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Gnised Political Party) FORM2A (See rule 4) NOMINATION PAPER leetion to the House of the People OiJ IHP/2019/RO 11-' I3J_ PC Recent stamp NO:~ jQ:B2_f f)j I A'[, 120) j Time : . I -, \ Oate~~ r • STRI OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE I, , - ~/ PART I (To be used by candidate set up by recognised political party) . Ino~l1:ate s a candidate for electionto the House of the People from the )I!..~.ft~~..~.!. Parliamentaryconstituency. Candid.I ate'a pame jI'yRJ.(O~Ll ~:LI+OSHOp,;s-rIPPr{):;v.... Fro+q..~uer..... 's/motliS rnomer'/hs usband's name ...$.. ..1?l:r.~~f.t...~9.ljrl~l:t.1?f!.~.T.l.l?B:~........................His postal address '[email protected].{!lt:..r.:.!....I!:~f.~.'::~.~:~:/?!:p.!l.!f.,}:/1t?'P.!f.~.1):f:1.1.~~t:1:.'f!!:.~«::.~~ili~.Ao~£e is entered at S. No } ..~.~ ~.. in Part No ~.~& of the electoral roll for.~!.~I.~~~~.~~.~.!rerssemblyconstituency comprised within) ..~~~./J.'!..~'!.:::.~!.. .:... Parliamenta Con tituency. My n me is R/:.T:t!.!.':!..gJ:t/?~.':'. and it is entered at S.No. ....J?~.......... in art No. ..~~.~....... of the electoral roll for 1~~:~~~~y'~~.~~~M ..................., * (!At ssem, blvy constituencyconsti compnse. d WIt. hiIn) 171 ~xIlftR.lfSAT . ................... Parr amentary constituency. ., .J '\. P\~g~, Date Signature of Proposer 1 PART II (To be used by candidate NOT set up by recognised political party) We hereby nominate. as candidate for election to the H se of the People from the Parliamentary Constitue Candidate's name Father's/mother's/husband's name ~ His.postal ad ess . .....................................................1 His name is entered at S.No :.~:inP rt No : ofthe electoral roll for ' :t(Assembly constituency comprised within) .................................... ~ Parliamentary constituency. I ~_. A. 1 I I J .. I' I~ We declare that we are el tors of the above Parliamentary Constituency and our names are entered in the el oral roll for that Parliamentary Constituency as indicated " below and we append ou ignatures below in token of subscribing to this nomination:- i • " ", ; ~ J • 4 f • I .." I. ••. ,. • " , . Particulars of the proposers and their signatures Name of Date Elector RoD No. of , Full Name Signature ' , component I' S. No. Proposer , ,.. ~ssembly . r ' " t ~,,: ..: I:',,,\O. ',i Constituency Part No:'of I' s.N~.i~ Electoral that part ' , Ron / 1 2 3 4 5 V 7 " I "'\ '. f I 1 ' .' · '-_ ( . I_ I/ 2 · • I ........, _, / . .- - . " /.,. 3 · 4 ... / 5: . v/ 6 · / - 7 ." · /_ .... 8 V · / 9 n. , - 1 · 7 I t, " 10. 7 ~ . N.B.- There should be ten electors or the constituency as proposers. 2 . PART III I, the candidate mentioned in Part IIP}Y't11(Strike out whic is n t applicable) • assent to this nomination and hereby declare that - (a)1am a citizen of India and have not acquired the citizenship of an foreign Sate or country. Go . .' f (b)1 havecomp 1eted _._ M ••• ,-, y~~rs__l_~ge~ __ [STRIKE-eJUTc(i)orc(ii)BELOWWHICHEVERISNO APP ICABLE] - . hi 1 . b h -ALL INP/A TR.lNAfvI OL ~fvq~e$S (c)(I)lamsetupatt Ise ection yt e I•••••••••••••••••••••• party, which is a recognised National Party/State Party in this Stat and that the \ , \ ." ..... ' , symbol reserved for the above party be allotted to me. -\ '>". -. .: 1\' \ \. - ',OR ,'.1'\,\' \ ",'\- \ " (c)(ii) 1am set up at this election by t party, which is a registered-u cognised political party/that I am c ntesting this r election as an independe candidate. (Strike out which is ot ap 1icab1e)and that the symbols 1ha chosen, in order of preference, are: (i) (..) I' . ' .( ... ) (~.)·~;~~~.~~·~~d·~;·F~th~~~~~oth~~~~iH...·~~~.~d;. ..~~·~~~e·h,.·~~~.~~~~~~ti~'~~~'lt,.~. out aboveove Ini £NG;LISH (namename 0oftht e l'angua e); , (e) to the best of my knowledge and belief, J am qya1ifi~~and o~,alsodisqualified for being chosen to fill the seat in ,t~p,~9,';l~eof the People. , \. r..', • " ',- f' I' *1further declare that 1am a member ofthe ./. :.~ **Caste/fribe which is a scheduled **caste/tribe of the State of ~ I .in relation to (area) in that State. ., . 1also declare that 1have not been, and all not be nominated as a cantlidate at the present general election/the bye-election eing held simultaneously, to the house of the People from more than two Parliament I Constituencies. kJJQ.c4JL' ~ . Date. ...• Signatureofd.1andid te •. " . J .. ,. +Score out the words "assembly constituency comprised within" in he cas of Jammu' and Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra dnd Na~ar,Haveli, Daman and Diu and Lakshadweep. ~! . *Score outthis paragraph, ifnot applicable. ' , { **Storeout~h~~<?rdsnotapplicab1e. > N.B.-A "recognised political party" means a political party recogni: ed byt e.Election Commissionunder the ~,1~~t~9~Symbols (Reservation and Allotment) Order, 1968 inthe State concerned. 3 PART IlIA (To be filled by the candidate) (I) Whether the candidate• (i) has been convicted - (a) ofanyoffence(s) under sub-section (I); or (b) for contravention of any law specified in sub-section (2), . if' of section 8 of the Representation of the People Act, 1951 (43 of1951); or ~o (ii) has been convictedforany other offence(s) for which he has been sentenced to imprisonment for two years or more.-- ----- ~-~ -_ ( ,: .-_ \ \ ! • ~,'/C. ~"",!,,, "\\(~ 1.\' :- If the answer is "Yes", the candidate shall furnish the following information: (i) Case/first information report No.fNos !Y.Q.T..&p.P.~J.~·:fY¢.'::F.. (11..) P0liIce station. ()s NrJ"T ftP'P.LIe_I}f?>L£ . District( s)..t'fP.T.~/!P!:!.~fl.'P.~.r:state(s)!:'.~7:..!tfl!!-:!.t;,~#.'::~ ; . (iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for , which he has been convicted ........ .f:!f?T./ttf!.y.r:.f.'/!l.'-::€..................................... ' (iv)Date(s) ofconviction(s) ......N.'l.r...f'rf.p.hl.rr!1:/!?f.:.f.. .. (v) Court( s) which convicted the candidate N/1.7:.,,,.(¥I.~LI!!:.~'::~ .. (vi)Punishment( s) imposed [indicate period of imprisonment( s) and/or quantum offine(s)] t:i~.T..ftJ>.f.?:!.~~.!fJf.:§ , (Vll")Date()soref 1ease ~.lrom pnson Nt:rr A-PfJ/.-Itt: ~/}ro,-G . (viii) Was/were any appeal (s)/revision( s) filed against above conviction/ s) . 'leS'fNo (ix) Date and particulars ofappeal(s)/application(s) for revision filed . •••• . ••••• •••••••• ••• •..... •• •••• •••• ••.••• 1:-1.f!..T...~/?.t;J.M.~1-:.~ .•..........•...........•....•...........•. (x) Name of the court(s) before which the appeal(s)/application(s) for revision filed ':1.f!.T... I:tPl?l·:! r;ft&f..€ . (xi) Whether the said appeaI( s)/application( s) for revision has/have been disposed of or is/are pending f;{~ .T..8.f!f.A.l.t;!J./?J,L;-; € .. (xii) If the said appeal( s)/app lication( s) for revision has/have been disposed of-, (a) Date(s) ofdisposal .......... .I:,/!.T..ftI?P.hl.~Id_!-t:. (b) Nature of order( s) passed .....1':I.Q.T.l!rP.P.l::!.~~ ~.I-e (2) Whether the candidate is holding any office of profit under the Government of India or State Government? ......... (ydfNo) , r.,' -If Yies, detai'1sotf heo ffiIce held . NO 7:.~A-DlJt.Ie.:.IJ-BLlJ.- , 'c .. (3) Whether the candidate has been declared insolvent by any Court? ~o) , -If Yes, has he been discharged from insolvency .....l:1_(~.7:FTffJl:.1 ef1-ltJt. B , (4) Whether the candidate is under allegiance or adherence to any foreign country? . (WsfNo) 'r' " '. .' No-r f}P{JL./CfJ'3l-c; ::If Yes" gIve details e e ••••••••••••••••••• ~ •••••••••••••••••• (5) 'Whether the candidate has been disqualified under section 8A of the said Act by an order ofthe President? ~ (YesfNo) f\ -If Yes, thepeno. d fror whi1Ch diisqua. lifi1 red ;No-r :Prl>fJt-/eIHtJLf:::.v!,-, .. 4 (6) Whether the candidate was dismissed for corruption or for disloyalty ~hile holding office under the Government of India or the Government of any Slate? ..I... ('(e(IN0) -If Yes, the date of such dismissal ........l:i.tI.7:..r::tP.ef-:!.t;.tJ./M·:f (7) Whether the candidate has any subsisting contract( s) with the Gevernnient either in individual capacity or by trust or partnership in which the candidate ha a share for supply of any goods to that Government or for execution of works urldertaken by . thatGovernment? (~lNo) -If Yes, with which Government and details of subsisting contrac (s); ..~ .. ...... .. .. .. .. .. ; JY.9.I...M.p..I;-.!. .ft.~.~... (8) Whether the candidate is a managing agent, or manager or Secret ry of a~companyor Corporation (other than a cooperative society) in the capital fwhich the Central Government or State Government has not less than twenty- rve percent share? (~/no) '. r'\ -If Yes, with which Government and the details thereof ........ !.Y.q... /}Rf.~r..t:,~.I!:...~.~ r (9) Whether the candidate has been disqualified by the Commission under ection lOA of the said Act.. (~INo) LU> L A A r: -If yes, the date 0f'dilsqua lificatiI ication NtJ7urP J nBLr=.. WJjJ. C)twL Place:~~ Signature of Date: ..Qi;<1/4 t-..2.0.~1-. PART IV (To be fi ed lY the Iteturniz. Officer) L • Serial No. of nomination paper .. ' ....... Jr.:f/..~ ..\l ..fU>..J1-~ This nomination was eliv ed :~_~ t my office t.. (hour) on ~~ate) by the .*cand.idate/p~. .." err. \(nameof propos.el&. .................................. ) (i.~(. \'ki . I R&tu. ;t,fof,bJ 13 . 9-h, D1-t /l()IJ ~~_i\ ).!)) 17..Bar~ atP'~1 Date :......... \' :~,",:.~ 1teturnl g Otllcef "-:,._'''PARTV Decision of Returning Officer Accepting or Rejecting the Nonitnatio Paper I have, examined this nomination paper in accordance with sectio 36 of the . Representation of the People Act, 1951(43 of 1951) and decide as folIo s:- ....................................................................................................................................... ............................................................................................................. ••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••.••••••••••••••••••••••••••••••••••••••••••••••• It •••••••••••••••••••••••••• Date ~ . Returni g om er 5 WEST BENGAL 28AB 866669 Form 26 (See rule 4A) BY THE CANDIDATE ALONGWITH NOMINATION PAPER BEFORETHE RETURNING OFFICER q.:.== (NAME OF THE HOUSE) FROM 17, Barasat Parliamentary CONSTITUENCY(NAME OF PART A ~O"1j 11'y·V6tY ~• ~1fI.~ o'v0HcI~ ~~~• ~' f (6'11f em; - J)c!J-f~ ~ ..- ~- .
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