':; <\ ,. .- j i~ INDIA NON JUDICIAL c, ~ (; f- Z

"'z ffi" > 8 -c »: -c f- z< '"-c "'u, 0 f- Z e-Stamp W :;; z ffi ~> -c -c -c Certificate No. IN-KA71923443707633R <. «z: Certificate Issued Date 12-Mar-2019 01:07 PM -c< u, 0 Account Reference NONACC (FI)/ kaksfclOS/GANDHINAGAR/ KA-BA Z .u ""z. Unique Doc. Reference SUBIN-KAKAKSFCLOS75447667096290R '1 »~ SHOBHA KARANDLAJE DAUGHTER OF MONAPPA GOWDA o Purchased tJYI, r• « Description of Document Article 4 Affidavit '"~ Z 0:" Description AFFIDAVIT ';\ C Consideration Price(Rs.) o z :;;-" (Zero) z ffi > First Party SHOBHA KARANDLAJE DAUGHTER OF MONAPPA GOWDA 0 'c: -c x: Second Party NA :" z~ Stamp Duty Paid By SHOBHA KARANDLAJE DAUGHTER OF MONAPPA GOWDA «cc u, 0'" Stamp Duty Amount(Rs.) 100 .. (One Hundred only) ~s: c£ ::.. ;~ « '" «'"f- z rr -s "

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Please write or type below this line ·········_-····-r---·-································---..----.------.- --"''5'" -< Form 26 (See rule 4A)

~~ "z AFFIDAVIT TO BE FILED BY THE CANDIDATEALON_GWITH NOMINATION PAPERBEFORETHE 6ffi RETURNING OFFICER FO~ ELECTlqN TO LOKSA:B..fl)\(;~~M& OF THE HOUSE) FROM ~ " ''''~~ .: '''''

Statuto' 01e(i)F CORRECTIONS:.~ONLY I ..S'l-clh ,Le_ ~J I~' r.o~~ ~t~l 1. The authenticity of this Stamp Certuicate should be verified at ."w. ww.sbcilestamp.corn". Any discrepancy in the details on this Certificate ann' available all the website r~nders i1l1lValld NOTA c y 2. The onus of checking the legifimacy is on tile users of the certificate. " 3. In case of any discrepancy please inforrn Ihe Competent Authority. W"P'U,P.I. h ...... PART A

I SHOBHA KARANDLAJE **Sffil/daughter/wtfe of MONAPPA GOWDA Aged 52 years, resident of#16, 2NDMAIN, 3RD CROSS, CHIKKAMARANAHALLI, NEW BEL ROAD, BAN GALORE -560094 (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under:-

(1) I am a candidate set up by BHARATIYA JANATA PARTY (**name of the political party) / **am contesting as an Independent candidate.

My name is enrolled in 158-HEBBAL ASSEMBLY CONSTITUENCY, KARNATAKA (Name of the Constituency and the state), at Serial No 47 in Part No 50

(2) My contact telephone number(s) is/are 9448087039, 9013869186 and my e-mail id (if any) IS [email protected] and my social media account(s) (if any) is/are

(i) https://www.facebook.com/shobha.karandlaj

(ii) https://www.facebook.com/ShobhaBJ P/

(iii) https://www.instagram.com/shobhabjp/

(iv) https://twitter.com/ShobhaBJP

(v) WhatsApp No: 9448087039,9013869186

No. OF CORREC1\ONS~ONLY

NOTARY UDUPI 2 (4) Details of Permanent Account Number (PAN) and status of filing of Income tax return:

The financial year for which Total income shown in Income tax return the last SI.No. Names PAN (in Rupees) for the last five Financial Income- Years Completed (as on 31st March) tax return has been filed (i) 2013-14 15,65,230.00 (ii) 2014-15 20,53,730.00 1 Self AJYPK5906C 2017-18 (iii) 2015-16 88,90,630.00 (iv) 2016-17 23,11,830.00 (v) 2017-18 24,16,090.00 (i) r---- (ii) NOT NOT NOT 2 Spouse (iii) NOT APPLICABLE APPLICABLE APPLICABLE !---- APPLICABLE (iv) !---- (v) (i) !---- HUF (If Candidate (ii) NOT NOT !---- NOT ".) IS (iii) NOT APPLICABLE APPLICABLE APPLICABLE !---- APPLICABLE Karta/Coparcener) (iv) !---- (v) (i) r---- (ii) NOT NOT r------NOT 4 Dependent - 1 (iii) NOT APPLICABLE APPLICABLE APPLICABLE r- APPLICABLE (iv) r- (v) (i) r- (ii) NOT NOT '--- NOT 5 Dependent - 2 (iii) NOT APPLICABLE APPLICABLE APPLICABLE ~ APPLICABLE (iv) r------(v) (i) r- (ii) NOT NOT !---- NOT Dependent - 3 (iii) NOT APPLICABLE 6 APPLICABLE APPLICABLE - APPLICABLE (iv) - ~.., A~ (v) ~~ '~-!_\'~ .., * DEVADAS * SWORN TO B~fP.: M~ $l__Q!~ \.L ~~ BAL., LL.B. « 7 G) Advocate I ~)1\e\ o UDUPI-576101 ~ 'OlA ~ LAW '133 LCL 06 !!IJ UDUPJ No. OF CORRECTIONS:0..H.(mLY '0 .~i'j 'P i!'"1X'iCt.....,;/1' --.~'\_:'"' '~ (5) Pending criminal cases

at there is no pending criminal case against me .

.. r..,..._._·... no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ii) below

OR

(ii) The following criminal cases are pending against me:

(If there are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give details of all pending cases in the Table below) Table SPL CC 124/2014, (a) FIR No. with CRIME NO. 627/17, NOT APPLICABLE DEPUTY DIRECTOR name and HONNA VARA POLICE (PRIVATE OF ENFORCEMENT address of the STATION, HONNA VARA COMPLAINT BEFORE DIRECTORATE, Police Station UTTARA KANNADA MAGISTARTE) ZONAL OFFICE, 3RD FLOOR, BMTC concerned SHANTHINAGAR, TIMC, KH ROAD, BANGALORE-560027 CRlME NO. 627117, PCR NO. 55750/2016, SPL CC LXXXI, (b) Case No. with PRINCIPAL CIVIL JUDGE ADDITIONAL CHIEF CITY CIVIL AND Name of the (JUNIOR DIVISION) AND METROPOLIT AN SESSIONS Court JMFCHONNAVARA MAGISTRATE MAYO JUDGE(CCH 82) HALL BAN GALORE

(c) Section(s) of the 45( I) OF PMLA ACT concerned RlW SECTION 200 OF ActslCodes 153A, 153, 505(2) OF IPC 449 & 500 OF IPC CRPC FOR OFFENCE involved (give no. VIS 3 AND 4 PMLA of the Section ACT ..... of IPC etc.)

No. OF CORRECTIONS~.ONLY

SWORN TO BEFORE ME ~1~/\l 4 ~RY UDUPI C (d) Brief description IT IS ALLEGED THAT, ON ROSHAN BAIG HAS IT IS ALLEGED of offense 14/12/2017 AT 20:37 I'VE FILED A PRIVATE THAT I HAVE TWEETED THAT "JIHADIS COMPLAINT INVESTED SOME TRIED TO REPE AND ALLEGING THAT 1 MONEY IN A SHELL MURDER A GIRL HAVE DEFAMED HIM. COMPANY. STUDYING IN 9TH STD NEAR HONNA VAR, WHY IS THE GOVT SILENT ABOUT THIS INCIDENT? ARREST THOSE WHO MOLESTED AND INJURED THIS GIRL. WHERE ARE YOU CM @SIDDARAMAIAH?" - THEREBY CREATED HATRED BETWEEN HINDUS AND MUSLIMS IN HONNAVARA TALUK HENCE COMMITTED OFFENCE O/S 153, 153(A), 202(2) 07 IPC

(e) Whether charges have been NO NO NO framed(mention YES or NO) (f) Ifanswer against(e) above is YES, then give NOT APPLICABLE NOT APPLICABLE the date on which NOT APPLICABLE charges were framed (g) Whether any WP N0.48543/20 14 IS Appeal/ Applicati PENDING BEFORE on for revision THE HON'BLE HIGH has been filed COURT OF NO NO KARNATAKA, against the APPEAL FILED BY proceedings(Men DIRECTORATE OF tion YES-or NO) ENFORCEMENT IN MSA NO. 112/2018 IS PENDING, I HAVE NOT RECEIVED ANY NOTICE.

OREME ?Op., \ er NOTARY UDUPI (6) Cases of conviction

(i) I declare that I have not been convicted for any criminal offence . ./

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 above, and give details in the Table below)

(i) Table

(a) Case No NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (b) Name of the Court NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (c) Sections of Acts/Codes NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE involved (give no. of the Section, e.g. Section of IPC, etc.

(d) Brief description of NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE offence for which convicted (e) Dates of orders of NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE conviction (f) Punishment imposed NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(g) Whether any Appeal NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE has been filed against conviction order (Mention YES or No)

(h) If answer to (g) above NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE is YES, give details and present status of appeal ~or~~ . OF CORRECT\ONS:&'ONLY .sL_",tlP-~ * 0EVADAS ).:. No. G)( Ad BAL., LL.B J * o Vocate' e: UOUPI-576

------... (6A) I have given full and up-to-date information to my political party about all pending criminal cases 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 APPLICABLE IN VIEW OF ENTRIES IN 5(i) 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 against each item. 3. Details should be given in reverse chronological order, i.e., the latest case to be mentioned first and backwards in the order of dates for the other cases. 4. Additional sheet may be added if required. 5. Caiididate is responsible for supplying all information in compliance of Hon'ble Supreme Court's judgment in W. P (C) No. 536 of2011.

(7) That I give herein below the details of the assets (movable and immovable etc.) of myself, my spouse and all dependents:

A. Details of movable assets:

Note: 1. Assets in joint name indicating the extent of joint ownership will also have to be given.

Note: 2. In case of deposit/Investment, the details including Serial Number, Amount, date of deposit, the scheme, Name of BankiInstitution and Branch are to be given. Note: 3.Value of Bonds/Share Debentures as per the current market value in Stock Exchange in respect of listed companies and as per books in case of non-listed companies should be given. Note: 4. 'Dependent' means parents, sorus), 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 investment

Note: 6. Details should include the interest in or ownership of offshore assets.

Explaniition.- For the purpose of this Form, the expression "offshore assets" includes, details of all deposits or investments in Foreign banks and any other body or institution abroad, and details of all assets and liabilities in foreign countries';

f"'rjPRI=r. ~1'4IS'W . ONLY No. OF . , -' i\O

7 e Dependent Dependent Dependent S~. Description Self Spouse HUF No. -1 -2 -3 (i) Cash in hand Rs.l,29,085-00 Nil Nil Nil Nil Nil

(ii) Details of deposit in Apex Bank, Nil Nil Nil Nil Nil Bank accounts LH Branch, (FDRs, Term S.B. Alc (No.594) Deposits and all other Rs.23,351-00 types of deposits Canara Bank, including saving Madhava Nagara, accounts), SB A/c. (No.56890) Deposits with Rs.38,220-00 Financial Fedaral Bank, Institutions, Ganganagara, NonBanking SB A/c. Financial (No. 147200100008074 Companies and ) Cooperative societies Rs.29,50,592-50 and the amount in Kotak Mahindra each such deposit Bank, Sadashivanagara, SB A/c. (No.8074) Rs.l,56,498-00 State Bank of India, Sansad Bhawan SB Alc (No.33921352645) Rs. 40,24,285-90 Federal Bank Tax Saver Fixed Deposit Rs.3,00,000-00 State Bank of India Recurring Deposit Rs.l,65,000-00

(iii) Details of investment Mis. Kapila in Bonds, Manjushree Apparels Nil Nil Nil Nil Nil debentureslshares and Pvt. Ltd., units in companies I Rs.50,000-00 Mutual funds and others and the amount

*NQ~ Sk___a;b~ C) D€'V4 ~ .J.. No. OF CORRECTIONS:..~NLY ~7 o ..q $.-4 D48 . < I UD(J.qy~i.., f./...IJ) * ...-\0iw 'P/~$7.t(} . , SWORN TO BEFORE ME . TJJ 10 '''f 8 o t.Cl,. 1 ::::::::=- X'- °6 ~V)\'1 NOTAR /fAR, _.~'"\~ UDUPI (iv) Details of L.I.C. Insurance investment in NSS, 1) Policy No: Postal Saving, 623110737: Nil Nil Nil Nil Nil Insurance policies and Rs.70,000-00 investment in any 2) Policy No: Financial instruments 623225436: in Post Rs.50,000-00 office or Insurance 3) Policy Company and the No:623185474: amount RsAO,OOO-OO 4) Policy No: 623110322: Rs. I,00,000-00 Birla Sun Life Insurance I) Policy No: 00005 I625 Rs.7,00,000-00 2) Policy No:000003196: Rs.2,00,000-00 (v) Personal Loans and Advances loans/advance given to I) M/s. Kapila any person or entity Manjushree Apparels Pvt. including firm, Ltd., RsA,O1,54,384-00 Nil Nil Nil Nil Nil company, Trust etc., 2) Relatives and other receivables Rs.83, I7,000-00 from debtors and the 3) Others amount RsA,OO,OOO-OO

I) Toyota lnnova (vi) Motor Vehicles / Aircrafts / Yachts / KA-02-MH-5886 Ships(Details of Make, Rs.16,31,281 Nil Nil Nil Nil Nil registration number etc. 2) Honda Activa year of purchase and KA-04-JR-8678 amount) Rs. 73,000.00

(vii) Jewellery, bullion and I) Gold Biscuit- valuable thing(s) (give 1000 gms (Current detai Is of weight and Market Value) value) . Rs.33,05,000-00 Nil Nil Nil Nil Nil 2) Gold Ornaments - 650gms 3) Silver - 1400gms 4) Silver Articles - 220gms SI. No.2, 3 and 4 Total Value Rs.22,OO,OOO-OO ;,._\.OIA~ ~/ =s» No. OF CORREClIONS:.f.\w.bNLY * DEVAOAS G) ( A BAL.. LL.B. o dVOCate SWORN TO BEFORE ME ;: UOUP'-576io-{ 9 .), LAW 133Lel 1 , \.''-,'0"'f::' 'f r. ,-.. ~~!l7(~ ~~'.".- UDUPI e (vii~ Any other assets such I) Cash Theft as value of Recoverable claims/interest Rs.15,71,149-00 2) Gun (License Nil Nil Nil Nil Nil No- 851RQP2017) Rs 25,000.00 3) Deposit with JDE Rs.71,48,822-00 (ix) Gross Total Value Rs.7,38,72,668-40 Nil Nil Nil Nil Nil

B. Details of Immovable assets:

Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated

Note: 2. Each land or building or apartment should be mentioned separately in this format

Note: 3. Details should include the interest in or ownership of offshore assets.

SI. Dependent- Dependent- Dependent- No. Description Self Spouse HUF 1 2 3 (i) Agricultural Land: Location(s) Survey Nil Nil Nil Nil Nil Nil number(s) Area (total measurement in Nil Nil Nil Nil Nil Nil acres) Whether inherited Nil Nil Nil Nil Nil Nil property (Yes or No) Date of purchase in case Nil Nil Nil Nil Nil Nil of self-acquired property Cost of Land (in case of Nil Nil Nil Nil Nil Nil purchase) at the time of purchase

No. OF CORRECTION~ONLY

SWORN TO BEFORE ME 10 ~~ NOTARY L UDUPI Any investment on the land by Nil Nil Nil Nil Nil Nil way of development, construction etc.

Approximate current market Nil Nil Nil Nil Nil Nil value (ii) Non-Agricultural Land: Location(s) I) Site measuring Survey 15Y2cents at Puttur Nil Nil Nil Nil Nil number(s) Area (total I) 6752 sq. ft. measurement in Nil Nil Nil Nil Nil sq.ft.) Whether NO inherited Nil Nil Nil Nil Nil property (Yes orNo) Date of purchase in case of self-acquired 04.03.2006 Nil Nil Nil Nil Nil property Cost of Land (in case of purchase) at the Rs.6,00,000 Nil Nil Nil Nil Nil time of purchase Any investment on the land by way of Nil Nil Nil Nil Nil Nil development, construction etc.

Approximate Rs.IO,OO,OOOfor 6752 current market sq. ft. Nil Nil Nil Nil Nil value (iii) Commercial Buildings: (including apartments) Location(s) Survey Nil Nil Nil Nil Nil Nil number(s) Area (total measurement in Nil Nil Nil Nil Nil Nil sq.ft.) Built-up Area (Total Nil Nil Nil Nil Nil Nil measurement in sq. Ft.)

NOr- rA I :If- /)12" ...... "1.-(\ No. OF CORRECTIONS:.I.~NLY

Cost of Land (in case of Nil Nil Nil Nil Nil Nil purchase) at the time of purchase Any investment on the land by Nil Nil Nil Nil Nil Nil way of development, construction etc.

Approximate current market Nil Nil Nil Nil Nil Nil value

(iv) Residential Buildings: (including apartments) Location(s) SYNO.1/1 & 44, #16, Survey 2ND MAIN, 3RD number(s) CROSS,NEW BEL Nil Nil Nil Nil Nil ROAD, CHIKKAMARANAHALLI, BANGALORE-560094

Area (total measurement in 2435 Sqft Nil Nil Nil Nil Nil sq.ft.) Built-up Area (Total 6,800 Sqft Nil Nil Nil Nil Nil measurement in sq. Ft.) Whether inherited NO Nil Nil Nil Nil Nil property (Yes or No) Date of purchase in case 18/12/2015 Nil Nil Nil Nil Nil of self-acquired property Cost of Land (in case of 2,07,97,090-00 Nil Nil Nil Nil Nil purchase) at the time of .nnrcbase /

SWORN TO BEFOR~ ME

~~ NOTARY UDUPI No. OF CORRECTlONS:.~ONLY Any investment on the land by way of Nil Nil Nil Nil Nil Nil development, construction etc.

Approximate current market Rs.3,OO,OO,OOO-OO Nil Nil Nil Nil Nil value (v) Others (such as interest In Nil Nil Nil Nil Nil Nil Property) (vi) Total of Current Market Value Rs.3,10,00,000 Nil Nil Nil Nil Nil of (i) to (v) above.>

(8) I give herein below the details of liabilities/dues to public financial institutions and govemment- (Note: Please give separate details of name of bank, institution, entity or individual and amount before each item)

SI. Depend Dependen Dependent -3 No. Description Self Spouse HUF ent-l t-2 (i) Loan or dues to Bank/financial institu tion(s) Name of the Bank Nil Nil Nil Nil Nil Nil of financial institution, Amount outstanding, Nature of Loan Loan or dues to any other M/s. Adarsha individuals/entity Developers other than Rs.4, 99 ,36,840-00 Nil Nil Nil Nil Nil mentioned above. Name(s), Amount outstanding, Nature of loan Any other liability Nil Nil Nil Nil Nil Nil Grand total of liabilities Rs.4,99,36,840-00 Nil Nil Nil Nil Nil

~ rr).l~ r."\:~~ •..,,'I-~ * DEVADAS * No. OF CORRECTIONS:~~.ONLY C) BAL., L .8.) 1 SV\'OR"'1 TO BEFORE ME ., ,Advocate

(i) The address of the Government accommodation: #101, 'NARMADA' , M.S FLATS DR. B.D. MARG, NEW DELHI-llOOOl

(ii) There is no dues payable in respect of above Government accommodation, towards- (a) rent; (b) electricity charges; (c) water charges; and (d) telephone charges as on 13.03.2019 (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 Dues Certificate' from the agencies concerned in respect of rent, electricity charges, water charges and telephone charges for the above Government accommodation should be submitted. (iii) Dues to department dealing with Government Nil Nil Nil Nil Nil Nil transport (including aircrafts and helicopters)

Self Spouse HUF Dependent I Dependent2 Dependent3 (iv) Income Tax dues Nil Nil Nil Nil Nil Nil (v) GST dues Nil Nil Nil Nil Nil Nil (vi) Municipal/Property Tax dues Nil Nil Nil Nil Nil Nil (vii) Any other dues Nil Nil Nil Nil Nil Nil (viii) Grand total of all Government Nil Nil Nil Nil Nil Nil dues (ix) Whether any other liabilities are in dispute, if so, mention the amount involved and the Nil Nil Nil Nil Nil Nil authority before which it is ~:ng.

*~Q_J~ 14 Dl:V4D .~. SWORN TO BEFORE ME No. OF CORRECT10P:3:..~ 'LY , C) 8.,4 ~S .0 Ad", .1.., LJ...8 . * <::: I UDUPIOcate . ~\q ~ LA,W 1JjS'?6101 ~ . LeL aS _:;LQ'\v\..L ~~ ~ o~ ~~. UDUPI fo;AR\'\~ (9) Details of profession or occupation:

(a) Self- MEMBER OF LOK SABHA

(b) Spouse - NOT APPLICABLE (9A) Details of source(s) of income:

(a) Self - SALARY FROM LOK SABHA AND RETURNS ON INVESTMENTS

(b) Spouse NOT APPLICABLE

(c) Source of income, ifany, of dependents- NOT APPLICABLE

(9B) Contracts with appropriate Government and any public company or companies

(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 the candidate or spouse or dependents have interest NOT APPLICABLE

(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 candidate or spouse or dependents have share NOT APPLICABLE

(10) My educational qualification is as under: St. Philomena College, Puttur, Mangalore BACHELOR OF ARTS University 1988 MASTER OF SOCIAL Roshni Nilaya, Mangalore University 1990 WORK(MSW) MASTER OF ARTS IN Correspondence - Open University, Mysore 1996 SOCIOLOGY University

(Give details of highest School/University education mentioning the full form of the certificate/ diploma! degree course, name of the School /College/ University and the year in which the course was completed.)

No. OF CORRECTIONS:,k'WONLY

15

UDUPI n PART-B (II) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A:

(II ) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A: 1. Name of the candidate SHOBHA KARANDLAJE

2. Full postal address #16, 2ND MAIN, 3RD CROSS, NEW BEL ROAD, CHIKKAMARANAHALLI, BENGALURU - 560094 3. Number and name of the J5-UDUPI- CHIKMAGALUR, KARANATAKA constituency and state 4. Name of the pol itical party wh ich set BHARATIYA JANATA PARTY up the candidate (otherwise write ,independent') 5. Total number of pending criminal THREE ONLY cases 6. Total number of cases in which NIL convicted 7. PAN of YEAR FOR WHICH TOTAL INCOME SHOWN LAST INCOME TAX RETURN FILED a) Candidate AJYPK5906C 2017-2018 24,16,090-00 b) Spouse NIL NIL NIL c)HUF NIL NIL NIL

d) Dependent NIL NIL NIL 8. Details of Assets and Liabilities (including offshore assets) in rupees

Description Self Spouse HUF Dependent Dependent Dependent -1 -2 -3 A. Moveable Assets 7,38,72,668-40 NIL NIL NIL NIL NIL (Total value) B. Immovable Assets NIL NIL NIL NIL NIL NIL

I Purchase Price of selfacquired 2,13,97,090-00 NIL NIL NIL NIL NIL immovable property

II Development/constru ct ion cost of immovable property NIL NIL NIL NIL NIL NIL after purchase (if .,,,,,,", A F-.....,. lIJ~ble)

'~~~~ G)* D€ltADAS):.. SWORN TO BEEORIR5ME -SL___e)b G_ l~o~Gf oI 4ct\f~'! LL.8.) * c:::. UOuP/ te: ~~~ ~ -\ LAW 13j576101 ~ Y No. OF CORRECTIONS:.~rl LV . CLOS ~ UDUPI ~I' .~ . j'\ r~R.~;;","" -.. III Approximate Current ,) market price of - (a) Self-acquired assets 3,10,00,000-00 NIL NIL NIL NIL NIL (Total Value) (b) Inherited assets (Total Value)

9. Liabilities

(i) Government dues (Total) NIL NIL NIL NIL NIL NIL (ii) Loans from Bank, Financial Institutions and Rs.4,99,36,840-00 NIL NIL NIL NIL NIL others (Total)

10. Liabilities that are under dispute

(i) Government dues (Total) NIL NIL NIL NIL NIL NIL (ii) Loans from Bank, Financial Institutions and NIL NIL NIL NIL NIL NIL others (Total) 11. Highest educational qualifications:- MASTER OF SOCIAL WORK(MSW) Roshni Nilaya, Mangalore University

MASTER OF ARTS(SOCIOLOGY) Correspondence - Open University, Mysore University (Give details of highest School/University education mentioning the full form of the certificate/ diploma! degree course, name of the School/College/ University and the year in which the course was completed.) :O.,~ * °12 ~~ 1 (;) No. OF CORRECTIONS:.~NLY l__cjb v..104 " G LL ~~ I0 4 • I!A (S )' !<; Un .~YOCC;t (i..,!J) )t- ~ _, ,-,{I' t-s... (J . I;' / J" ...rr:,", '''7i-, SWORN TO BEFORE ME ~'\ NOTARY UDUPI

17 •

VERIFICATION

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. Ifurther declare that-

(a) there is no case of conviction or pending case against me other than those mentioned 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 UDUPI THIS THE 20TH DAY MARCH 2019

No. OF CORRECT'ONS:~NLY

SWORN TO BE E ME ...... ,,,~R~p/~! \~

EGISTEB UDUPI

Note: 1. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations.

Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class 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 may be, should 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 Affidavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavit is sworn

18