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PROFORMA (TO BE SUBMITTED SEPARATELY FOR EACH CANDIDATE) (In case of any discrepancy in the account submitted by the Candidate and the Shadow Observation Register. copies of all the Registers and Evidences collected. should be sent along with this Report) SI.No. Description Smt.V. Kumari 01 Name and address of the Candidate No. 39, Annai Indra Nagar, Karuvadikuppam, Puducherry - 605 008 02 Political Party affiliation, if any Naam Tamilar Katchi No. and Name of Assembly/Parliamentary 03 12- Kalapet Constituency Shri.M.O.H.F. Shajahan 04 Name of the elected candidate Indian National Congress 05 Date of declaration of result 19.05.2016 06 Last date prescribed for lodging Account 18.06.2016 07 Date of lodging of account by the candidate 14.06.2016 Whether account lodged by the Candidate is in 08 (a) Yes the prescribed format (Yes or No) Brief note on 08 (b) Defects noticed in the format by the RO. Tick rows details of the defects Abstract statement (Part I to IV and Schedules 1 (i) Filled & Signed to 9) not filled up/not duly signed (ii) Duly sworn in Affidavit of the candidate not filed Filed Register of day to day accounts along with Bank (iii) Register and Cash Register not duly signed by the Signed Candidate 2., -2 SI.No. Description Vouchers in respect of items of election expenditure (iv) not submitted/not signed by the candidate or his Submitted and signed election agent Self certified copy of the Statement of Bank account (v) Submitted for election expenses not submitted All receipts for election expenses not deposited in the Through bank account (vi) aforesaid bank a/c and all payments except petty expect petty expenses expenses not made by cheque. Grand Total of all election expenses by the candidate 09 as mentioned in Part-It of the Abstract Statement, filed Rs. 14,000/ by the candidate. Whether the items of expenses reported by the Candidate correspond with the expenses shown in the 1O(a) Yes Shadow Observation Register and Folder of Evidence (Yes or No.) If No, then, please fill up the details where expenditure (b) has been understated I not mentioned at all by the NA candidate. Mention As per the Page No. of amount as per account Amount under Items of Shadow the Shadow Date submitted by stated by the expenditure . Observation Observation the Candidate Register Register/Folder Candidate of Evidence " Total 3., -3 SI.No. Description Did the candidate produce his Register of Election 11 (a) Expenditure for inspection by the Observer/RO One time (Ill) (Yes or No) 3 times during campaign period Was any discrepancy pointed out to the (b) Candidate at the time of inspection of Register by No the Observer. If yes, mention the discrepancy? Was a notice pertaining to any discrepancy in expenditure given to the candidate by the R.O.? (c) NA Please mentioned date and nature of discrepancy. Did the candidate given any reply to the notice? (d) (Please Annex copy of the notice and explanation NA received) . Whether the R.O. agrees that the expenses are correctly reported by the Candidate (Yes or No.) 12 Yes (Should be similar to point n0.8 of Summary Report of R. 0 . Lump sum amount given to the candidate in Cash or Cheque by Political Party as mentioned in 13 Nil Part-Ill of the Abstract Statement. Also mention name of the party. Lump sum amount given to the candidate in Cash 14 or Cheque by any other person /entity. Also Nil mention name of the party. Was there any incident of distribution of money, food or other items in the constituency by the 15 candidate or his agents or his party functionaries Nil or any other person related to the candidate? Please mention date and name of person. " \.Y/ P.JAWAHARv, l.A.S Date: 17.06.2016 DISTRICT ELECTION OFFICER (P. JAWAHAR, I.A.S.,) !)! STRICT ELECTION OFFICER. -4 Note for item No. lO(b) : 1. Please mention detail of particular events where expenditure is under reported vis-a-vis the shadow observation register. 2. If practicable, please attach separate annexure indicating item wise break up of expenditure. Comments, if any, by the Expenditure Observer* Date: Signature of the Expenditure Observer Forwarded the Election Commission of India by the CEO Date: .2rfol,f{h fDr.V.C AVELOU, l.A.S.) CHIEF ELECTORAL OFFICER ELECTIONS DEPARTMENT ature of thlthiif Elect~ral Officer** * If the Expenditure Observer has some more facts that have not been covered in the DEO' s report, he may annex separate note to that effect. ** If the CEO feels like giving additional comments, he or she may forwarded the comments separately. .

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