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*T a Form 26 GaQgo rnnere (See rule 4A) cD 785477
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AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG
PAPER BEFORE THE RETURNING OFFICER FOR ELECTION
LEGISLATIVE ASSEMBLY (NAME OF THE HOUSE) FROM I . coNSTITUENCYCNAME OF THE CONSTITUENCY)
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\ h '3. t{0, E2b i ! i l:,.;r<:.-l i,/. "-.\ _ ,:- F.i;.:i,i., !-l-.; tt"',' | ,- i :ii,c;i:lliaitdaihii +wDv' \ ' ---' '.:;Y.cii: & llotary ::, :{ l'::-tijt Disi., Kerala, E ': _...-.. ::-.,-. :i!. K 1 734 l19L:a\ . ...: 1..,:.i.1 ? r liir. E t No.legsl 3..... Darp ..*':.?.:..Q.-o..(.? Rs..roe.(...... a...... - -. Name .. .. . :raqcJ'.-e+ee""' Name .....S=+.=i.a't-srt":J House alo.gld doroBil x"r, I Por,Otn1 ""a6.t''t"ct-'nn* !t:fr. o:lced.qwt't PARTA I Adv. JOSE TOM ** son/daughte#+ift of THOMAS Aged 62 years, resident of PULIKUNNEL HOUSE, POOVATHODU P.O, KOTTAYAM DIST, KERALA STATE 686578 (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under:-
(1) I am a candidate set up by KERALA CONGRESS (M) (**name of the political party) / * xam endent+andidae.-(* * strike out whichever is not applicable)
(2) My name is enrolled in 093 PALA ASSEMBLY CONSTITUENCY, KERALA STATE Qrlame of the Constituency and the State) at Serial No 434.IN part No 145
(3) My contact telephone number(s) islare 9447466145 and my e-mail id (if any) is [email protected] and my social media account(s) (if any) is/are (D 9447466145(WhatsApp) (ii) . NIL (ii i) NIL
4) Details of Permanent Account Number (PAN) and status of filing of Income Tax return: Sl. No. Names PAN The financial Total income shown in year for which Income-tax return (in the last Income- Rupees) for the last five tax return has Financial Years (as on the been filed 3l.t March) l (I) NOT APPLICABLE Self (ii) NOT APPLICABLE Adv.JOSE TOM NO TAXABLE AORPT7383N INCOME - (iii) NOT APPLICABLE NOT SUBMITTED (iv) NOT APPLICABLE (v) NOT APPLICABLE Spouse (I) NOTAPPLICABLE JESSIAMMA ( ii,) NOT APPLICABLE MICHAEL NO TAXABLE FF"TPM3466K INCOME. (iii) NOT APPLICABLE NOT SUBMITTED (iv) NOT APPLICABLE (v) NOT APPLICABLE HUF (If the (i) Nor APPLTCABLE Candidate is (ii) Nor APPLTCABLE Karta or Coparcen-er) NOT APPLICABLE NOT APPLICABLE (iii) NoT APPLICABLE (iv) NOT APPLIcABLE (v) NOT.APPLT94BLE =+#- .slp 4. Dependent- 1 (i) NOT APPLICABLE
(ii) Nor APPLTCABLE
AMAL TOM JOSE (iii) NOT APPLICABLE No PAN allotted NIL (iv) NOT APPLICABLE (v) NoT APPLICABLE
(i) NoT APPLICABLE Dependent-2 (ii) NOT APPLICABLE 5. (iii) NA NA NA NoT APPLICABLE (iv) Nor APPLTCABLE (Y) NoT APPLICABLE
Dependent-3 (i) Nor APPLTCABLE 6. (ii) NoT APPLICABLE NA NA NA (iii) NoT APPLICABLE (iv) Nor APPLICABLE (v) NOT APPLICABLE
Note: It is mandatory for PAN holder to mention PAN and in case of no PAN' it should be clearly stated "No PAN allotted".
(5) Pending criminal cases
(i) I declare that there is no pending criminal case against me. / (Tick this alternative if there is no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ii) below) OR
intherabret":b ,,*g
-N,W>'-".-' Table (a) FIR No. with name and address of Police Station NOT NOT APPLICABLE NOT APPLICABLE concerned APPLICABLE
(b) Case No. with Name NOT APPLICABLE NOT APPLICABLE of the Court NOT APPLICABLE
(c) Section(s) of concerned Acts/Codes involved the NOT (give no, of NOT APPLICABLE NOT APPLICABLE Section, e.g. APPLICABLE Section.,.....of IPC, etc.).
(d) Brief description of NOT offence NOT APPLICABLE NOT APPLICABLE APPLICABLE
(e) Whether charges have been framed (mention YES or NOT APPLICABLE NOT APPLICABLE NO) NOT APPLICABLE
(0 If answer against (e) above is YES, then give the date on which charges were NOT NOT APPLICABLE NOT APPLICABLE framed APPLICABLE
(g) Whether any Appeal/Application for revision has been filed against the NOT NOT APPLICABLE NOT APPLTCABLE proceedings APPLICABLE (Mention YES or NOI,..; '.\--'.'.'-..: , i"\: \)\ \U toY.=t ,;,1.,tg"'.'t s.j,-J+J--4F-Iv\ (6) Cases of conviction
(i) I declare that I have not been convicted for any criminal offence r' (Tick this alternative, if the candidate has not been convicted and write 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 alternative and score off alternative
(i) atrove, and give details in the Table below)
Table
(a) Case No, NOT NOT APPLICABLE NOT APPLICABLE APPLICABLE (b) Name of the NOT Court APPLICABLE NOT APPLICABLE NOT APPLICABLE (c) Sections of Acts/Codes involved (give no. of the NOT NOT APPLICABLE NOT APPLICABLE Section, e.g. APPLICABLE Section.,..... of IPC, etc.). (d) Brief description of NOT offence for which NOT APPLICABLE NOT APPLICABLE convicted APPLICABLE
(e) Dates of orders of NOT APPLICABLE conviction NOT APPLICABLE NOT APPLICABLE imposed NOT (f) Punishment NOT APPLICABLE NOT APPLICABLE APPLICABLE G) Whether any Appeal has been filed against NOT conviction order NOT APPLICABLE NOT APPLICABLE APPLICABLE (Mention YES or No)
(h) If answer to (g) above is YES, give NOT APPLICABLE details and present NOT APPLICABLE NOT APPLICABLE statilS bf appeal
/^J (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 ofconviction as given in paragraphs (5) and (6).NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), above
Icandidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), abovel Note: L 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 chronological order, 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 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 indicatingthe extent ofjoint ownership will also have to be given.
Note: 2. ln case of deposit/lnvestment, the details including Serial Number, Amount, date o1- deposit, the scheme, Name of Bank/lnstitution 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) ofthe candidate or spouse and any other person related to the candidate whether by blood or maniage, who lave no seoarale means of income and who are dependent on the candidate for their |re|lnooc.
Note: 5. Details including amount is to be given separately in respect ofeach 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 foreign countries. +q# st Description Adv.JOSE JESSIAMMA HUF Amal Tom No. TOM (Self) MICHAEL Jose (Dep (Depend (Spouse) (Dependent ende ent-3) nt-2\ (D Cash in hand 'Rs.20,000/- Rs.25,000/- NA Rs.8000/- NA NA
(iD Details of deposit in Bank accounts (FDRS, Term Deposits and all other types of Rs.1,22,595/- Rs.63,928/- (See Annexure (See deposits Annexure I) including saving D Rs.11l8/- accounts), Deposits (See NA NA NA with Financial Annexure I) Institutions, Non- Banking.Financial Companies and Cooperative societies and the amount in each such deposit
(iiD Details of investment 150 shares of in Bonds, Meenachil Debentures/Shares Senice Co- and units Operative Bank worth in Rs. 200 each companieYMutual 150 shares of Total value 1 Share Of Funds and others and Meenachil Rs. 30,000 Rs. 200/- the amount. Service Co- of Operative 100 shares of Bank worth Rs. Poovarani NA Meenachil NA NA 200 each Total Service Co- Service Co- value Rs. Operative Operative 30,000/- Bank Worth Rs. 50 Bank each - Total value Amt. 5000/- -j15-q]:
i I l r-AL P.:t.:P.., !..r .. Pulick3li:: i:.j2r\11 a,1,, f,c:ia i io'-::r :,ala, !(o"';., i;n Di:;t , lr:- EiJRL. to. li I7l-111: 1 lYlob. No: f i47':{ 'j liirl (iv) Details of investment in NSS, Postal Saving, LIC Policy Insurance Policies and Number investment in any 396290794 NIL NIL NA NA NA Financial instruments Paid up in Post office or value Rs. Insurance Company 49,41u- and the amount (v) Personal loans/advance given to any person or entity including firm, NIL NIL NA NIL NA NA company, Trust etc. and other receivables from debtors and the amount. (vi) Motor Vehicles/Aircrafts/ Yachts/Ships (Details NIL NIL NA NIL NA NA of Make, registration number. etc. year of purchase and amount ) (vii) Jewellery, bullion and 248 Grams ' valuable thing(s) (give 48 Grams Rs.1,68,000/ details of weight and NIL Rs.8,68,000,/ NA NA NA value)
(viii) Any other assets such as value of claims/interest Capital and current NIL NIL NA NIL NA NA account balance in Royal Marketing & Distribution (ln Rupees)
Rs. (ix) Gross Total value Rs.9.91.928/- NA NA NA Rs.1,72,595/- 2,26,7291- B. Details of Immovable assets:
Note: l. Properties in joint ownership indicating the extent ofjoint 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 D€scription Adv.JOSE JESSIAMMA Amal Tom Dependent-2 Dependent-3 TOM (self) MICHAEL HU Jose (Spouse) F (Dependen t -r) (D Asricultural Land Location(s) Poovarany Survey number(s) Village Sy No.87/1-1 NIL NA NIL NA NA Sy No.83/l ,Sy No,83/3 Sy No.83/3-2
Area (total measurement in 2,37 acre NIL NA NIL NA NA acres) Whether inherited property YES NIL NA NIL NA NA (Yes or No)
Date of purchase in case ofself- NOT NA acquired property APPLICABL NIL NA NIL NA E
Cost of Land (in NOT case of purchase) at APPLICABL NIL NA NIL NA NA the time of E purchase Any Investment on the land by way of NIL NIL NA NIL NA NA development, construction etc. Approximate Rs. Current market 3,55,oo,ooo NIL NA NIL NA NA *- '-".. value,- - Land: NIL NIL NA NIL NA NA Location(s) Survey number(s) Area (total measurement in sq. NA NA NA NA NA NA ft.) Whether inherited property NA NA NA NA NA NA (Yes or No) Date ofpurchase in case of self - NA NA NA NA NA NA acquired property Cost of Land (in case of purchase) at NA NA NA NA NA the time of NA purchase Any Investment on the land by way of NA NA NA NA NA development, NA construction etc. Approximate current market NA NA NA NA NA NA value (iiD Commercial Build !!cs (including NIL NIL NA NIL NA NA apartments) -Location(s) -Survey number(s) Area (total measurement in sq. NA NA NA NA NA NA ft.) Built-up Area (total measurement in NA NA NA NA NA NA sq.ft.) NA NA NA NA NA NA !-j: )! !': tr ' 1., -.1.-i'-'t- 1.ti" ii.*': '''" q+#{ ,...it1rl:l,,, ,' W4Yj2 ', ;r'ii:l ..-, a}, j Date ofpurchase in case ofself- acquired property NA NA NA NA NA NA Cost of property (in case ofpurchase) at the time of NA NA NA NA NA NA purchase Any Investment on the pfoperty by way ofdevelopment, NA NA NA NA NA NA construction etc. Approximate market cunent NA NA NA NA NA NA value (iv) Residential Buildi 4S Poovarany (including Village apartments): Sy No.83i3- NIL NA NIL NA NA -Location (s) ) -Survey numbe(s) Area (Total measurement in sq. 2700 NIL NA NIL NA NA ft) Built up Area (Tolal measurement NIL NA NIL NA NA in sq. ft.) 2700 Whether inherited property NIL NA NIL NA NA (Yes or No) YES Date ofpurchase in case ofself- NA NIL NA NIL NA NA acquired property .NA NA NA NA NA NA l,;'i';tt'fl"'"' \.}"I;Ilil:;;Ysil +a@ Any Investment on the land by way of development, Rs. NA NA NA NA NA conshuction etc. 5,00,000/- Approximate Rs. NA NA NA NA NA Current Market 30,00,000/- value (v) Others (such as interest in property) NIL NA NA NA NA NA (vD Total ofcurrent Rs. market value of (i) 3,85,00,000 NA NA NA NA NA to (v) dbove LAL P.K. BA.' LL N Fulickalkandatnll '"#iff*,Tl},it'^ (8) I give herein below the details of liabilities/dues to public financial institutions and govemment:- (Note: Please give separate details ofname ofbank, institution, entity or individual and amount before each item) S. No. Description Adv.JOSE JESSIAMMA HUF Amal Tom Depen Dependent-3 TOM (Self) MICHAEL Jose dent-2 (Spouse) (Dependent- t) (D Loan or dues Meenachil Meenachil to Bank/Financial Service Co- Service Co- Institution(s) Operative Operative Name of Bank Bank Bank Rs.15,00,000 or Financial Rs.15,00,000 Institution, (A/c (A/c Amount No:7069) No:7070) NIL outstanding, Nature of (owN (owN loan FT]ND FUND LOA19 LOAN) NA NA NA .Meenachil Service Co- Operative Bank - (Chitty Instalments remaining to be paid) Amt. 1,60,000/- Loan or dues to any other individuals/ entity other than mentioned above. NIL NIL NA NA NA NA Name(s), Amount outstanding, nature of loan Any other liability NA NA NA NIL NIL NIL Grand total of 'trr{titie* NA NA NA NA r,! j't:r I '. RS. RS. 15,00,000/- 16,60,000/- I !_i (iD Government Dues: (A) Has the Deponent been in occupation of Dues to accommodation provided by the Government at any YESN{O departments dealing time during the last ten years before the date of (PI. tick the with notifi cation of the current election? appropriate Govemment alternative) accommodation (B) If answer to (A) above is YES, the following declaration may be fumished namely:- (i) The address of the Govemment accommodation: NOT APPLICABLE NIL (ii) There is no dues payable in respect of above Govemment accommodation, towards- (a) rent; NOT APPLICABLE (b) electricity charges; NOT APPLICABLE (c) water charges; and NOT APPLICABLE (d) telephone charges as 0l .06.201 9 (date) NOT APPLICABLE [the date should be the last date ofthe third month prior to the month in which the election is notified or any date thereafter]. Note- 'No Dues Certificate' from the agencies concemed in respect of rent, electricity charges, water charges and telephone charges for the above Govemment accommodation should be submitted. (iiD Dues to department dealing with Govemment transport NOT APPLICABLE (including aircrafts and helicopters) (iv) Income Tax dues NIL (Self) (Spouse) HUF (Depend Depende Dependent- ent- l) nt-2 3 (v) GST dues NA NA NA NA NA NA (vi) Municipal/Property NA NA NA NA NA NA tax dues (vii) Any other dues NA NA NA NA NA NA Grand*., total of ""'l NA NA NA NA NA NA $@Yf (ix) Whether any other Rs. 42,53,215/- liabilities are in (Appeal is dispute, ifso, mention pending before the amount involved Secretary to Government NA NA NA NA NA and the authority Co-Operative before which it is Department, pending. Government of Kerala) (9) Details of profession or occupation: (a) Self- Adv.JOSE TOM - ADVOCATE (b) Spouse - ressrAMMA MTCHAEL-SOCIAL WORKER (MEENACHIL PANCHAYTH MEMBER) (9A) Details of source(s) of income: (a) Self- Adv.JOSE TOM - PROFESSION, HONORARIUM & AGRICULTURE (b) Spouse - ressIAMMA MICHAEL- HONORARIUM (c) Source ofincome, ifany, ofdependents, NIL (9B) Contracts with appropriate Govemment and any public company or companies (a) details ofcontracts entered by the candidate... NIL. (b) details ofcontracts entered into by spouse ...... NIL (c) details ofcontracts entered into by dependents ...NIL (d) details of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest . ..NIL (e) details ofcontracts, entered into by Partnership Firms in which candidate or spouse or dependents are partner NIL (f) details of contracts, entered into by private companies in which candidate or spouse or dependents have share ...N lL (10) My educational qualification is as under: MASTER OF COMMERCE : (SREE SANKARA COLLEGE, KALADY-KERALA UNIVERSITY - 1982) LAW DEGREE (LL.B) :(TRIVANDRUM GOW LAW COLLEGE -KERALA UNIVERSITY'1985) (Give details of highest School / University education mentioning the full form of the name of the School /College/ University and the year in =+ffi+ ' ':. PART - B (11). ABSTRACT OF THE DETATLS GMN IN (1) TO (10) OF pART - A: Name of the candidate Sh./Sm#f.t*m Adv. JOSE TOM 2. Full postal address PULIKUNNEL HOUSE, POOVATHODU P.O, KOTTAYAM. KERALA 686578 J. Number and name of the constituencv and State 093 PALA ASSEMBLY CONSTITUENCY. KERALA STATE A Name of the political party which set up the KERALA CONGRESS(M) candidate (otherwise write,,lndependent") 5. Total number ofpending criminal cases NIL 6. Total Number of cases in which NIL convicted 7. PAN of Year for which last Total lncome Income Tax Retum filed Shown (a) Candidate AORPT7383N NO TAXABLE INCOME NOT APPLICABLE (b) Spouse FFTPM3466K NO TAXABLE INCOME NOT APPLICABLE (c) Dependent I NO PAN ALLOTTf,D NO TAXABLE INCOME NOT APPLICABLE (d) Depetrdent 2 NIL NIL NOT APPLICABLE (d) Dependent 3 NIL NIL NOT APPLICABLE 8. Details of Assets and Liabilities (including offshore assets) in Rupees Description Self Spouse Hu Dependent-l Dependent-ll Dependent-lll F Moveable Rs. NA NA NA (Total Rs. Assets 9,91,928t- 2,26,729/- value) L,72,sgs/- B. Ifirmova,ble' NA NA NA Rs. NA NA u"t".::... 3,85,00,000/- (+ u. I Purchase Price of self-acquired NA NA NA NA NA NA immovable proDertv II Development /construction cost of immovable property NA NA NA NA NA NA after purchase (if applicable) III Approximate Cunent Market Price (a) Self- acquired NA NA NA NA NA assets (Total Value) (b) Inherited Rs. assets (Total 3,85,00000/-' Value) 9. Liabilities (i) Govemment dues (Total) NIL NIL NA NIL NA NA (iD Loans from Bank, Financial Rs. Rs. Institutions NA NIL NA NA 15,00,000/- 16,60,000/- and others (Total) 10. Liabilities that are under dispute (D Govemment dues (Total) NIL NIL NA NIL NA NA (iD Loans from Bank, Financial Rs. NIL NA NIL NA NA Institutions and 42,53,2r5t- 'otFF(loruU -+# : -Sgs, I l. I Highest educational qualification: (Give details ofhighest School /University education mentioning the full form ofthe certificate/ dipfoma/ degree course, name ofthe School lCollegel University and the year in which the course was completed.) LAW DEGREE (LL.B) :(TRIVANDRUM GOVT LAW COLLEGE -KERALA UNtVERStry- 1985) 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 ofconviction or pending case against me other than those mentioned in items 5 and 6 of Part A and B above; O) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 7 and 8 ofPart A and items 8, 9 and l0 ofPart B above. Verified at Pala this the 04th Day of September, 2019. Sohmrl|' firfisd ad tlgr.d DEPONENT b.to?c ns by tho depon$t qho b lnom to mo on this he..!*J:Oay NOTARIAL REGISTER vot.Ho...l.X....page Ho..7$.... st. N o. 3.3. l..... Dut"..*\.9\3.. Note: 1. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations. Note:2. Affidavit should be swom before an Oath Commissioner or Magistrate of the First Class or before a Notarv 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'Nill'or'Not applicable" as the case may be, should be mentioned. Note: 4. The aftidavit should be either typed or written legibly and neatly. Note: 5. Each page ofthe A!fidavit should be signed by the deponent and the Atfidavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavit is sworn. (Ministry of Law & Justice Notification No. Hl l0l 9(412018-Leg.ll. dated 1Otr October,20l8 and Notification No .H-ll0lgll3/2016-Leg. II, dated 26m February, 2019) :+# s$4 LAL P.K, BA., LL.B Pulickalkandathil Advocate & Nohrv Pala, Kottayam Dist., Kirata. ENRL. No. K / 734 /i990 Mob. No: 94470 21202. ANNEXURE - I (Form 26 Para (7)(ii)) DETAILS OF MOVABLE ASSETS OF JOSE TOM AND HIS FAMILY MEMBERS Details of deposit in Bank accounts {FDRS, Term Deposits and all other types of deposits including saving accounts), Deposits with Financial Institutions, Non-Banking Financial Companies and Cooperative societies and the amount in each such deposit SPOUSE (JESIAMMA DEPENDENT AMAI Sl No sELF (JOSE TOM) MICHAEL) TOM JOSE Federal Bank Poovarani Br. SB A/c 1 No. 111501000s6001 6t44 NIL NIL Meenachil Sevice Co-Operative Bank SB A/c 1018 4048 KDCB Paika A/c No.050351200420371 403 South Indian Bank Arunapuram A/c No. 0453053000016357 (Election A Account) 2000 Chitty - Meenachil Service Co- 5 Operative Bank No. 274118 1,10,000 Federal Bank Poovarani Br. SB A/c o No. 11150100074228 27766 Meenachil Sevice Co-Operative 7 Bank SB A/c 1037 28662 Meenachil Service Co-Operative Bank (Fixed Deposit No. 1.233) Dtd: 8 25.03.20t9 7500 Federal Bank Poovarani Br. SB A/c 9 No. 1.1150100074210 L state Bank of India KUoc 10 Trivandrum A/c No.38604364881 0 lClCl Bank, Thoppumpady Branch 11 169101502485 tt2 Meenachil Sevice- Co-Operative L2 Bank SB Alc 2927 1005 Total 122595 63928 1118 c\ -g@y)