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~~
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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 iIn £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~~ 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~ ~ ..-
~- .
. ~ JJitlfJ ~ - '0 8 A PR~\2019 (1f$'" C""'A 'l'U - - 4-,,1~ -~II''''\I' I 0 0 0 0 8' \OtG'" • "l9f'l 'PB ~
,. (Name of the (2) My name is enrolled in 118, Madh am ram Assembl Constituenc
Constituency and the state), at Serial No. 1010 in Part No. 226 (3) My contact telephone number(s) is/are 09013180190 /9830159332 (Mobile), LabClllne N~. 03325260404/03325262026 and my e-mail id (if any) is [email protected] and my social
media account(s) (if any) is/are (i) FaceBook- Dr. [email protected]
(ii) Whatsapp No.- 9830159332
(iii) Tweeter- Dr. kakolighoshdastidar 4. Details of Permanent Account Number (PAN) and status of filing of Income Tax return:
The financial year for Total income shown In Income Tax which the last Income- Return (in RJpees) for the last five PAN 51 No. Name tax return has been Financial Veirs comP:rted (as on filed 31st March (i) 201~-14- Rs!8,11,380 (ii) 201~-15- RS,7,61,490 Self (iii) 201~-16- Rs,\8,36,090 1 ADCPG1617N 2017-18 Kakoli Ghosh Dastidar (iv) 201~-17- Rs·116,35,370 (v) 2011-18- Rs.15,20,430 (i) 201~-14- Rsj8,35,750 (ii) 2014-15- Rs.J12,46,800 Spouse (iii) 201~-16- RS·114,79,610 2 AGGPG9087K 2017-18 SudarsanGhosh Dastidar (iv) 201d-17- Rs.j18,97,180 (v) 2011-18- Rs.30,67,270 (i) Not Applicable (ii) INot Appllcable HUF(If Candidate is (iii) lNot Applicable 3 Not Applicable Not Applicable Karta/Coparcener) (iv) lNot Applicable (v) Not Applicable (i) Not Applicable (ii) Not Appl cable (iii) Not Applicable 4 Dependent 1 Not Applicable Not Applicable l (iv) Not Applicable Not Applicable (v)
(i) Not Applicable (ii) Not Appl cable cable 5 Dependent 2 Not Applicable Not Applicable (iii) t Not Appl (iv) l Not Appl cable (v) Not Appl cable (i) Not Applicable (ii) Not Appl cable L Not Appl cable "" '.' ~~pendent3 Not Applicable Not Applicable (iii) (iv) l Not Appl cable ~~ ,. -- ...., . ~.IIr (v) I, Not Appl cable _7.~ht' '\ 4\
Page 2 of 19 7. ~ ~Y~:lb.~~ fr' I I
Note: It is mandatory for PANholder to mention PANand in caseof no PAN.It should be clearly stated liN~ PANallotted".
(5) Pending criminal cases
(i) I declare that there is no pendin iminal case against me. (Tick this Iiternatl~e if there is no criminal case pen . g against the Candidate and write NOTAPPLICABLE against alternative (ii) be )
OR
~ The follwing criminal casesare pending against me :
(If there are pending criminal casesagainst the candidate, then tick thi alternative and score off alternative (i) above, and give details of all pending casesin the.Table below)
Table
1) F.I.R.No. 177/18, 2) RC0102017A0010, FIRNo. With name dated 03/08/2018, dated 16(04/2011, Police Station NIL (a) and address of Police Under Udharband Police Station concerned Station, Cachar District - CBI/ACB/Kolkata! Silchar, Assam. Districti Kolkata
, Page 3 of i9 11..1 II
CaseNo. RC0102017AOdl0 CaseNo. 177/18, dated. dated 16/04/2017, Not CaseNo. with Name of (b) 03/08/2018, Silchar, CBI/ACB/Kolkata, District- Applicable the Court Assam Kolkata ,
Section(s) of concerned Acts/Codes U/s 120B IPC& 7, 13(2)r/W 13 Not involved (give no. of (1) (a) and 13 (1) (d) P.C.Act (c) U/s 353/323/34 IPC Applicable the Section, e.g. 1988 Section ...... of IPC, etc).
Public servants acceptink or agreeing to accept iIIe.al gratification, committihg Assault and restrain the Not Brief description of offences of habitual acce~tance (d) Public servant work with Applicable offence common intention of illegal gratification, crltnlnal mis conduct and crimi~al conspiracy. l
Whether charges have Not NO (e) been framed (mention NO Applicable YESor NO)
If answer against (e) Not above is YES,then give Not Applicable (f) Not Applicable Applicable the date on which chargeswere framed tc
Whether any Appeal/Application for Not revision has been filed NO (g) NO Applicable against the proceedings (Mention YESor NO) j_
Page4 ori9 (6) Cases of conviction ~eclare that I have not been convicted for any criminal offence. (Tick this alternative, If the candidate has not been convicted and write NOTAPPLICABLEagainst 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) above,
and give details in the Table below) Table
(a) CaseNo. Not Applicable Not Applicable Not Applicable
(b) Name of the Court Not Applicable Not Applicable Not Appltcable
Sections of Acts/Codes
involved (give no. of the (c) Not Applicable Not Applicable Not Ap~licable Section, e.g. Section...... of
IPC,etc.). I.
' , Brief description of offence (d) Not Applicable Not Applicable Not Applicable for which convicted ,
Dates of orders of (e) Not Applicable Not Applicable Not Ap~licable conviction
(f) Punishment imposed Not Applicable Not Applicable Not Applicable
Whether any Appeal has
been filed against (g) Not Applicable Not Applicable Not Appllcable conviction order (Mention
YESor NO)
(h) If answer to (g) above is
YES,give details and Not Applicable Not Applicable Not Ap~licable present status of appeal (6A) I have given full and up-to-date information to my political party about all pending criminal tases against me and about all cases of conviction as given in paragraphs (5) and (6).
[Candidates to whom this Item is not applicable should clearly write NOT APPLlCPiBLE IN ViEW OF
ENTRIESIN SCi)and 6(i), above]
Note:
1. Details should be entered clearly and legibly in BOLD letters.
2. Details to be given separately for each case under different columns agai~st each Item.
3. Details should be given in reverse chronological order, i.e., the latest case to be m~ntioned
first and backwards in the order of dates for the other cases.
4. Additional sheet may be added if required.
S. Candidate is responsible for supplying all information in compliance of Hdh'ble Su~reme
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.) bf myself my
spouse and all dependents: A. Details of movable assets: Note: 1. Assetsin joint name indicating the extent of joint ownership will also have to be giv~n. Note. 2. In caseof deposit/Investment, the details including Serial Number, Amount date of deposit,
the scheme, Name of Bank/Institution and Branch are to be given.
Note. 3. Value of Bonds/Share Debentures as per the current market value in Stock Exchang~in respect of listed companies and as per books in caseof non-listed companies sho'uldbe
given. Note. 4. 'Dependent' means parents, son(s}, daughter(s) of the candidate or spouse and any other person related to the candidate whether by blood or marriage, who have no separate
means of income and who are dependent on the candidate for their livelihood.
Note. 5. Details including amount is to be given separately in respect of each investments.
Note: 6 Details should include the interest in or ownership of offshore assets.
Explanation- For the purpose of this Form, the expression "offshore assets" inchJdes,detbils of all deposit or investments in Foreign banks and any other body or institution abro d, and details of all assetsand liabilities in foreign countries'; '.
Depend D~pend Depend S. HUF Description Self Spouse ent-l 'nt-2 ent-3 No. NIL NIL NIL (i) Cashin hand Rs.16,648.00 Rs.35,274.00 NIL Fixed Deeosit with SBI,Parliament Fixed Deeosit with BOI,' House, New Delhi, at RashBehari Avenue A/C No.- Branch, 33668949580 Rs.56,77,513.00 Rs.12,23,797.00
P.P.F.with SBIA/C P.P.F.with SBIAIC No. No. 11000236194 11000225218 Rs.19,43,261.00 Rs.18,55,884.00
Savings Bank A/C : SavingsBank Ale:
Details of SBI,Parliament Bank of India, No. deposit in Bank House, New Delhi, AIC 401510100011010, accounts (FDRs, A/C No.- Rs.8,03,153.00 Term Deposits 30782968193 and all other Rs.9,90,691.00 BOI, RashBehari types of Bankof India, A/C No. Avenue, NO. Deposits A/C 400210100612574, 401510100013613, including savings Rs.50,739.00 accounts), Rs.11,96,026.00 Deposit with Standard Chartered ~IL NIL NIL (ii) Standard Chartered NIL Bank, Gariahat I Financial Bank,A/C No. Branch, A/C No. Institutions, 32111009417, 32710276129, Non- Banking Rs.60,862.00 Financial Rs.73,671.00 Companiesand UCOBank,42 SN Cooperative Banerjee Road, SBI,AIC No. societies and A/C No. 35699426080, the amount in 03220100009240, Rs.13,409.00 each such Rs. 15,839.00 deposit Standard Chartered Axis Bank, A/C No. Bank,AIC No. 916010010862356, 32710141924, Rs.21,331.00 Rs.1,662.00 SBI,A/C No. 32238469952, Rs.3,81,705.00 SBI,A/C No. 31699981713, Rs.3,496.00 4~ ,..... " SBIA/C No. J ._•.",.,. j 10521574945, +..,~' '" '<: I,,.., ''It' Rs.16,189.00 11-./..._" 1liA."1I ,,' ~t faa1'o, 01 ~ 8 S~} ~ A\ 'no If},.(:tC4'Jt .''}; ~"': 1o~~ ')1.[. 7'Ii ~ ~ pJge 7 ofI9 _ ·K..b\-·. , . ~.~, '. "''''''''''4~ l\!,;'" r ~. ~?R 1Q\~ 1. M·~~ ,,' '.
l Details of Ghosh Dastidar Ghosh Dastidar investment in institution for institution for Fertility Bonds, Fertility Research Researchpvt. Ltd.- Debentures/ Pvt. Ltd.- Rs.1,07,000.00 NIL ~IL NIL NIL (iii) Sharesand units Rs.85,000.00 in Companies/ 5BI Corporate Bond Mutual Funds Fund- Regular Plan and others and Growth the amount. Rs.8,00,000.00 SBILife Smart Wealth Builder, Policy No.- 1K016360702SA- Details of Rs.10,00,000.00 investment in Yearly Premium NSS,Postal paid Saving, Rs.1,00,000.00 Mediclaim Policy in Insurance total premium paid National Insurance, Policies and up to 31.03.2018 Policy No.- NIL ~IL NIL NIL (iv) investment in Rs.4,00,000.00, 1010005018100004155 any Financial Maturity date- A, Rs.5,00,000.00 instruments in 27.03.2025, Yearly Premium Post office or Mediclaim Policy in Rs.21,908.00 Insurance National Insurance, Company and Policy No. the amount 101000501810000 414SA, Rs.5,00,000.00 Yearly Premium ! Rs.34,875.00 ,J Personal loans/advance given to any Professional Fees person or entity Receivable Professional Fees Rs.83,485.00 including firm, NIL NIL NIL NIL (v) Receivable company, Trust Salary Receivablefrom Rs.93,000.00 etc. and other WB Assembly, receivables Rs.21,870.00 from debtors and the amount J (1) HONDACITY, Motor DL4CAN6490 Vehicles/ Air (Value crafts/Yachts/ Rs.4,43,705.00) Ships (Details of Against S.B.1. Make, Parliament House, NIL NIL NIL NIL (vi) NIL registration New Delhi -"if\~ber. Etc. Hypothecation '. ' .. (2) MAHINDRA ,.-",.'r1f • .!yearof .~...~ ~, purc~as;eand JEEP,WB027451 *11'· ~ ,.1. a)nount (Value t • ~ I.!_ 1; Rs.20,880.00, .~ -:..lctv -: -w.n."_' . Phge 8 of 19 ~~firl,'("j~:+~, NOTAtn ,~,~, ~.I,ll l evt, d\oil' t .' ' ' .
(.:SJ rovorx FORTUNNER, WB02AH3880 (Value Rs.17,08,367.00) Chain-1, Kaan 1 Jora, Navaratna Haar-2, Navaratna Ear Paasha-2 Jora, , Navaratna Churl- 1, Diamond Necklace- 1, Diamond Ear Paasha-2Jora, 3 Nos.of Gold Ring, Churi Pearl Jewellery, Diamond RingGold Necklace- 1 Jora, bullion and Botton- 1, Necklace, Pearl Ear Paasha-2 valuable Wrist Band,Gold Coin- Jora, Mangalsutra- NIL (vii) thing(s) (give 12 Nos. NIL ~IL NIL 2, Gold Mina details of Net weight- Necklace- 1, Ear weight and 100gm, Ring- 1, Baala- 1, value) Estimated Value: Choor- 2 Jora, Rs.2,13,281.00 Churl- 10, EarTop- 2, Bauti- 1, EarTop- 2 Jora, Diamond pendent Set- 1, Net weight- 850 gm, Estimated Value: Rs.13,23,280.00 l Any other Furniture & assetssuch as (viii) Fixtures, NIL NIL ~IL NIL NIL value of Rs.'50,000.00 claims/interest
GrossTotal NIL NIL NIL (ix) Rs.1,04,05,496.00 r Rs.93,25,522.00 NIL value
B. Details of Immovable assets:
Note 1. Properties in joint ownership indicating the extent of joint ownership will also have to be ~jcated .'~ "'. ~Nit~~Each. land or building or apartment should be mentioned separately in this tormat .... :"....-_....,- ....,. ,~.; ht f,lote3..Details should include the interest in or ownership of offshore assets. '-rt •• ,Ui' " ~"I> '\ . tflt ~~••, ~I ~ i> }tt; ~ ~ ·"\ ..~~~!'i~d!'jIt~t,. t t:l~ ::;'(0;.; -: 'f4;:""" " '''Ii-:•• · '/& .., ..•• ~ - '~c$, . ~'.·...... A:_"' ~... ,'.:\' ~t -;;,~'!"or,. J ..."'~;:;i II' "
S. Dependent- D~pendent~ Dependent- Description Self Spouse HUF No. 1 2 3 Agricultural (i) Land Location(s) Digberia, NIL NIL NI:" NIL NIL Madhyamgram, Survey Mouza- Digberia, Dag number(s) No.-199 Area (total 35 decimals or 21 measurement NIL Kottas, 2 chhataks, NIL NIL NIL I NIL in acres) 15 sqft Whether inherited NIL NO NIL NIL NIL NIL property (Yes or No) I. Date of purchase in case of self- NIL 1981 NIL NIL NIL NIL acquired
property .1 Cost of Land (in case of purchase) at NIL 5,000.00 NIL NIL NIL NIL the time of
purchase ! AnyInvestment on the landby wayof NIL NIL NIL NIL NIL NIL development, constructionetc. ,j Approximate Current market NIL 48,00,000.00 NIL NIL NIL NIL value I. I N2n;: Sulangari, (ii) Agricultural Rajarhat, Land North 24 Location(s) Digberia, NIL NIL NIL NIL Parganas, Madhyamgram, Survey Dag No-294, Mouza- Digberia, number(s) JL No. 22 Dag No.-183 , Area (total 36 decimals on 21 5 Kottas, 7 measurement Kottas, 2 chhataks, NIL NIL NIL NIL chhataks in sq. ft.) 15 sqft Whether inherited NO NO NIL NIL NIL NIL property(Yesor No) I. Date of purchase in 02/03/2015 case of self- (jointly with 17-02-2004 NIL NIL NIL NIL acquired her son) property I
./" ...... , -_. ... j; "- '.l."
Page 10of1~ Cost of Land (in case of purchase) at 14,00,000.00 7,50,000.00 NIL NIL NIL NIL the time of purchase Any Investment on the land by way of NIL NIL NIL NIL NIL NIL development, construction etc. Approximate Current 16,00,000.00 50,00,000.00 NIL NIL NIL NIL market value Commercial (iii) Buildings (including apartments)- NIL NIL NIL NIL NIL NIL Location(s)- Survey number(s) Area (total measurement NIL NIL NIL NIL NIL NIL in sq. ft.) , Built-up Area (total NIL NIL NIL NIL NIL NIL measurement in sq. ft.) Whether inherited NIL NIL NIL NIL NIL NIL property (Yes
or No) j Date of purchase in case of self- NIL NIL NIL NIL NIL NIL acquired property Cost of Property (in case of NIL NIL NIL NIL NIL NIL purchase) at the time of
purchase J Any Investment on the property by way of NIL NIL NIL NIL NIL NIL development, construction etc.
~!.I- ~.... CJf t ~ NIL NIL NIL NIL NIL NIL r ....Jla~tv ue ...... " . , Residential (1) Digberia, Buildings Madhyamgram, North 24 Parganas, (including 2400 sqft. Residential NIL NIL NIL (iv) apartments)- NIL Building Constructed NIL Location(s)- (G+1), (2) Survey 119,Southern Avenue, Kol-29, number(s) " . 1250 Sqft Flat (1) 2400 sqft Area (total Residential Building NIL NIL NIL NIL NIL measurement Constructed (G+1), in sq. ft.) (2) 1250 sqft Built-up Area (1) 2400 sqft (total Residential Building NIL NIL NIL NIL NIL measurement Constructed (G+1), in sq. ft.) (2) 1250 sqft Whether inheri NIL NIL ted property NIL NO NIL NIL (Yes or No) Date of (1) Land Purchased purchase in on- 17/02/2004, NIL NIL NIL NIL NIL case of self- (2) Flat Purchased on acquired -1996 property Cost of (1) Building Cost Property (in (G+l)-, case of NIL NIL Rs. 26,91,560.00, NIL NIL NIL purchase) at (2) Cost of Flat- the time of Rs. 15,05,000.00 purchase l .I Any Investment on the land by NIL NIL NIL NIL NIL NIL way of develop ment, construe tion etc. I Approximate (1) Rs.40,00,000.00 NIL NIL NIL NIL NIL Current (2) Rs.54,00,000.00 market value .1 Others (such ,NIL NIL as interest in NIL NIL NIL NIL (v) property) ., J Land- Rs.98,00,000 Total of Building- current market NIL NIL NIL (vi) 16,00,000.00 Rs. 94,00,000 NIL value of (i) to Total k_,,~ve Rs.1,92,00,OOO I , '!J >II:~ '!tI ~ ,, .r'i!r~_~".....' - "'" ""':.. Phge 12 of 19 .. (8) I gave herein below the details of liabilities/dues to public financial institutions and government:- (Note: Pleasegive separate details of name of bank, institution, entity or individual and amount before each item) Dependen bependeh Dependen S. HUF t-1 t-Z t-3 No Description Self Spouse , .' , Loanor dues to SBI,Parliament (i) Bank/ Financial House Branch, Housing Loan From Institution(s} Sansad BOI,RashBehari Name of Bank Bhawan, New Avenue, A/C No. NIL NIL NIL NIL or Financial Delhi 401561110000284, Institution, Car LoanA/c Rs.5,25,216.00 Amount No- outstanding, 35116933346, Nature of loan Rs.9,57,914.00 Loan or dues to any other individuals/ entity other than NIL NIL mentioned NIL NIL NIL NIL above Name(s), Amount outstanding, nature of loan u Any other Election fund- NIL NIL NIL NIL NIL liability Rs.12,929.00 NIL Grand total of Rs.9,57,914.00 Rs.5,38,145.00 NIL NIL NIL liabilities J Page 13 of 19 (ii) Government Dues: (A) Hasthe Deponent been in occupation of Duesto departments accommodation provided by the YES/Nt! dealing with Government at any time during the last ten (PI.tick the Government years before the date of notification of the ap~roprlate accommodation current election? aIt~rnatlve) (8) If answer to (A) above is YES,the following declaration may be furnished namely:- The addressof the Government (i) NOT accommodation: ...... Applicable ...... (ii) There is no dues payable in respect above Government accommodation, towards- (a) Rent; (b) Electricity charges (c) Water charges; and (d) Telephone charges as on ...... (date). [the date should be the last date of the third month prior to the month in which the election is notified or any date thereafter]. Note- 'No DuesCertificate' from the agenciesconcerned in respect of rent, electricity charges,water charges and telephone chargesfor the above Government accommodation should be submitted. (iii) Duesto department dealing with Not Government transport Not Applicable Applicable (including aircrafts and helicopters) ~ .r ~.~ .C)it. ) NOTAk'i , ,~u·vt. ~f \M.a. ( ~ll\~ ...~ ~()~ 2£1. ~.'io>' 1. ~ ~I'R 11)\f3 ------ ,", Dependent"2 Dep~ndent-3 S.No Description Self Spouse HUF Dependent-l NIL NIL (iv) Income Tax dues NIL NIL NIL NIL NIL NIL (v) GSTdues NIL NIL NIL NIL NIL NIL (vi) Municipal/Property NIL NIL NIL NIL tax dues NIL NIL (vii) Any other dues NIL NIL NIL NIL NIL NIL (viii) Grand total of all NIL NIL NIL NIL Government dues NIL NIL (ix) Whether any other NIL NIL NIL NIL liabilities are in dispute, if so, mention the amount involved and the authority before which it is pending I. (9) Details of profession or occupation: (a) Self Doctor (b) Spouse Doctor (9A) Details of source(s) of income: (a) Self- Professional Fees (b) Spouse- Professional Fees (c) Sourceof income, if any, of dependents, - Not Applicable (9B) Contracts with appropriate Government and any public company or cornpanie] (a) Details of contracts entered by the candidate - Not Applicable (b) Details of contracts entered into by spouse - Not Applicable (c) Details of contracts entered into by dependents- Not Applicable (d) Details of contracts entered into by Hindu Undivided Family or trust in which th~ candidate or spouse or dependents have interest- Not Applicable Page 15 of 19 "- JW1j,OuJ1 ~ ,. , ,. (e) Details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners- Not Applicable (f) Details of contracts, entered into by private companies in which candida~eor spouseor dependents have share - Not Applicable (10) My educational qualification is under: Bachelor of Medicine and Bachelor of Surgery (MBBS) KOLKATA, Post Graduate Training in Advance Ultra Sound (London, U.K.) (Givedetails of highest School/University education mentioning the full form of the certlflcale/ diploma/ degree course, name of the School/College/ University and the year in which the course was completed.) ~ ~, .U. 'N0TA'k",( ~'tN"1.,., ~ f' .~~. ?":""'" ,,;. -.J (}"'~i '. \ ~>' '>t;.) , Page 16 otI9 " PART-B (11) ABSTRACTOFTHEDETAILSGIVENIN (1) TO (10) OFPART-A: £I:r./Smt./~. Kakoli Ghosh Dastidbr 1. Name of the Candidate Digberia Uttarpara, P.O.- Badu, P.SI-Madhyamgram, 2 Full postal address District - North 24 Parganas, Kolkata - 7001~8, West Bengal 17, Barasat Parliamentary ConstitJency 3 Number and name of the constituency and State West Bengal 4 Name of the political party which set up the All India Trinamool Congress candidate (otherwise write 'Independent') 5 Total number of pending criminal cases 2 (Two) 6 Total Number of casesin which convicted Not Applicable Totallntome Shdwn 7 PAN of Yearfor which last Income Tax Return filed 15,20,do.oo (a) Candidate ADCPG1617N 31.03.2018 30,67,270.00 (b) Spouse AGGPG9087K 31.03.2018 Not Ap~llcable (c) HUF Not Applicable Not Applicable Not Applicable Not Applicable Not Ap~llcable (d) Dependent j 8 Details of Assets and Liabilities (including offshore assets) in rupees Depen~ent Depen Description Self Spouse HUF Dependent -1 -2 dent- 3 A. Moveable Assets 1,04,05,496.00 93,25,522.00 NIL NIL NIL, NIL (Total Value) B Immovable Assets J I PurchasePriceof 1) 1) Rs.5,000 self-acquired 14,00,000.00 2) Rs.7,50,000 NIL NIL NiL NIL immovable property 3)Rs.15,05,000 II Developmentlconstru ction cost of NIL Rs.26,91,560 NIL NIL NIL ~ovable property NIL i/.f; V Ik ~ ij1' ~r.purchase (if "~,.-?"", --, "'applicable) .hl' ,on- <. Page 17 ofI9 AJ( ! .) ~~,vs ;; .~!t.;f .. ~;~j'~':.'.:: 'l l ~I'R 'It\Luo. ~ ~ ...... III Approximate Current Market Price- NIL NIL (a) Self-acquired 16,00,000.00 1,92,00,000.00 NIL NIL , assets(Total Value) NIL NIL (b) Inherited assets NIL NIL NIL NIL (Total Value) 9. Liabilities NIL ·NIL NIL (i) Government dues NIL NIL NIL (Total) NIL NIL (ii) Loansfrom Bank, Rs. Rs. NIL NIL Financial 9,57,914.00 5,38,145.00 Institutions and others (Total) 10. Liabilities that are under dispute NIL NIL (i) Government dues NIL NIL NIL NIL (Total) NIL NIL (ii) Loansfrom Bank, NIL NIL NIL NIL Financial Institutions and others (Total) 11. Highest educational qualification: Bachelor of Medicine and Bachelor of Surgery (MBBS) KOLKATA, Post Graduate Training in Advance Ultra Sound (londonl U.K.) (Give details of highest School/University education mentioning the full form of the certificate/ diploma/ degree course, name of the School/College/ Univ~rslty and the year in which the course was completed.) fifO:? .,,11\ ~ ~(JTAk' ,'(Jt>vt, , f YIf.fi ' .~"'t ..,./ "',,*- 2 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 of conviction or pending case against me other than those mdntloned in items 5 and 6 of Part A and B above; (b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 7 and 8 of Part A and items 8, 9 and 10 of Part B above. Verified at Barasat;;~thiS.~the .m...... dav:m~Qf ARril, ~2019.a ~.tkJ.l ~l\ __j ~A ... , lcIeD~ "'1 - ~. ~EPONEN1 ~.iJ2.J ...i::;:::(f...- Advoc." _,...~ t \i~lI'" ,..,\, (: _ " ..~.'1 ~ ~ ·\"~Ul'f~ ~ ~~o/t'"-(' ,,\ _ ,Y Q~Pt.:"._ ~~ pR ")q ::'. . _-~o 1 ~ t') ~ ~\ NOTARY - I" ~ '_...... ,C...... ('ta:-'1 C !er-\l. .24·-1·1'1 Note: 1.Affidavit should belllillil' ..... 3;90' PM on the last day of filing nomi~atlons. Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate Of the Flr'stClass or before a Notary 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 "Nil" or "Not applicable", as the case m~y be, sheuld be mentioned. Note: 4. The affidavit should be either typed or written legibly and neatly. Note: 5. Each page of the Affidavit should be signed by the deponent and the A fldavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before l.vhom the Affidavit is sworn. Page 19 of 19