ~n property)

(vi) [I'otal of current market NIL NIL NIL Ivalue of (i) to (v) above

(i) I give herein below the details of liabilities/dues to public financial institutions and government:-

(Note: Please give separate details o~name of bank, institution, entity or individual and amount before each item) I s. Description Self Spouse Dependent-! ~o. (i) Loan or dues to NIL NIL Took educational loan of !Bank/Financial Rs.6,60,000/- from rOB, Himayatnagar, Hyderabad Institution's' in 2014 for studying MBA., Name of Bank or Financial Institution, iAmount outstanding, Nature of loan

~oan or dues to any NIL NIL NIL other individuals / entity other than mentioned above. Name(s), Amount outstanding, nature of oan

IAnyother liability NIL NIL NIL

Grand total of liabilities NIL NIL Rs.6,60,OOO /- (ii) Government Dues: (A) Has the Deponent been in occupation of ~/NO • Dues to accommodation provided by the Government at (Pl. tick the departments dealing any time during the last ten years before the appropriate Jwith alternative) Government date of notification of the current election? accommodation (B) If answer to (A) above is YES, the following declaration may be furnished namely:- (i) The address of the Government accommodation: ...... ~.C!"~ .. "4\l?~'.~~···· ......

(ii) There is no dues payable in respect of above Government accommodation, towards- (a) rent; (b) electricity charges; (c) water charges; and (d) telephone charges as ...... (date) [the date should be the last date of the third' month prior to the month in which the election is notified or any date thereafter]. Note- 'No Dues Certificate' from the agencies concerned in respect of rent, electricity charges, water charges and telephone charges for the above Government accommodation should be submitted.

(iii) Dues to department dealing with ",Iv Government transport ""L ,..., \ \... t-l'L (including aircrafts and !helicopters)

Self Spouse Dependent-l

;.... - "1.., NIL NIL!" . "NIL (iv) Income Tax dues J' " . ' .- .~"~ .r NIL ,NIL NIL (v) GST dues ." ~ t- .;

.. .\ .. ... , NIL (vi) !Municipal/Property tax NIL NIL dues

(vii) lArryother dues NIL NIL NIL

(viii) Grand total of all NIL NIL· NIL Government dues NIL \Whether any other I NIL NIL (ix) iabilities are in dispute, ~f so, mention the amount involved and the authority before which it is pending.

(:3} Details of profession or occupa tion: (a) Self: Social work (b) Spouse: Doctor

(9A)Details of source(s) of

income: (a) Self: Social work

(b) Spouse: Doctor.

(9B) Contracts with appropriate Govbrnment and any public company or companies

(a)

(b)

(c)

·ATTESTED" (10) My educational qualification is as under:

Passed Intermediate in 1976 from Govt. Junior College, Nalgonda.

Discontinued B.Com., from Nagarjuna Degree College, Nalgonda

(Give details of highest School j University education mentioning the full form of the certificatej diplomaj degree course, name of the School /Collegej University and the year in which the course was completed.)

PART-B

(11). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A:

1. Name of the candidate CHINTHA SAMBAMURTHY 2. Full postal address H.No.16-1-295j2RT, Srinilayam Apartment, Near Last Bus Stop, Saidabad Colony, Opp: Charminar Function Hall, Hyderabad

3. Number and name of the 15-WARANGAL(sc), LOK SABHA,TELANGANA constituency and State STATE

4. Name of the political party which BHARATIYAJANATAPARTY set up the candidate (otherwise write 'Independent')

5. iI'otal number of pending criminal NIL cases

6. [l'otal Number of cases in which NIL convicted 7. \PANof IYear for which last ~otal Income Shown Income Tax Return filed

(a) Candidate NIL NIL NIL (b) Spouse iAUWPB7097E ASSTYEAR2018-19 Rs.460 160j- (c) Dependent-1 NIL NIL NIL

8. Details of Assets and Liabilities (including offshore assets) in rupees

, " .' ,..

NIL B. Immovable Assets I NIL NIL I Purchase Price of NIL NIL NIL self-acquired 'mmovable IProperty

~I Development/ cons NIL NIL NIL ruction cost of immovable property after Purchase (if applicable)

III !Approximate NIL NIL NIL Current Market I Price - (a) Self- acquired assets (Total Value) (b) Inherited assets (Total Kralue) c) Liabilities (i) Government dues NIL NIL NIL (Total)

(ii) Loans from Bank, NIL NIL Rs.6,60,OOOj- Financial Institutions and others (Total)

10. Liabilities that are under dispute. , I (i) Government dues NIL NIL NIL (Total) ,

(ii) Loans from Bank, NIL NIL NIL Financial nstitutions and others (Total) .v- ". ~

11.Wghest educational qUa~fications:' . Passed Intermediate in 1.976,t't.G~vi.Junior College,lfljlgo Discontinued .Cam.--Z.' ,·f om Na a,r.juna Degree. College, Nalgon ,

" t"~ ~URYAN I AYANP,s M~TTESTED 'ADVOCATE l'~O';AARY"" ·~·tNo1:-1-336/101,Vivek Nag"r .: ChikkadpaUy, Hyd"rabad-500 020. Telangana. (Givedetails of highest School j University education mentioning the full form of the certificatej diploma/ degree course, name of the School jCollegej University and the year in which the course was completed.)

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 and no part of it is false and nothing material has been concealed there from. I further declare that:- (a) there is no case of conviction or pending case against me other than those mentioned in items 5 and 6 of Part A and B above; (b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 7 and 8 of Part A and items 8, 9 and 10 of Part B above.

~ Verified at ..~ ':t.~~~~.~~ this the z. 'i)' day

Note: l. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations.

Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public. Note: 3. All columns should be filled up and no column to be left blank. If there is no information to furnish in respect of any item, either "Nil" or "Not applicable", as the case may be, should be mentioned. Note: 4. The affidavit should be either typed or written legibly and neatly.

Note: 5. Each page of the Affidavit should be signed by the deponent and the Affidavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavitis sworn.

'" t"-",'1. '. it'~,~,. r -. . .. .a.Com. B.A. ll.S. ,e ~D"OC.ATE" NOTARY tt·t:ol~;·.,~~1-3,36/10;Viv.kNagar, Chlk~adpaHy.;Hyderabad-IOO 020. ',< '., -, Tetartga,na. ... . ", .,0,_: • j. -{ ", _.' ~ ~ ~~-. ~~' t," ;~.,') , ...... ',' ,~_,:" FORM OF OATH OR AFFIRMATION (ARTICLE 84(A) OF THE CONSTITUTION OF INDIA) (Tobe made by a candidate for election to Parliament)

I, CHINTHA SAMBAMURTHY, having been nominated as candidate to fill a seat in the Council of states ( * House of the people) do swear in the name of God/Solemnly affirm that I will bear true faith and allegiance to the constitution of India as by law established and that I will uphold the sovereignty and integrity of India.

Signature and n letters of the candidate.

Sworn in the name of God/Solemnly affirmed by Shri/Shrimathi------at

------(Place) at------(hour) this the ------day of ------

20 19----before me.

Signature of authorized person Name and designation and seal.

(CERTIFICATE FOR RECIEPT OF OATH) (Tobe handed over to the candidate by the authorized person)

Certified that------(name) a candidate for election to the Council of

states ( * House of the people) has made and subscribed the oath/affirmation as required

by the Constitution of India before me at my office at ------(hour) on ------

date.

Signature of authorized person Name and designation and seal. Date: "Scoreout which is not applicable.

N.B: This form should be supplied to the candidates both in English and in the Official Language of the state/Union Territory. ""AT-T£,STE,D" <=._. ..~~ .A. S1:JRYANA AYANA-, \~ B;Com. B.A. LL.B. . ADVOCATE & NOTARY H.No: 1-1-336/10, Vivek Nagar, Chlk~adp.lly,Hyderabad-500 020. Telangana. Format C-l.

for Candidate to publish in News papers, TV) Declaration about Criminal Cases (As per the judgement dated 25th September, 2018, of Hon'ble Supreme Court in lVP (Civil) No. 536 of 2011 (Public Intrest Founda_tion & Ors. Vs Union of India & Anr.)

Name of the Candidate: CHINTHA SAMBAMURTHY.

Name of the Political Party: BHARAHTIYA JANATHA PARTY

(Independerit Candidate should write (Independent)

Name of Election: HOUSE OF THE PEOPLE.(PARLIAMENT)

Name of Constituency: lS-WARANGAL (SC)

I, CHINTHA SAMBAMURTHY, a candidate for the above mentioned election, declare for public Information the following details about my criminal cases antecedents.

S1. Pending Criminal Cases Details about cases of No. conviction for criminal offences. Name of the Case No. and Section(s) of Acts Name of Description of 'Court status of case. concerned and Court & offence(s) brief description date(s) of punishment of offencets). order(s) imposed. 1 NIL NIL NIL NIL NIL

• In the case to council to states or election to Legislative Council by MLAs,mention the election concerned in place of name of Constituency. Note: (i)Details should be given separately for each case in separate rows. (ii)The matter in newspaper should be in font size of at least 12.

. ". ·~ATTESTED \C. K~SAJRYA :RAYAN'A I.Com. SA LI...B.\. ADVOCATe & NOTARY H:No: 1~1-336/fO,Vi".k Nagar, . ch.ikka~.pall~,Hy. 6itilbad-500 020. , .",. '. TltiftBana. _" -.":." ..

18 I

Format C-2 (For Political party to publish in website, newspapers, TV) Declaration about criminal antecedents of candidates set up by the party. (As per the judgment dated 25th September, 2018, of Hon'ble Supreme Court in WP (Civil) No. 536 of2011 (Public Interest Foundation & Ors. Vs Union of India & Anr.) Name of the Political Party: BHARATHIYA JANATHA PARTY. Name of the Election: HOUSE OF THE PEOPLE.(PARLIAMENT) Name of the State f UT: TELANGANA.

1 2 3 4 5 Sl Name of Name of the Pending Criminal Cases Details about cases of No. the Constituency Conviction for Criminal Candidate Offences Name of Sections of Name of Court Description the Court, the Acts & date(s) of of Offence(s) Case No. & concerned & Order(s). & status of brief Punishment the Case(s) description of imposed. Offence(s) 1 NIL NIL NIL NIL NIL NIL

*in the case of election to Council of States or election to Legislative Council by MLAs, mention the election concerned in place of name of Constituency. Note:- (i)The above information shall be published state wise for each StatefUT. (ii) The matter in newspapers should be published in font size of at least 12.

19 .. !

FORMATC-3

OFFICE OF RETURNING OFFICER.

Name of the Constituency: lS-WARANGAL (SC).

Name of the State: TELANGANA.

Name of the Election: HOUSE OF THE PEOPLE.(PARLIAMENT)

It is to inform that as pr the judgment dated 25th September, 2018, of Hon'ble Supreme Court, in WP(Civil)No. 536 of 20 l Iff'ublic Interest Foundation & Ors Vs. Union of india & Anr., and the direction in the Commission's Letter No. 3/ER/2018/SDR, dated 10-10- 2018, all the candidates with criminal cases-either pending cases or cases of conviction in the past, are required to publish declaration regarding such criminal cases in newspaper and TV channels on three occasions during the period from the day following the last date for withdrawal of candidature and two days before the date of poll. Publishing declaration in TV channels should be completed before the period of 48 hours ending with the hour fixed for conclusion of poll.

Since you, Shri. CHINTHA SAMBAMURTHY, mention the name of the Candidate) a candidate nominated for the above mentioned election, have declared information about criminal cases in items 5/6 form-26, your are required to publish information in newspapers having wide circulation in the constituency area and on TV channels on atleast three occasions each as mentioned above. The format for publishing the information is enclosed herewith. It is also informed that copies of the newspapers publishing the information about criminal cases should be submitted to the District Election Officer along with the account of election expenses under section 78 of Representation of People Act, 1951.

Signature Date:

Name of the RO/ARO.

Signature of Candidate.------

Note: Once copy of this should be given to the candidate and one copy retained with RO.

•AT1'~·STE~~·,:, ~.~~~~ ,;,}t....~ ~t";~,t~.,..(:~~~"' , """ -, B.Com. s:B.A. ;lL.8'';..\, ~ , ADVOCATE g. NOTARY H:No:>~.,1-33611.0Vivek; Nagar, En_red 'n The NotariII Registar ChlkkadpaIlYi·,HY.cter.mad-$OO'020. .'. Tetang'8na." ~;.··Year~'1S\. No:->-b .page No. \

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