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!Pdf FORM 2A (See rule 4) '0\\ NOMINATION PAPER Election to the House of the People r$ v' Al /\ r STRIKE OFF PART I OR PART tr BELOW WH]C}IEVER IS NbT APPLICABLE PART I (To be uscd by caadidate set up by recognised politictl parry) oominatc a candidate for election to the House of the People from .Parliamentary corstihrency. Caodidate' .V.L.e{.r- FathYr's/me$€i{6/h$b.sd's aame...*+lgra{" postal address rui(L/(l .r*p"t. ?*h*m *ea/ a ; P*rt.ufu"' elecmral roll !pdf";4* Constituency. My name is.1flad\o..M.elea..Elu*ar*4. and it is entered at S.No..9.4t...in part No../15-...of the electoral roll tN 39....no-*4?.......-.....................'(Assembly constituetrcy compriscd witbinlf:r{tr<c"**O&a .............Parliamentary constituency. ,fraolon ada-, mtao- oate ..$,11:lJ. Signarule of Propos&r_+g PART II Cto be us.d by candidate NOT set up by recogtriscd potirical pady) Wc hereby nominate as for electiotr to the Hougc of thc Pmplc &on the.....................................,............ P Constihrency z Candidate's name.....................: Fathet'Vmoth€1$/husband's a narlre.......,...,...,..,...,..,,,,,..,..,,..,,.........His address. I is enarod S.No....................in pat \ No..................................ofthc claioral roll fot --- - "\ - .......t(A!€cobly coDltitr:ncy conFilcd within) ....I-.*._ _ _"\ .-.....padirlncorrfy coostirEocy. We declan: tb!. r wc arE ct\ors of tbc above partiaoatrry Co*itrmy and ouLr names are cotcrcd in thc clectoral roll &at padilrtr€Dt8ry \ Coortitumcy as indicaied bcilow End we cppeDd our sigrlturr! bclow i! totsD of 8ubscdbing !o rhis lomirstion: _ Prrticulrrc dfrhe rnd thclr llmtturc! Sl.no. N8me of Elcdlor Rott No. of Full Namc Signature Date comlx)tretrt \roporer Asscmbly Pan xo. d( S.No. ia CoDstitueocy Elecbral \ rbat pafi Roll I 3 5 6 7 L 2. 3. 4. 5. 6. 7. 8. 9. 10. N.B.- Thereshouldbe@ I, the cardidare meot,"""o t a*,i*llrlfsrt *" ow *h"t is not applicsble) assert to this nomination and hereby declare_ (a) that I am a citizefl lndia of and havc trot acquired the citizenship of atly foreign state/countly. (b) that I have completed.....J.(...................years of agc; t.JlY o* .(O:: c(n) BErow wHr€Hnvrn rs xor lPPrrcerLrl (c) (r) tiar I am s€t rp at Ois electioD by rte... pety, which is a recogniscd Nationfpafyi Sra& i""y L , , i"" ,U, ,1" symbo/rcserved for the sbovc palty be a]loted to E€. "ra OR (c) (,, that I sln at this ele&tion by rhe ....-....il.a*...Ab_bLc.i../*_- .. party, which \ a registered-unrecognised politicat party/that I sm cootesthg rhis elcction_ as an (Strite {ependent candidate. out which is aot applicable arj tbar thc symbols I ha\ choseq in order ofprefcrence, are:_ i b+- t t... effl;c.atl<\ u t 4FpL e4 i- t i ti . iii.. aspL.CAAk. (d) that my narnenarpe a)da4d ^1"* rglrqy farbefvmother'Vhusbaad'sfarbefvmother'Vhr.rsband's name havehq..l-.h.^turtv becn correcrly spelt-, out above h..€.n$*+(........... (name of thc langrage); (., that to the bysr ofmy krowledgc and beliel I am qualified and not also disqualificd for b€ing choscn lo fill the sear in the House ofthe people. 'l frrnher dcclare that I 8m a rr/-ynbet ol the.....5tttt1lAl.................................*.Castrftr6 which is a r.esadEi# schedulcd of the State of .........dd.rU.*-..,........................_..in n:lation 24.W!V.-.....tatr(a\ itr that Stare. declarE tiat I have aotnot been,been andanrt shall not be oomimted as a candidate at the pres€nt gercral election/rhe bye-elections being held simultaneously, ro the House of the people ftom more than two Parliamentary Constiruencies. 'A.&{,"Jet\/L-,Y D*e..$.:.!:1.:l.J Signature of Catrdidate- 7 - l. r 7 ?Score out thc words "assembty coDsrit!€ncy *iOio; i, O"GIiG, Kashmir, "o-p.i""a -a Andaman and Nicobar Islalds, Chandigarh. Dadm and Nagar Haveli, Damaa and Diu and Lakshadweep. tscor€ out this paragraph, if nor applicabie. "Score out the words not applicable. N.B.-A "recogtrised political party,' means a political party recognised by the Election Commission under lhe Election Symbols lReservation and Allotneflo Order, 196g itr the State concemed. PART ITIA (To be filled by the candidare) (l) Whether the candidate- (i) has beell coovicted- (a) ofany olfeuce(s) under sub.section (l); or (b) fior coDr.sveorion ofany law speciied in suLsectioo (2), ofsection 8 of the Represetrlation of the people Acq l95l (43 of l95l rlcsl.{o (ii) has been convicted for any other offence(s) ihr which he has b€en senienced to imprisonment lbl t*o yeaft or more. l l;atL' Ifth€ answer is'YeJ', the candidate shall furnish the following informatioo: il ctaP (i) Case/frst infomation rcpon No.iNos.... ,rrl!.1.< (ii) PoliG $ation(s)-.. ....... ... .. 4l.t-. District(s)......... rr1 1I-.......... s""<.j......... - l. t. t--. (iii) Section(s) of&e concemed Act(s) and brief desgriprion pf thc offence(sl for which hc has bcen convicted... .............. *J e 1 .. *f,k h: I4b4i .. .. (tu)D;;(;t.;""";i;;;;;i';.......;,;."fp L; i-;JL lffi:1il;;il#;:i; ;;"}o;fll *1rLr* u.. (vilPunishmcllt(s) imposed liodicate period^r.* oi imprisonmen(s) and/or quantum of nn{s)l... .... ..r.'l ).L: (vii) Date(s) of release from prison......... .,\1. r.t=1... .,....... (viii)WaJwerc -atry appeal(s)/revision(s) filed against above cosviction(s).. .')!:.i... v".nY (.!) Date aod particuta$ of app€al(slapplicatioB(s) for rcvision li rca.......N.aL.41Lt-ll'- (r, Name ofthe court(s) be{ore which the appeal( r/application(s) for revision filed. .....ilel..*ffr.X$.bk- (r,) Whether thc said appeal(s)/application(s) ft,r revision has,4rave been disposed of or israre pending....,rJ** a'SlL' e- t t'- (.ri, If the said Apcal(syapplication(s) for revision has/have been disposed of- (a) Date(s) ot disposal. .. NIL,-r..... (b) Nature of ord<s) p"s."a... dl.l-..-. ... ... (2) Wherher the candidate is hrdiDg-atryz office of prolit under the Govemment of lndia or Statc covemmenr?.d0.. (Y6lt -tfYes,detailsoftheofficeheld...........d!.D1.'.... .-...--..-.. -,' (3) Whether the candidate has beer declared insolvert by any Coutl?.......... (ycs?N6 Jf Yes, has he been discharged fiom insolv ency... at.l L- (4) Whether the candldate-,.-is under allegiance or adherence to any foreign country?.........(Ycs/Nbf -lf Yes. give dctails........el lt-r............ ....... .. (5) whether the candidate has been disqylified under section 8A ofthe said Act by an order of the President?..... o...... ( YeVN&f ^I Jf Yes, the period for which disqualified.... rE. NI.L-,:......... .. (6) whether the candidate was dismissed for corruptio0 or lor disloyalty while holdigpottcc under the Governmcnt of lndia or the Govcmmcnt of any State? rle. .tYegt\-ot -lfYes. the date ofsuch dismissal.... IL........ (7) whcthsr the candidate has any subsisling coDtract(s) with the Govemment cither in iadividual capacity or by trust or pa.hr€rship in which the candidate has a share for supply of any goodr to ther Crovet4r*ot or for cxcciniolr of works tndatrtcn by ibat GoverDnre[t? ...G.rFb- Jf Yes, with which Govemoent and dctails of subsisting coorac(s)...... /l.L,=,:: (t) Wbeti€r thc cedidrtc is s nl'nrg'g Egcat, or rn,'l'ger or Sccr(fry of my coqoay c Corporain (oinc( tl'"" a coopqrtive society) itr thc cspiirl of wti:h the Cqtd Crovernnqt or Slre Govcnr"urr hls Dot lcss rS.a twcaqFfivc FrEeot sh[r? G4dr8!. -IfYes! wilh which covsram€nr aod the dctails therpof .-.-.Nl t = (9) Whc&lr thc cEDdide hrs bcco.,drqu.lifGd by tbc Cmnissioo rnder s€ctim tOA of ltc sril Acr................. (YciiMtf Jf yrs, thc dsE of disqudiecadoo........fl/l-<.......... l,,J-e^"p)r Plrrr.:..Dugo)a z-A-, Slgtshr!'of Cardi&te rg Drlc:.qlai.t9.. b/ri PART IV I hEve cr.oinod tnis oomin:tiot paper in accordaacc with sectioo 36 of the Rrtr€scoeti@ ofrbc Peoplc Act, l95l(43 of l95l) and tleci& rs fotlows:- Date Retumilg Officer (PcNforlti@) 5 -( Oeclaration by Candidater'Election agent/Proposer while submltting the photograph of the candidate subject: Election to '..1,.tx..T.*.1.,1* (mention the name of the House) from .*.nryt-lk/'..r.t-'.A.........-... (name of the constituency) / election to Councile of Statls/ Legislative Council by Assembly Members. t..Sa.i'...Aili/.sdkk..:f..sy'*.......1r*t'kA*-/'alJ"aa,*4*!.e6^?.e.,.lda ..a**.,tQyt*./Lat...,................... (name and address), s(n/daughter/wife of \hri .l*J*t1..-t-tt u-.-..-.-................... ......., nontinated as .:andidaie for the abovementioned election, am submitting herewith my photograph for the purpose of printing the same on the ballot.paper. I declare th.rt the photograph has been taken during the last 3 months before the date of n0titication of election. (Filleel up this part when the candidate himself is submitting the photograph)' OR r-.ler'ti,rn agent/proposer of Shri .. (name and address 0f thc candidate), son/daughter/wife of Shri'................... ,'...". ''", e {:ardidate tbr the abovementioned election, hereby submit the photograph of the ';airl cartrlidate for.the purpose of printing the same on the batlot paper. I declare ttrat lire photograph tras been taken during the last 3 months before the date of notification of electiofl . photograph). {i:ill up thi5 part }vhen the election agent/proposer is submitting the onte: .. /..:..!....1.?., a8q0r Llll-0rofl s".175 o€c'ac s0937002 (Receipt Book)' 6,6 s'. 3 q66 a'. @... :,.W.1.1... Ai. "..0-h r'slt *ha *tt.e*-..1i4!*........:. r.....q o8 lsppafrlry.b ,o*",.0.flb fr Ps.
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