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AFFIDAVIT

I, MANSUKHBHAI VASAVA s/ o. DHANJIBHAI KHATARIABHAI VASAVA, Age: 56 years, Resident of: RAJENDRANAGAR SOCIETY, RAJPIPLA, DIST. NARMADA, STATE, - candidate of aforesaid election, do hereby solemnly state and affirm as follows that: •

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1. I am candidate promoted by the (Name of the political party).

2. My name is registered in the Voters list of 21-Chhota Udepur (S.T.) Loksabha Election constituency, (S.T.) Vidhansabha Election Constituency, Gujarat (Name of the constituency and State), Part 152/289 Sr. No. 424.

3. My contact No. is (R) (02640) 224300 and my e-mail ID (if any) is mansukhbhaidhanjibhaivasava©gmail.com and my Social Media Account (if any) is with on Facebook.

4. My Permanent Account Number (PAN) and details of payment of Income Tax Return:

Sr. Name PAN No. Accounting Total Income No. year of last as shown in payment of Income-Tax Income Tax Return Return (Rs.) 1 Self ADSPV1810G 2013-14 4,50,000/ - 2 Spouse-Sarashvatiben APGPV6380K 2013-14 3,03,075/ - 3 Dependant-1 No N.A. N.A. N.A. 4 Dependant-2 No N.A. N.A. N.A. 5 Dependant-3 No N.A. N.A. N.A.

5. I am NOT an accused of any crime in which the competent court has formed the charges or in which charges more than two years or more can be given.

If the deponent is accused in any of the aforesaid crime, following information shall be given:

(1) No any case is pending, in which the charges are formed by the court in the following crime/ s, in which punishment more than two year • ore can be given. - Not Applicable - • 3

(a) Case/First Information No/ s alongwith full details - Not Applicable - of relevant Police Station/District/State (b) Brief description of the crime in which the charge - Not APplicable - are formed under Sec. of the Relevant Act (c) Name of the Court, Case No. and Date of order - Not Applicable - (d) Court/ s who has formed the charges - Not Applicable - (e) Date on which the charges are formed - Not Applicable -

(f) Is any aforesaid proceeding/ s kept pending by the - Not Applicable - competent court?

(2) (Except above mentioned cases) Details of cases lodged against me, in which the order is passed by the Court, are as follows: - Not Applicable -

(a) Name of the Court, Case No. and Date of order - Not Applicable - (b) Details of case including section and court: - Not Applicable - (c) Details of any Appeal or Review made against the - Not Applicable - aforesaid order

(3) I am NOT held guilty for any crime under Sec. 8 Sub-Sec.(1) or Sub-Sec. (2) or for any other crime except the crimes as mentioned Sub-Sec. (3) of the Lok

Prathinidhitva Act, 1951 (43rd of 1951), and NOT given punishment of jail for one 'year or more.

In case the deponent is held guilty as mentioned above and given punishment, he shall furnish following information: - Not Applicable -

I am held guilty and given punishment by the Court in following cases:

(a) Details of Sections and Act/ s of the case, in which I - Not Applicable - am held guilty. (b) Name of the Court, Case No. and Date of order - Not Applicable - (c) Given punishment - Not Applicable - (d) Details of any Appeal made against the order of - Not Applicable - punishment? If yes, Details of Appeal and status? •

(7) I hereby submit details of properties of mine/my s on me: • 4

A. Details of movable properties:

Sr. Description Self Spouse Dependant Dependant Dependant No. 1 2 3 1 Cash on hand Rs. 80,000/- Rs. 40,000/- N.A. N.A. N.A. 2 Deposits in Bank (1) State Bank (1) State Bank N.A. N.A. N.A. Account (FDR, of India . of India, Term Deposit) and Parliament Rajpipla other funds House, Balance: including savings New Delhi Rs. 11,216/35 Ps. A/c. No. account, Financial (2) Dena Bank Institution, Non- 1002381728-4 Rajpipla banking Financial Rs.3,63,787/82. Ps. (Joint A/c.) Institution and Balance Funds in Rs.1,67,917/43 Ps. Cooperative (3)Bank of Society and details Baroda of amount in all Rajpipla such deposit Balance Rs. 168052/- 3 Bond, Debenture/ 1 Share in 1 Share in N.A. N.A. N.A. Share/Mutual Dharikheda Sugar Dharikheda funds in Company Factory Sugar Factory and other and Rs. 1000/- Rs. 1000/- Investment in Unit and details of amount 4 National Savings LIC Policy LIC Policy N.A. N.A. N.A. Scheme (NSS) Rs. 4,00,000/- Rs. 2,00,000/- Postal Savings, National Savings Post MIS Insurance Policies Scheme Rs. 1,20,000/- and details of Rs. 50,000/- amount of KVP Rs.50,000/ investment in Post office and Insurance company 5 Personal Loan/ N.A. N.A. N.A. N.A. N.A. advance given to any Firm, Company, Trust etc. and other amounts receivable . . from the debtors. 6 Vehicle/Air Craft/ Innova N.A. N.A. N.A. N.A. Yat/Boat No. GJ 16 (Manufacturing, BB 8109 Reg. No. etc., year Year-2013 of Purchase and Rs.15,00,000/- amount) 7 Jewellery, Gold- 2 Tolas of Gold 35 Tolas of Gold N.A. N.A. N.A. Silver and other Rs. 60,000/- Rs. 10,50,000/- 500 Gms. of Silver expensive items Rs. 25,000/- (Give details of weight and value) 8 Other rights, N.A. N.A. N.A. N.A. N.A. claims/ interest 9 Total value Rs.26,87,877/73 Ps. Rs.18,33,185/78 Ps. N.A. N.A. N.A. •

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B. Details of Movable properties:

Sr. Description Self Spouse Dependant Dependant Dependant No. 1 2 3 1 Agriculture Land (In Joint name) N.A. N.A. N.A. N.A. Place/s Nava Waghpura Survey No. S. No. 165 Area (Total admeasuring in H-Are-sq.mt. N.A. N.A. N.A. N.A. Acre) 0-61-71 Is it ancestral property (Yes Yes N.A. N.A. N.A. N.A. or No) In case of self-acquired Not Applicable N.A. N.A. N.A. N.A. property, date of purchase (In case of purchase) Value Not Applicable N.A. N.A. N.A. N.A. of land at the time of purchasing Development, construction N.A. N.A. N.A. N.A. N.A. etc. raised over the land Estimated recent Rs. 2,50,000/- N.A. N.A. N.A. N.A. \ , market value 2 Non-Agriculture Land N.A. N.A. N.A. N.A. N.A. Place/s . Survey No. Area (Total admeasuring in N.A. N.A. N.A. N.A. N.A. Acre) Is it ancestral property (Yes N.A. N.A. N.A. N.A. N.A. or No) In case of self-acquired N.A. N.A. N.A. N.A. N.A. property, date of purchase (In case of purchase) Value N.A. N.A. N.A. N.A. N.A. of. land at the time of purchasing Development, construction N.A. 11.A. N.A. NA. etc. raised over the land Estimated recent N.A. N.A. N.A. N.A. N.A. market value • 6

Sr. Description Self Spouse Dependa"7-Virligare ependant No. 1 2 3 3 Commercial Building N.A. N.A. N.A. N.A. N.A. (including Apartment) . Place(s) Survey No.(s) Area (Total admeasuring in N.A. N.A. N.A. N.A. N.A. Acre) Built up Area (Total area in sq.ft.) Is it ancestral property (Yes N.A. N.A. N.A. N.A. N.A. or No) In case of self-acquired N.A. N.A. N.A. N.A. N.A. property, date of purchase (In case of purchase) Value of N.A. N.A. N.A. N.A. N.A. land at the time of purchasing Development, construction N.A. N.A. N.A. N.A. N.A. etc. raised over the land Estimated recent N.A. N.A. N.A. N.A. N.A. market value 4 Residential Building (1) Residential N.A. N.A. N.A. N.A. (including Apartment) House No. 79/A Place(s) Survey No.(s) Rajendranagar Society, Rajpipla Area (Total admeasuring in Approx. N.A. N.A. N.A. N.A. Acre) 153.18.64 sq.mt. Built up Area (Total area in Approx. sq.ft.) 2000 sq.ft. Is it ancestral property (Yes No N.A. N.A. N.A. N.A. or No) In case of self-acquired Date 17/11/2013 N.A. N.A. N.A. N.A. property, date of purchase (In case of purchase) Value of 4,91,111/- N.A. N.A. N.A. N.A. land at the time of purchasing Development, construction No N.A. N.A. N.A. N.A. etc. raised over the land Estimated recent Rs.10,00,000/- N.A. N.A. •N.A. N.A. market value 7 v..1 CI 43 3,-"?od"i 4 Residential Building (b) Residential N.A. N.A. .A.. 1 .40 (including Apartment) House No. 23, r Place(s) Survey No.(s) Mandir Faliyu, 0 04 Nava Waghpura, Ta. Nandod, Dist. Narmada Area (Total admeasuring in Approx. N.A. N.A. N.A. N.A. Acre) 1600 sq.ft. Built up Area (Total area in Approx. sq.ft.) 1400 sq.ft. Is it ancestral property (Yes Yes N.A. N.A. N.A. N.A. or No) In case of self-acquired No N.A. N.A. N.A. N.A. property, date of purchase (In case of purchase) Value of No N.A. N.A. N.A. N.A. land at the time of purchasing Development, construction No N.A. N.A. N.A. N.A. etc. raised over the land Estimated recent Rs. 8,00,000/- N.A. N.A. N.A. N.A. market value 5 Other (Interest in property) No N.A. N.A. N.A. N.A. 6 Total of recent market value Rs.20,50,000/- N.A. N.A. N.A. N.A. from (1) to (5)

(8) I, hereby submit details of my debt and details of Government recoveries in Public financial institutions as follows:

(Note: Give individual details of Bank, institution, legal entity and name of person and amount against their name)

Sr. Description Self Spouse Dependant Dependant Dependant No. 1 2 3 1 Loan from Bank/ Financial The Bharuch N.A. N.A. N.A. N.A. Institution(s) and . District Central outstanding amount and Co.Op. Bank Ltd. name of Bank/Financial Vehicle Loan institution, Type of loan Outstanding amount of Rs. 6,39,000/- (Not Overdue) Any other loan, outstanding N.A. N.A. N.A. N.A. N.A. mount, type of loan from the persons/legal entities except the above mentioned. Any other responsibility N.A. N.A. N.A. N.A. N.A. Total of all the Rs. 6,39,000/- N.A. N.A. N.A. N.A. responsibilities 8

Sr. Description Self Spouse Dependant Dependant Dependant No. 1 2 3 1 Government Loan: N.A. N.A. N.A. N.A. N.A. Arrears of the departments working relevant to the Government houses Arrears of the departments N.A. N.A. N.A. N.A. N.A. working relevant to the Water Supply Arrears of the departments N.A. N.A. N.A. N.A. N.A. working relevant to the Electricity Supply Arrears of the departments N.A. N.A. N.A. N.A. N.A. working relevant to the Telephone/ Mobile service Arrears of the departments N.A. N.A. N.A. N.A. N.A. working relevant to the Government Transportation (Plane and Helecopter) Arrears of the Income Tax N.A. N.A. N.A. N.A. N.A. Arrears of the Wealth Tax N.A. N.A. N.A. N.A. N.A. Arrears of the Service Tax N.A. N.A. N.A. N.A. N.A. Arrears of the N.A. N.A. N.A. N.A. N.A. Municipality/ Property Tax Arrears of the Sales Tax N.A. N.A. N.A. N.A. N.A. Any other Arrears N.A. N.A. N.A. N.A. N.A. 2 Total of all the Government N.A. N.A. N.A. N.A. N.A. arrears 3 In case of dispute regarding Not N.A. N.A. N.A. N.A. any of the responsibilities, . Applicable amount involved therein and the name of authority before whom the matter is being pending.

Occupational Details: (9) TA

(a) Self Agriculture and Social Work 44 're..Mahendra M. Kansara (b) Spouse Agriculture and Household Dist. Bharuch 6.1) Regd. No. 4332 / 2007 (10) My educational qualification is as follows: %01 UP. To. 1/8/2017 goo -1•1 ./' (1) B.A. Year 1977-78 South Gujarat University, Surat Q i (2) MSW Year 1982 Gujarat Vidyapith, Ahmedabad

(Furnish details of Certificate/Diploma/Degree Certificate with full name and details Higher Secondary School/ University education, Name of University, and year of completion of course)

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Part-B

(11) Conclusion of the details given in Part-A (1) to (10) 1 Full Name of candidate MANSUKHBHAI DHANJIBHAI VASAVA 2 Full postal address Rajendranagar Society, Rajpipla, Dist. Narmada 3 Constituency No. and Name Sr. No. 424 in Part No. 152/289 in 21-Chhota Udepur and State (S.T.) Loksabha Election constituency, (S.T.) Vidhansabha Election Constituency, Gujarat State 4 Name of the political party, by whom the candidate is BHARATIYA JANATA PARTY promoted (Otherwise mention as "Apaksh") 5 Total numbers of pending cases, Not Applicable in which the court has held him guilty for the crime punishable for two years or more (2) Total numbers of pending Not Applicable ....1,....„....-.:--72-7.r., , cases, which are lawfully — —"V 1— A,,I s:- -,-k, considered by the court. (Cases .,, except as mentioned in above rvi a h endr.., \ (1)) O. Kans-i''ct , - ti:1 1-1-,=.111—. 6 Total numbers of cases, in which Not Applicable Disl ,,.; z--.) , :-,C Pe., 9 ' A - - i the candidate is being held 4 -..5 c, ,: i 2 U..)1 guilty, and given the ,\ uP. To. 1 it1/20 i 7 punishment for one year or * \\,'.■...,„..." more. (Crimes except as mentioned in Sec.8 Sub-Section 0 f (1), (2) or (3) of the Lok Pratinidhtva Act) Name PAN No. Accounting year of Total Income as shown in last payment of Income-Tax Return (Rs.) Income Tax Return 7 (a) Candidate ADSPV1810G 2013-14 4,50,000/- (b) Spouse APGPV6380K 2013-14 3,03,075/- (c) Dependants N.A. N.A. N.A. 8 Details of properties and liabilities, in Rupees Description Self Spouse Dependant- Dependant- Dependant- 1 2 3 a Moveable Rs.26,87,877/73 Rs.18,33,185/78 N.A. N.A. N.A. Properties (Total Ps. Ps. value) • b Immoveable House N.A. N.A. N.A. N.A. Properties 1 Purchase value Approx. N.A. N.A. N.A. N.A. of the Rs.8,00,000/- Immoveable property 2 Development/ N.A. N.A. N.A. N.A. N.A. Constructio; I cost of the immoveable property after purchase (if applicable) 3 Approx. recent Rs.20,50,000/- N.A. N.A. N.A. N.A. market price: (a) Self-acquired Rs. 10,00,000/- N.A. N.A. N.A. N.A. properties (Total value) (b) Ancestral Rs. 10,50,000/- properties (Total value) 10

Description Self Spouse Dependant- Dependant- Dependant- 1 2 3 9 Liabilities N.A. N.A. N.A. N.A. N.A. 1 Government N.A. N.A. N.A. N.A. N.A. arrears (Total) 2 Loan obtained Rs. 6,39,000/- N.A. N.A. N.A. N.A. from Bank, Bharuch Dist. Financial Central Co.Op. institutions and Bank Ltd. other (Total) Vehicle Loan (Not Overdue) 10 Liabilities N.A. N.A. N.A. N.A. N.A. under dispute 1 Government N.A. N.A. N.A. N.A. N.A. arrears (Total) 2 Loan obtained N.A. N.A. N.A. N.A. N.A. from Bank, Financial institutions and • I A,4 IkAivo other (Total) * 11 Higher Educational Qualification: > South Gujarat University, Surat No 4382 I 2007 (1) B.A. Year 1977-78 BliANUCN (2) MSW Year 1982 Gujarat Vidyapith, Ahmedabad O F (Furnish details of Certificate/Diploma/Degree Certificate with full name and details Higher Secondary School/ University education, Name of School/ College/ University, and year of completion of course)

Verification

I the undersigned, do hereby verify that, all the facts as stated in this Affidavit are true and correct to the best of my knowledge and belief, and nothing as mentioned herein this affidavit is false or concealed. I further declare that,

(a) No any case, except the cases as mentioned in above Part-A and B, 5 and 6, is lodged or pending against me. (b) I, my spouse and dependents on me, do not own any properties or responsibility except the details as mentioned in above facts of Part-A 7 and 8, and Part-B 8, 9 and 10.

Verified on this 5-Nday of b '41 , 2014.

Solsnitylliirtii before me by A-RIM lihe itMentried by advocsW....-- VA whom I %now IVY Ti-41 OF STATE FOR HEN RA M. KA NSARA ,AL AFFAIRS MA NOTARY vt, of India (Govt. Of Indio) 12/131S, Ma Pc~it aPP- MP* betwo sivaucwastect.tionit 5 Jul_ 201