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(*S-:# ee o t6 tf d 5' err*r strr. ANDHRA PRADESH 643137 s. r.ro. -Qd,fi ir- 100/=*ot&o I os I ao 8 t .,ANircA SRINIVAS Viroyoadf LtcENCED srAMP vENDoR \) / / Lic. No.0621-001i2017, Rl. No. 27nu8 For Whom Plot No. 165, New P&T Colony,Patamata, . FORM 26 VIJAYAWADA-1O, Ph : 9346641586. (See Rule 4A) r q AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG WITH NOMINATION PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO THE HOUSE OF THE PEOPLE ( NAME OF THE HOUSE) FROM VIJAYAWADA PARLIAMENTARY CONSTITUENCY &'i (NAME OF THE CONSTITUENCY) d T E It (*S-:#" '/-t by I {i,,1$:'ffi4.t1 t! PART-A I DILEEP KILARU **son/da*ghte#rvife of MADHAVA RAO Aged 48 years, resident of 59A- g-7141A3, Flat No.l, First floor, Aruna Residency, RTC Colony, Ist Road, Near Sai Baba Temple, Vijayawada-520008, a candidate at the above election, do hereby solemnly affirm and state on oath as under :- (l) I am a candidate set up by BHARATIYA JANATA PARTY (** name of the political party)/** (**strike out whichever is not applicable) Gr- (Z) My name is enrolled in Assembly constituency Vijayawada East, Andhra Pradesh (Name of the constituency and the State), at Serial No 632 in Part No 72. (3) My contact telephone number (s) isiare 93102911 19 and my e- mail id (if any) is [email protected]. And my social media account(s) (if any) is/are (i) Facebook Id: DILEEP KILARU (ii) Face book Page: DILEEP KILARU (iii) WhatsaPP :9310291119 (4) Details of Permanent Account Number (PAN) and status of filing of Income Tax return. S.No Names PAN The financial Total income shown year for which in Income Tax the last Return (in Rupees) income tax for the last five return has financial years been filed completed (as on 31't March) ADOPK6OO5A 2017-18 (i) 488s l0 L. {+ 2016-17 (ii) 1289790 J &kKILARU \J ;\ 'lzt $l< t{.1 lyw ffiq&MM-EPu "q€m .! J 20ts-16 (iii) 1077240 2014-15 (iv) 10s0000 2013-14 (v) I 100000 2 Spouse AGUPKO944K (i) Not applicable AMARESWARI KILARU (ii) Not applicable NIL (iii) Not applicable (iv) Not applicable (v) Not applicable J HUF (lf Candidate is Not Applicable Not (i) Not applicable Karta/Coparcener) Applicable (ii) Not applicable (iii) Not applicable (iv) Not applicable (v) Not applicable 4 Dependent I NO PAN Not (i) Not applicable SARUHA LAKSHMI ALLOTED Applicable (ii) Not applicable KILARU (iii) Not applicable (iv) Not applicable (v) Not applicable 5 Dependent 2 NO PAN Not (i) Not applicable RAJA SARVAGNYA ALLOTED Applicable (ii) Not applicable KILARU (iii) Not applicable (iv) Not applicable (v) Not applicable 6 Dependent 3 Not Applicable Not (i) Not applicable Applicable (ii) Not applicable (iii) Not applicable (iv) Not applicable (v) Not applicable is mandatory for PAN holder to mention PAN and in case of no PAN it should be \ # T}d.'NO PAN ALLOTED'" ,lrt '( d;W.,,r-# W ry ,s (5) Pending Criminal cases (i) I declare that there is no pending criminal case against ^"r,/ (Tick this alternative if there is no criminal case pending against the candidate and write NOT APPLICABLE against alternative (ii) below). 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 all pending cases in the table below.) TABLE (a) FIR No. with name and address of Not Not Not police station concerned the Applicable Applicable Applicable (b) Case no. with name of the Court Not Not Not Applicable Applicable Applicable (c) Section(s) of concerned Acts/Codes Not Not Not involved (give no., of the section, e.g. Applicable Applicable Applicable section......of IPC, etc.) (d) Brief Description of offence Not Not Not Applicable Applicable Applicable (e) Whether charges have been framed Not Not Not (mention YES or NO) Applicable Applicable Applicable (0 If answer against (e) above is Yes Not Not Not give date on which charges then the Applicable Applicable Applicable were framed. (e) Whether any appeali application for Not Not Not revision has been liled against the Applicable Applicable Applicable proceedinss (mention YES or NO) (6) Cases of conviction (i) I declare that I have not been convicted for any criminal of"n""./ (Tick this alternative if the candidate has not been convicted and write NOT APPLICABLE against alternative (ii) below.) OR ,ffi" been convicted for offences ntentioned below: NOT APPLICABLE #\Y.sns\A o/rt bW iiiffi.i5i'7 'ffir':'$$qk',a5 r:. (If the candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the table below.) Table (a) Case No. Not Not Not Applicable Applicable Applicable (b) Name of the Court Not Not Not Applicable Applicable Applicable (c) Sections of Acts/Codes Not Not Not involved (give no. of the Applicable Applicable Applicable section, e.g. Section ....... of IPC, etc.) (d) Brief description of Not Not Not for which offence Applicable Applicable Applicable convicted (e) Dates of orders of Not Not Not conviction Applicable Applicable Applicable (0 Punishment imposed Not Not Not Applicable Applicable Applicable (g) Whether any appeal has Not Not Not been filed against the Applicable Applicable Applicable conviction order (mention YES or NO) (h) If answer to (g) above is Not Not Not YES, give details and Applicable Applicable Applicable present status of appeal (6A) 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 IN VIEW OF ENTRIES IN 5(i) and 6(i), above (Candidates to whom this item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), above) Note: l:i;'l,i?-*. l. Details should be entered clearly and legibly in BOLD letters. : ( :r;ji;-;;;.'i\ft[,\,,3,""T',':"::: , ^-"-i'r'1l,}Y, Dofoils fn re}ronirran given separatervsonorqfolrr forfnroqah each casepqsa underrrndordiffcrpnf different corumnsr.n against .\each item. t/zt 3. Details should be given in reverse chronological order, i.e. the latest case to be mentioned first and baclrwards in the order of the dates for the other cases. 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme court's judgment in W.P (C) No. 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: A. Details of movable assets : Note: l. Assets in joint name indicating the extent of joint ownership will also have to be given Note:2. ln case of deposiVlnvestment, the details including Serial Number, Amount, date of Deposit, the scheme, Name of the Bank/lnstitution and Branch are to be given. 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. Note:4. 'Dependent' means parents, son(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' I by $.. (.: .-..I r u/, t S.No Description Self Spouse HU Dependent I Dcpen Dcpen F dent 2 dent J (i) Cash in hand Rs.10,00,000/- Rs.2,00,000/- NA NIL NIL NA (ii ) Details of deposit VIJAYA BANK HDFC Bank NA NIL NIL NA in Bank accounts Savings A/c No. Savings.A/c No. (FDRs, Term 41940101 1000738 08r 1 153005961 1 Deposits and all Rs.8.00 lakhs Rs.5,00,000/- other types of deposits including ICICI Bank NIL NA NIL NIL NA Savings No. saving accounts), A/c 42820 I 50003 1 Deposits with Rs. 16.89 lakhs Financial lnstitutions, Non- HDFC Bank banking financial Savings A/c No. NIL NA NIL NIL NA cooperative and 08111530049604 cooperative Rs.3.l2lakhs societies and the amount in each LAKSHMI VILAS such deposit BANK Current A/c No. NIL NA NIL NIL NA 0801 360000005216 Rs.20.00 lakhs (ii i) Details of Madhava Hytech Madhava Hytech Madhava investment in Engineers Pvt. Ltd. Engineers Pvt. Hytech Bonds debentures Ltd. NA Engineers PW. NIL NA /shares and units 3,78,137 shares Ltd. inCompanies/mut 61,485 shares ual funds and Value 60,000 shares Rs.3,78, 13,7001- others and the Value Rs.61,48,500/- amount. Value Rs.60,00,000/- SLS Infrastructure SLS Infrastructure SLS (India) Pvt. Ltd. (India) Pvt. Ltd. Infrastructure I1,010 shares I 1,010 shares NA (lndia) Pvt. NIL NA Ltd. Value Rs.l1,01,000/- Value Rs. I 1,01,000/- 20 shares Value Rs.2.000/- (iv) Details of Insurance policy NIL NA NIL NIL NA investment in ICICI NSS, postal PRUDENTIAL LIFE Saving, insurance INSURANCE policies and roI furcstment in any Rupees l0 lakhs .*;1,- ""\, ' . ,i 0,. \.,,;tl .;t "f ,/rt I G +' ..)' .*: I, vi*t;,; ,ffi vy '-i\ -i-, \ x?i *w ff4rffi.,:.
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