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Candidate's Name J Lit * 0sc1 FORM 2A (See rule 4) NOMINATION PAPER Election to ihe House of the PeoPle p-- 1n-rn.i-- *{r J lit * STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PART I (To be used by candidate set up by recognised political party) I nominate as a candidate for election to the House of the People from the..1:.2AMAN. ....k. ..).t.U.M. CN)..Parliamentary constituency. PATEL Candidate' n"m".BlTE!"..-L/1.LU.B.HAl...RABUDlrFaher's/motherslMs name. |KU.TIRz)g'dAaal .RAB.UBliAl..... His postal address tl:l'19:29.k.h,f'A'D.Rl fl uA./.R*s.$t.AAM,NANl bAMANAI62lo His name is entered at s.No..l2.?.......in Part No...10......... ..... of the electoral roll in) Parliamentary for.L. 1 * U*rt..& I t U.l! -Constituencv. il;; is.T..+rl.).EL).E-E.P.E]!/...T.H2!9.5W# ,t is entered at S.No. 1.3.0""i n Part No..f ?......or the electoral roll for ..1.-..D.&nN-'t....A..j.!.1)"(6gf')'.t""tt'uy-"tttstl enmlrised withil) .... .. Parliamentary constitue n I D"t" ?.q.l.q-g-l?o 19 roposer PART II (To be used bY candidate NOT up by recogrrised political panY) We herebY nominate as candi for election to the House of the People from +L^ P iamentary ConstituencY Candidate's name ...Father's/mothcr's/husband's n4me................... .His postal address 1 His name is entered at S.No ......in Part No..... of the electoral roll for 1(Assembly constituency comprised within) Parliamentary constituency We declare that we are electors of the above Parliamen stituency and our names are entered in the electoral roll for that Parliamentary Consti bncy as indicated below and we append our signarures below in token of subscribing to thi omtnatlon:- Particulars of the proposers d their signatures S[.no. Name of Elector Roll No. Full Name Signature Date component Proposer Assembly Part No. of )No. in Constituency Electoral Roll fhatoan 2 4 5 6 7 l. ) 3. 4. 5. 6. 7. 8. 9. l0 N.B.- There shoul ten electors of the constituency as proposers PART III I, the candidate mentioned in Part I/Part-ll (Stdke out which is not applicable) assent to this nomination and hereby declare- (a) that I am a citizen of India and have not acquired the citizenship of any foreign State/country. (b) that I have completed.. ... ...6.9. .years of age; ISTRIKE OUT c(i) or c(ii) BELOW WHICHEVER IS NOT APPLICABLEI (c) (i) rhat I am set up at this election by the...BHA.RA.Il yA. .. JA/.{A.IA.. pany, which is a recognised National Party/Sgre+arty in this State and that the symbol resen'ed for the abovc party bc allotted to me. OR ) rJO0l- (c) (ii) that I am set up at this election by t party, which is a registered-un ognised political party/that I am contesting this election as an independent idate. (Strike out which is not applicable) and that the sr..rnbols I have chose in order ofpreference, are:- (r........,. (jr. (,,,) (d) that my name and my father's/mother's/husband's name have been correctly spelt out auore in...€N.6 .L!.|H.. ... (name of the language); (e) that to ihe best of my knowledge and l-,cliel I am qualified and not also disqualified for being chosen to fill the seat in the House of the People. +I further declare that I am a of the.............., +*Caste/tribe which is a scheduled **caste/tri the State of. ,....in relation to in that State I also declare that I have not been, and shall not be nominated as a candidate at the present general election/the bye-elections being held simultaneously, to the House of the People from more than two Parliamentary Constituencies. Date-?.c4.0-3.1.:. o I 9 Signature of andidate rScore out the words "assembly constituency comprised within" in the case of Jammu and Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep *Score out this paragraph, ifnot applicable. t+Score out the words not applicable. N.B.-A "recognised political party" means a political party recognised by the Election Commission under the Election Symbols (Resewation and Allotment) Order, 1968 in the State concemed. PART IIIA (To be filled by the candidate) (l) whether the candidate- (i) has been convicted- (a) of any offence(s) under sub-section ( I ); or (b) for contravention of any larv specified in sub-section (2), of section 8 of the Representation of the People Act, 195 I (43 of I 95 I ); or Y^' (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more, 3 t If the answer is "Yes", the candidate shall fumish the following information: (i) p.p.Ll.CAp.!=e Case/first information repo( No.Atos.. N 0.T . .. A .... (i!) Police station(s)... .. AI0 :f . .. A.p.p.L.l 9 *.D.LE .. Distric(s).f{07..n?.P.1-.1C4.ht .A.Statels;...N0.?...Afl.pt1CARIF................. (irr) section(s) of the concerned Act(s) and bnef description of the offence(s) for which he has been conv i cted. ... N. 0.7. .. b.P.p.L l.e.A.h L e.. ... (iv)Date(s) of conviction(s) . NQ f ... *.?.?. L!.c AR L€ (v) Court(s) which convicted the candidate.NiT..ADt)!..tc.F.BL€.......................... (vi)Punishment(s) imposed Iindicate period of imprisonment(s) and./or quantum of fi ne(s)1... N 07.. a 0pLt.cAnt€... (vrr) Date(s) of release from prison.....N.0.T.. A.l.Q.L-t.efrfrL-e (viii)Was/were any appeal(s)/revision(s) filed against above conviction(s).............. YcVr.Io (,-r) Date and particulars of appeal(s/application(s) for revision filed..f(.gz..Appl=l.cARt-E (;r) Name of the court(s) before which the appeal(s)/apptication(s) for revision filed...N0.Z ....A.P.P.1-t.CA.B !-8............ (,rr) whether the said appeal(s)/applicalion(s) for revision has/have been disposed of or is/are pending...l,l 07 h ll L t gAr5LE (xil) If the said appeal(s)/application(s) for revision has,4rave been disposed of_ p0.Ll.(.A.BLC (a) Dare(s) of disposat. .. N 0 1.. A (D) Nature of order(s) passed. .l!.? L . A.P. P.f J. C,a BC -E . (2) whether the candidate is holding any office ofprofit under the Govemment of lndia or State Government?....... ()e6alo; yes, -If detai ts of theoffi ce held...r)l 9_7:.. .. Al P !.t gn l3ue (3) Whether the candidate has been declared insolvent by any Court?.......... ()e6nVo) -lf Yes, has he been discharged fiom insolven cy..N0.7. Ap? Ll cAbLE (4) whether the candidate is under allegiance or adherence ro any foreign country?.........()eSNo) -lf Yes, give detaits... ...N9.f .. A ?.l? !.1.q4 B.LE .... (5) whether the candidate has been disqualified under section gA ofthe said Act by an order of the President?..... ... .. .....(pstNol -lf Yes, the period for which disqualified.,.fl.Q.I..4. PPf.!.q.4.R. !.8_.. (6) whether the candidate was dismissed for comrption or for disloyalry while holding office under the Government of India or the Covemment of any StateZ . (!X?I,lo) -If Yes, the date of such dismissal ...|:,lCT..A.P.PLIcARLe (7) whether the candidate has any subsisting contmct(s) with the Governmenl either in individual capacity or by trust or pa(nership in which the candidate has a share for supply 4 .i001 of any goods to that Govemment or for execution of works undertaken by that Government?-........ .. ()efmo; -lf Yes, with which Govemment and details of subsisting contract(s).. Nc).T...4.1D. !,!.c.8 ttLE (8) Whether the candidate is a managing agent, or manager or Secretary ofany company or Corporation (other than a cooperative society) in the capital of which the Central Govemment or State Govemment has not less than twenty-five percenr share?............ (Y7,clno) -[f Yes, with *hich Gorernment and rhe details thereof ... N?.T... *! !..9.1.34 n l€ .... (9) Whether the candidate has been disqualified by the Commission under section l0A of the said Act... ... ... .. .... gefl{o) -lf yes, the date of d isqualifi cation... lt{QT.. 4.?P .L l.< a B,L.. Ptt(.;e: .?.A.n.4.N.. Signature of Candidate oate: .tgt.otlzo lg PABT IV (To be Slled !y the Rqturning Officer) Serial No. of nomination pup", ..Ql.l..k.P./..H.l1lRO b4' This nomination was delivered to me at my office at.t2-4 ....(hour) on....T/Oflmf .(date) by the *candidate/prepos€r. (name of proposer ..... ....... ) ,*" 3jqdttr R mrng flicer PART V Decision of Returning Officer Accepting or Rejecting the Nomination Paper I have examined this nomination paper in accordance with section 36 of the Representation of the People Act, I 95 I (43 of I 95 I ) and decide as follows:- Date Retuming Oflicer (Perforation) 5 i eo*. ptg. fi'ess, Daman.- 03/2019 - 15O- .- ;+.'.. I \ AFFIDAVIT of PATEL LALUBHAI BABUBHAI H. No. 2O6-G, Sabri Kutir, Dungri Falia, Kachigam, Nani Daman, Dist-Daman, Rs. 100 ). 'k6TiltrqilI :. I ONE )- 100 HUNDRED HUPEES |.' F{iqqqt ,:\ l o(r TTVil INDIA .}a)1c)c!!! I 1 ()C) -. ) ,? ()c)c)(. , ( N ,-,!()O1 )( ) \, I .,. ertrfl il.I d[q. <cq sfu ts DAMAN AND Dru 18798i I seaat No.2?.!.6-/.
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