FORM2A (.eerule 9 NSR P'C 4) I NOMINATIONPAPER st. n to the House of the people
rime....l.?-.i..!k1....k ..:...... """ d) venue...&P-...**a+*."/4..
STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOTAPPLICABLE PARTI (To be used by candidate sa up by recogdsed political parry) I a candidate for election to the House of the people .o tbm the ...t...... NA.RA.5.hP..s liamengly "o*tituency. Candidate' narne.. .A.LLi .kh3.E.Sff ... Father,vne6er,s,/h$band,s name..N...h.!+_.i.. ru.LRS.9.r.m.nt tf\u H address . I t .a,.m.Al..':r..8 .r..tDr.s.E.ru.rftT.h0r ..t.h.x.K.A.u_* t,AAm Ks.D. ,Y-.:.5..a.:.r.5_._o.... p..h. !.,.t..h.\.rs.h..r:.ilsL qDf ' His name is entered at S.No.... in Part No...... [Y.J...... of the QA!ft*.:.t!.yr(Assembry electoral rol for...f]... comprised within) ... N. h. 3...NS.Sf Constituency. .9 &*r.-.otu.y
My name is..Y.E_).L.4..eALti. ff\ LSrJ"a rt is entered at S.No.L5.l...in part No..,5t...ofthe electoral roll for....N.h.g. s P-V..B$.eD....XAssembly constituency comprised withint....C*.fi:.R S ft. ..P tary constituency.
Dare.*-....S:I:t 1 nA"x Signature ofproposer
I b PART II (To be used by candidate NOT s€t up by recognised political party)
We hereby nominate as candidate for election to the House of the People fiom the-.....fl...... -... N A R.hS.S.9. 9.(Parliamentary Constioencv
Candidate's name. . nr.bLL.i.....Afi-:i..e.-5.H...-....-.....'Father's/rnether's/truab'od's f, mme.AJ.A!..L-i..s.r*.a.Art.'Lnn.Tiff#.fir address .l:.Lf.,.rnh.!.1Y..(t.t.Pz..y..e.*.\1.s'I ..t A.rr.x.*.t-.s.Ks.D.E-.ts v..:--.i))1k9-!.....Q.S.-u..4..*:.L-.s.*..{:.}.1.:....\J.S}t- His name is entered at S.No...... I.1.9...... in Part No...... \.)4.I1...... of the electoral rolt for ..5..I1.,....P-.8.!=.ft..K.:.t.....'...-...... ----...r(Assembly constituency comprised within) .....-..r..L.Ngh..9.S..eV.A-...... Parliamentary constituency' names are We declare that we are electors of the above Parliamentary Constituency and our below and we entered in the electoral roll for that Parliamentary constituency as indicated append our signatures below in token of subscribing to this nomination:- Particulars of the proposers and their signatures Sipature Date Sl.no. Name of Elector RoU No. of Full Name component Proposer Assembly Part No. of S.No. in Constituency Electoral tbat part r Roll 6 7 I 3 4 5 I PALAT
N.B.- There should be ten electors of the constituency as proposers'
2 I PART III
I, the candidate mentioned in Part VPart II (Strike out which is not applicable) ass€nt to this nomination and hercby declare-
(a) that I am a citizen of India and have not acquired the citizenship ofany foreign Stat€lcountry.
(b) that I have completed...... -..3.1e...... years of age; ISTRIKE OUT c(i) or c(ii) BELOW WHICHEYER IS NOT APPLICABLEI
(c) 0) that I am set up at this election by the.. t ..t>LD_.P*e..P N .p_ E NI party, which is a recopised National Party/State Party in this State and that the symbol reserved for the above parly be allotted to me.
OR
(c) (r, that I am set up at this election by the ... party, which is a registered-unrecopised political partylthat I am contesting this election as an independent candidate. (Strike out which is not applicable) and that the symbols I have chosen, in order ofpreference, are:- (r....At^rto...... (,,)...81*t-i,r-!".e&t,r,... od
(d) that my name and my father's/mother's/husband's name have been correctly spelt out above in....E.NA.!-.I..9-hf.. (name of the language);
(e) that to the best ofmy knowledge and belief, I am qualfied and not also disqualified fsl being chosen to fill the seat in the House ofthe People.
*I further declare that I am a member of the.....-1.-c--h.E.D..Q.LL-D...... **Caste.itribe which is a scheduled **castey'tribe of the State or...4..$..0.H..R.f'.e.S.h.$.85-t...i" relation to 1) (area) 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 S Candidate rScore out the words "assembly constituenq, comprised within" in the case of Jomnu and Kashmif
Andanan and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Dama and Diu and Iakshadweep.
3 *Score out this paragraph, f not applicable. **Score out the words tnt applicable-
N-B'-A "recognised polirical party" means a political party recognised by rhe Elecrion Commission under the Election symbols @eservation and Allotment) ordet t96g in the state concerned- PARTIIIA
(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 law specified in sub-section (2), of section 8 of people the Representation of rhe Act, l95l (43 of 1951); or (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more.
If the answer is "yes", the candidate shalr fumish the folrowing information: (i) case/firstinformationreportNo,/Nos...n-.r.9.lI.ltp.p.Lt.cR.D!-A--d-\.A)
(i, Police station(s)...... 0*.y\
(iii) Section(s) of the concemed Ac(s) and brief description of the offence(s) for which he has been convicted ,\r
(,, Date(s) of convicrion(s) ...... 1^.*
(v) Court(s) which convicted the candidate ,.S. (v, Punishmen(s) imposed [indicate period of imprisonment(s) andlor guantum of fine(s)l
(vii) Date(s) of release from prison...... (viii) WaVwere any appea(s/revision(s) filed again 4 (ix) Date and particulars of appea(s)/application(s) for revision fi1ed.....t):.4...... (*) Name ofthe court(s) before which the appeal(s/application(s) for revision filed...... (xi) whether the said appea(s/application(s) for revision has/have been disposed of or iVare pending....N.$ (xiD lfthe said appeal(s/application(s) for revision has/have been disposed of- (a) Dat{s) of dsposal...... hr..N...... (b) Nature of orde(s) passed...... f9 ,s (2) whether the candidate is holding any office of profit rmder the covernment of India or State Govemment?...... (ks/No)'/ -If Yes, details of the office held ,t-a' (3) Whether the candidate has been declared insolvent by any Court?...... €fun,Io) -If Yes, has he been discharged from insotvency. . . N.h. (4) Whether the,/ gndidate is under allegiance or adherence to any foreign country?...... (&MNo)- -IfYes, give details...... N (5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the President? CtrsNdf -IfYes, the period for which disqualified. s (6) Whether the candidate was dismissed for comrption or for disloyalty while holdin&office under the Govemment of India or the Government of any State? ...... g€df.Ioj" -If Yes, the date of such dismissal (7) whether the candidate has any subsisting contrac(s) with the Govemment either in individual capaclty or by trust or partnership in which the candidate has a share for supply of any goods to that Govemment or for execution of works undertaken by that Govemment?...... qAsRVoy/ -IfYes, with which Govemment and details ofsubsisting contrac(s) ,N+ 5 (8) whether the candidate is a managing agent, or mrnager or secretary of any company or corporation (other than a cooperative society) in the capital of which the cenhal Govemment or State Govemment has not less than twanty-five percent share?...... (Yes/no) -If Yes,withwhich ,..l A (9) Whether the by the Commission under section l0A of the said Act. -If yes, the date of disqualification. Ns- prace: J-v. a.(.s s ?rPu A^ Signaturew of Candidate oate:..*5:3::k\) 6 I t t I I D t,1tn f.x re t V es ord 15 d 5' slr*r vtvl ANDHRA pRADESH 'i"'la=r- D at-=ssl>- l.ie+I - i;A-"4€=FJdf,"-*t{s>' 3';Lo*c& i I FORM 26 I It (See rule 4A) :\ I I I a i qnJ AFFIDAVIT TO BE FITED BY THE CANDIDATE ATONG WITH NOMINATION PAPEFETFORE THE RETURNING OFFICER FOR ETECTION TO LOK SABHA FROM NARASAPURAM CONSTITUENCY Ng.s _A I PART I tlAtll RAJESH Son of NARASIMHA MURTHy(Late), aged 36 years, resident of D.No.1-28, Main Rold, Venkatapuram, Palakol Mandal, West Godavari District a candidate at the above election dlhere by solemnly affirm and state on oath as under:- t s[P. i----r.-1:. -. .- R.V. S 8.1., iI aamtrnegd.D€paffiicnt NOTARY PUBLIC . NOTARY PUBLIC w..t oistricl A"P. INOIA GOFTNo. E9s lodavarl i,, v.Idub2l+2023 ( t-rl;ai.ri.ryu-r..,... . ! E (1) I am a candidate set up asan lndependent candidate. (2) My name is enrolled in Palakol Constituency, West Godavari District, Andhra pradesh, at Serial No70 . in Part No 147. (3) My contact telephone number(s) islare 99487 67667 and my email id nallira iesh pkl@ema il.com and my social media account(s) (if any) is/are (ilwhat's up Number 99487 67667 (ii)Facebook mail id [email protected] (4) Details of Permanent Account Number (PAN) and status offiling of lncome Tax return: The Financial Total income Sl.No. Names PAN year for which shown in lncome- the last lncome- tax return(in tax return has Rupees) for the last been filed five Financial Years completed (as on 31i March) 7 (i) (self) Ntt AEPPN9871D Ntt NAtt| RAJESH (ii) NIL (iii) Ntt (iv) NIL (v) Ntt 2. Spouse (i) NA[I.I SUJATHA Ntt ALMPN4844L N L (ii) NIL ATTESTE D /UlP R.V. S PALAKOL - 534 West INDIA (iii) NIL (iv) NIL (v) NIL 3 HUF (lf Candidate is Karta No PAN allotted (i) NIL /Coparcener) NIL Ntt ( ) Nrt (iii) (iv) Ntt (v) NIL 4. Dependent 1 No PAN allotted Ntt (i) NIL NATLI NIRUPA ANURADHA Ntt (ii) (iii) Ntt 5 D ',/w R.V. SU f,,8.1., PALAKOL . 53.1 - NOTARY PUBLIC . Worl Godavari Oiskht AP. INDIA (iv) Ntt (v) Ntt 5 Dependent 2 (i) NIL PRATYUSHA No PAN allotted Ntt (ii) NIL (iii) NIL (iv) N - (v) Ntt Note: lt is mandatory for PAN holder to mention PAN and i n case of no PAN, it should be clearly stated "No PAN allotted" (5) Pending criminal cases (i) I declare that there is no pending criminal case agaimt me. (Tick this alternative if there is no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ii) below) /oR .jfi) The following criminal cases are pending against me: (lf there are pending crimlnal 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 4,P R.V. SURYAN ,8;1, PALAKOL . 534 NOTARY PUBLIC . W6st Godavari Di3tricl A"P. lt{DlA ( FIR No. 17l2Ot5,at tol2ol7, tosl20 tLLl2Ot8, LLtl2016, r3sl20 a with name Palakol Rural at !7,at Palakol Penumantra L7, at ) and Police station Palakol Attili cou rt Police Palako address of Rural Polici station deru Police Police Station police Station station station concerned ( Case No. zttl20ts, t8ol2oL8, No No number 92Sl2Ot6, gstl20 b with Name Palakol Court Palakol numbe at Tanuku L7, ) of the cou rt f Bhimav Couft aram cou rt ( Section(s) 447,323,3s2,3 341,505,15 143,33 L43,M8,353 t43,283,341 34L,L4 c of 41,505,tPC 3(Al,rPc 2,Rlw ,s06,R/w 34 ,506,R/W 3,R/W ) concerned R/W 149, 149 tPC tPc 149 tPC 149 tPC Acts/Code IPC and s involved section (Give no.of 7ltl, (B) section of criminal lPC, etc., ). ammanme nt act ( Brief NIL NIL NIL Ntt NIL Ntt d description l of offence ( Whether YES YES YES YES YES YES e charges ) have been framed (mentione d YES or No) (f lf answer Not known Not Not Not known Not known Not ) against (e) the date known the known the date the date known above is date the the YES, then date date give the date on which charges were framed ATTtrE TED i/uDrg R.V. SURYANAR 8.4.,8.1., PALA KOL - 534 20o NOTABY PUBLIC . Wost Godavari Olltrict A.P. ll{Ol^ ( Whether NO NO NO NO NO NO c any ) Appeal/Ap plication for revtslon has been filed against the proceeding s (Mention YES or NO) jd c^r", of conviction (i) I declare that I have not been convicted for any criminal offence, (Tick this alternative, if the candidate has not been convicted and write NOT APPLICABl-E against alternative (ii) below ) OR (ii) I have been convicted for the offences mentioned below: N oT cjf f LYr-Bi1t-L {lf the candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the Table below) Table (a Case No. NOT NOT NOT NOT NOT NOT ) APPLICAB APPTICAB APPLICAB APPTICAB APPTICAB APPTICAB LE tE TE tE TE tE (b Name of the NOT NOT NOT NOT NOT NOT ) Cou rt APPTICAB APPTICAB APPTlCAB'. APPTICAB APPI.ICAB APPTICAB tE tE tE TE tE tE (c Section of ) Actsl Codes involved (give no, of NOT NOT NOT NOT NOT NOT the Section, APPTICAE APPTICAB APPLICAB APPLICAB APPLICAB APPLICAB e.g. IE LE LE tE tE tE Section...,..... of lPC, etc.,) ED /wd R,V. SURYANARA 8.t., PALAKOL . 594 260 NOTARY PUBLIC . Wost Godavari oistrict A.P. INOIA (d Brief description ) NOT NOT NOT NOT NOT NOT of offence APPLICAB APPTICAB APPTICAB APPLICAB APPTICAB APPTICAB for which LE tE LE LE TE tE convicted (e Dated of NOT NOT NOT NOT NOT NOT ) orders of APPLICAB APPTICAB APPTICAB APPTICAB APPTICAB APPLICAB conviction LE LE IE TE TE LE (f) Punishment NOT NOT NOT NOT NOT NOT imposed APPLICAB APPTICAB APPLICAB APPTICAB APPLICAB APPTICAB LE TE tE tE LE TE (e Whether ) any Appeal has been NOT NOT NOT NOT NOT NOT filed against APPTICAB APPTICAB APPtICAE APPTICAB APPTICAB APPTICAB conviction LE TE TE TE tE t-E order (Mention Yes or No) (h lf answer to ) (g) above is YES, give NOT NOT NOT NOT NOT NOT detalls and APPTICAB APPLICAB APPTICAB APPLICAB APPTICAB APPTICAB present tE LE TE tE TE TE status of appeal (6A) I have glven fill and up-to-date information to my political party about a pending criminal cases against me and about all cases of conviction as given in paragraphs (5) and (6). [candidates to whom this ltem is not applicable should clearly write NOT APPIICABI-E lN VIEW OF ENTRIES lN 5(i) and 5(i), above l N ote 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 ie,, 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. ATTE S ED /"ulIuL S* R.V. SURYANARAY t, PALAKOL . 534 260 NOTARY PUBLIC Wosl Godavari District A.P. INDIA 5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court judgment in W.P. (C) No. 536/2011. (7) That I give herein below the details of the assets (moJable and immovable etc.) of myself, my spouse and all deponents: A, Details of movable assests: Note:1. Assets in joint name indicating the extent ofjoint ownership will also have to be given. Note 2: ln case of deposit/lnvestment, the details including Serial Number, Amount, date of deposit the scheme, Name of the Ban k/lnstitution and Branch are to be given. Note3: Value of Bonds/Share Debentures as per current market value in Stock exchange in respect of listed companies and.as.per:.boo.ks in case of non-listed companies should be given. Note4: 'Deponent' means parents, son(s) daughter(s) ofthe 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 candidatb 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 assests. Explanation:- For the purpose of this Form, the expression "offshore assets" includes, details of all deposit of investments in Foreign banks and any other body or institution abroad, and details of all assets and liabilities in foreign countries, Sl.No Description Self Spouse HUF Dependent- Dependent- 1 2 Rs.s000/- Ntt Ntt Ntt (i) Cash in hand Rs.s0,000/- (ii) Details of deposit In Bank accounts Rs43,616/- in Rss0,595/- in (FDRs, Term AXIS bank, AXIS bank, NrI NIL Ntt Deposits and all Poolapalli Branch Poolapalli ATTE S EO $J "z11ll)' R.V. SURYANAR PALAKOL . 534 NOTARY PUBLIC w'rt Godavari Dkt.icl A.P. ll{D,A r twes of Branch deposits including Rs.564/- !n saving accounts), Andhra Bank Deposits with Lankalakoderu Financiat Branch lnstitutions, Non- banking Sinancial Companies and Cooperative societies and the amount in each such deposit' Details of in A5 investment in, lnvestment News Channel of NIL Ntt Bonds, Rs. 1O,OO,OOO/- debentures/shares : and units in companies/Mutual funds and others and the amount. Detbils of investment in NSS, Postal saving. lnsurance Policies and investment in any Financial instruments in Post office or . insurance. Company and ihe amount. Loan Personal loans Personal loan Car Rs. 11,00,000/. ladvanies given to Rs.4,s0oo0/'in ln HDFC Bank may person or AXIS Bank, Bhimavaram entity including Poolapalli Branch. firm, companY, Gold Loan Trust etc, and Rs;1,i5,000/- other receivables from debtbrs and Personal loan the amount. AlTEs ED 0J /SIDL R.V. SURYANARA ,8.1., PALAKOL : 534 26.0 NOTARY PUBL'C weat Godavati DistrictA.P. ,NO,A \ Rs. 6,tt ,4201 - (vl) Motor Ntt Scropio car NIL NIL NIL Vehicles/Aircrafts/ AP37 CW Yatches/Ships ( 2444 Detalls of Make, . registration L8lrol20t6 number etc., year of purchase and Rs.16,0O000/ amount) (vii) Jewellery, bullion 150 grms, NIL NIL NIL and valuable Nlt And its value thing(s) (give is details of weight Rs.490,000/- and value) (viii) Any other assets NIL Nlt Ntt NIL Ntt such as value of ii claims/interest Rs.10,94180/- Rs,21,45,595/ NIT Ntt NIL (ix) Gross Total Value B. Details of lmmovable 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 Sl.No Description Self Spouse HUF Dependent-i Dependent-2 (i) Aericultural Land Location(s) Survey Ntt Ntt Nlt Ntt Ntt number(s) Area (total measurements in NIL NIL NIL Ntt NIL acres) Whether inherited property NIL Ntt NIL Ntt Ntt (Yes or No) ES EO R.V. SURYANAR @ PALAKOL . 534 260 NOTARY PUOLIC W€st Godavari Oistrict AP. ]NOIA Date of Purchase in case of self' NII- Ntt Ntt NIL NIL -acquired Cost of Land (in case of.purchase) Ntt Ntt NIL Ntt NIL at the time of purchase Any investment on the land bay NIL way of Ntt Nrt NtL NIt developrnent, ionstruction etc. Approximate NIL current market Nrt Nlt NIL Nlt value Non-Agricultural Land: NIL NIL NIL NIL Ntl Locations(s) Survey number(s) Area (total NIL measurement in Ntt Ntt Ntt NtI s .ft) Whether inherited property (Yes or NIL NIL Ntt NIL NIt No) Date of purchase NIL in case of self- Ntt Nlt Nlt Ntt acquired p Cost of'Land (in case of Purchase) NIL Nrt Ntt NIt NIL at the:time of urchase Any investment . on the land, by way of Nrt Nlt Ntt Ntt NIL development construction Approximate current market NIL Nlt Ntt NIL NIL value ATTES D $r P R.V. SURYANARAY 8.1., pALAKOL - 53a 260 . NOTABY PUFLIC . W6rt Godavari Di$tricl A.P. ll{DlA Commercial Buildines (including NIL NtI Ntt Ntt NIL apartments) -Locations(s) -survey number(s) Area (total NIL Ntt Ntt Ntr Ntt measurement in sq.ft) Built-up Area (total NIL Ntt Ntt Ntt NIL measurement in sq.ft) Whether inherited property (Yes or Ntr NIL NIL Ntt Ntt No) Date of purchase in case of self- Ntt NIL NIL NIL Ntt acquired property Cost of property (in case of NIL NIL NIL NIL NIL purchase) at the time of purchase .Any investment on the property by way of Ntt NIL NIL NIL NIL development, construction etc., Approximately current market Ntt NIL Ntt NtI Ntt value. Residential Buildines (in clu ding NIL NIL NIL NIL NIL apartments); -Location(s) -Survey number(s) Area (total NIL NIL Ntt Ntt Ntt measurement in sq.ft) ATTES sr /*9 R.V. SURYANA PALAKOL 63'1 NOTARY 'PUBLIC . w.rt Godavari oislllct A"P. ltlol^ Built-up Area (total Ntt NIL Ntt Ntt Ntt measurement ih sq.ft) Whether inherited 'property (Yes or NIL NIL Nlt Ntt NIL No) Date of purchase in case of self- NIL Ntt NIL NIL NIL acquired property Cost of property (in case of NIL NIL Ntt Ntr Ntt purchase) at the time of purchase Any investment on the property by way of NIL NIL Ntt NIL NIL development, construction etc., Approximately current market NIL Ntt NIL Nrt Ntt value, Others (such as interest in Ntt Ntt Ntt Ntt Ntt property) . Total of current market value of (i) NIL NIL NIL NIL NIL to (v) above (8) I give here in below the details liabilities/dues to public financial intuitions and government:- (Note:-Please give separate details of name of bank, institution, entity or individual and amount before each item.) Sl. No Description Self Spouse HUF Dependent- Dependent-2 T ATTE D ,tl|@ $r R.V. SURYANA 8.t., PALAKOL . 534 NOTABY PUBLIC . Wsst Godavari District A.P. INDIA (i) Loan or dues to Personal Car Loan Bank/fi nancial loan Rs. institutionls) Rs, u,00,000/- Name of the bank 4,so,ooal- in In HDFC Bank Bhimavaram or financial AXIS Bank, NIL Ntt Ntt lnstitution, Foolapalli Gold loan amount Branch. Rs.1,75,000/- outstanding, Nature of loan. Personal loan Rs,6,37,4201- Loan or dues to any other individuah/enthy other than NIL NIL NIL NIL NIL mentioned above Name(s), Amount outstanding, nature of loan Any other liability NITL NITL Ntt Ntt Ntt G rand total of Rs.4sO000/- Rs,Lg,L2;4201- NIL NIL NIL liabilities (ii) Government due: (A) Has the Deponent in occupation of YES/NO Dues to accommodation provided by the (Pl.tick the Departments : Government atanytime during the last ten appropriate dealing with year before the date of notification of the alternative) Government current election? accommodation. (B) lf answer to (A) above is YES, the following declaration may be furnished namely:- NO (i) The address of the Government Accommodation: (ii) There is no dues payable in respect of above Government accommodation. towards (a) RenU (b) Electricity charges (c) Water charges and (d) Telephone charges as on _(date) I the date should be the ilto date of $TE TED ,uP R.V. SURYANARA 8.A., B.L, PALAKOL - 534 260 NOTARY PUOLIC we8t Godavari Di3trict A'P. INOIA the third.month prior to the month in which th! election is notified or any date thereafterl. Note:- "No Dues certificate from the agencies concerned in respect of rent, electricity charges \ water charges and telephone charges for the above Government accommodation should be submitted. (iii) Dues to , de;artment dealing with Ntt NIL N[- 'Ntt Government NIL NIL transport (including aircrafts and helicopters) (iv) lncome tax dues NIL Ntt NIL Ntt Ntt NIL Self Spo use HUF Dependent-1 Dependent-2 (v) GST Dues NO NO NO NO NO (vi) Municipal NO NO NO NO /property tax dues (vii) Any other dues NO NO NO NO NO (viii) Gran total of all NO NO NO NO NO Government dues (ix) Whether any NO NO NO NO NO other liabilities are in dispute if so, menlion the amountinvolved and the authority before which it is pending. (9) Detaiis of profession or occupation; (a) Self :- Social Worker (b) Spouse:- Aqua Business (9A) Details of sources of income: (a) Self:- Agriculture former ,$P T STED R.V. SURYANA 8.1, PAI-AKOL - 33/r NOTARY PUBLIC . W.rl Godavari Dillricl AP. INDIA (b) Spouse Aqua Business (c) Sources of income, if any of deponents NIL (98) Contacts with appropriate Government and any public company or companies (a) Details of contracts entered by the candidate:- Nl[ (b) Details of contracts entered by the spouse:- Nlt (c) Details of contracts entered by the dependents:- NlL (d) Details of contracts entered by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest NIL (e) Details of contracts entered into by partnership Firms in which candidates or spouse or dependents are partners A5 News Channel (f) Details of contracts entered into by private companies in which candidate or spouse or dependents have share NIL (10) My educational qualification is as under : t 'l - 1 ' 5Lj A eA , I'T' I 4 el VA^rKA T E A i EHIKKAL SrwADur'''t rrvA t{SO L 1. t.T.t TECHNICAT EDUCATION BOARD OF 2002 ANDHRA PRADESH 2 s.s.c BOARD OF SECONDARY SCHOOL 2000 CERTIFICATE ATTE D $.r @ R.V. S PALAKOL - NOTARY PUBLIC . . Wost c6davari Districi A.p. tIOtA \ PART (11) ABSTRACT -B OF THE DETIALS GIVEN IN (1) ro (10) oF PARr_A: 1. NALLI RAJ ESH s o N A RAS M HA M U RIH D.No.1-28, Main Road, Venkatapuram, Palakol Manddl, West Godavari District, Andhra prad 3. esh. Number and name of the No.9, NARASAFURAM, consistenc y and state ANDHRA PRADESH 4,. Name of the political party INDEPENDENT which set up the candidate otherwise write independent Tota I number of pendin! criminal cases 6. Total number of cases in which Ntt convicted 7. PAN of Year of which last Total income income tax return field shown (a ca ndidate AEPPN987lD Ntt Ntt (b AtMPN4844t Nlt Ntt (c) HUF Ntt Ntt Ntt {c)Dependen Nrt Ntt Nrt ts of Assets and in Sl.No Descri tion Self Spouse HUF De endent-l De A. endent-ll Movable Assets Rs.lQ94 Rs.21,45 Ntt (Total vlrlue ,t8ol- ,sssl- Ntt Ntt D lmmovable Nil. Assets Nil. NIL Ntt Nrt t. Furchase Price Ntt of Self-Acquired Ntt NIL im movable NIL NIL rope rt Development/ NIL construction cost of lmmovable NIL Nlr Ntt Ntt property after urchase (if TED 4P R.!.SURYANAR B.A.,BI., PALAKOL . 534 260 NOTARY PUBLIC Wsst Godavari District A.P. INDIA APProximate Current market Nrt Price- (a)Self-Acquired assets (Total Value) (b) lnherited assets (Total VaJue 9. (i) Government Ntt dues (Total) Nil_ Ntt Loans from Ntt Ntt Bank, Financial Nlt lnstitutions;nd others otal) 10 tiabil ities that are under dispute (i) NIt Ntt Ntt Ntr dues Laons from NIL NIL Ntt Banlg Financial lnstitutions and Tota High est educational qualification: l,T,t ,1. t.T.t TECHNICAI, EDUCATION 2002 EOARD OFANDHRA PRADESI{ , . 2: s.s.c BOARD OF SECONDARY 2000 SCHOOL CERTIFICATE TED ; M R.V. R 8,4.,8,1,, . 260 I PALAKOL 534 NOTARY PUBLIC . Wesl Godav{iri Oistrict A.P. INDIA VERIFICATION ': l, 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. lfurther declare that:- (a) there is no case of conviction or pending case against me other that than those mentioned in items5 and 6 of Part A and B above: (b) l, 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 item 8,9 and 10 of part B above. verif ied at .PAL*J'-...... ,his the.*11...-Nw day of ..lh**1r..?.e.1.[..... D ,M Noter 1. Affidavit should be filed by 3.00 PM on the last day of filing nominations. Note} 2. Affidavit ihotrld 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. ff 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 ofthe Affidavit should be signed bythe deponent and the Affidavit should bear on each page the stamp ofthe Notary or Oath Commissioner or Magistrate before whom the Affidavit is sworn. .4!4 ,\TTE s ED T\J : r5rqltlellfu R.V. SURYANA ,8.t., ]ETAFY ITJ}IO PALAKOL . 534 260 i, o(mt5I i(IIAi/ NOTABY PUBLIC -u.IrFttail West Godavati Districr A.P. INDIA Llrrigrero"_ \q, omrrns"l*'-lr6l aocrrmcrltS -O,r*le--f.f*mc"S is Brc"'?S'+qr t.ha6 'E the...li.-::r..-'hrr i$+s'. : wooo45336i zr-d5 J$lgo r2a dSprj-S'o'J5') r656rD6o 4rS. !: l\I)l \ J.€6Q'd'r)@<-e- t:t-t( I R)\ ( olrltlllsl('\ or rr)fiilll b6 )os!D id@ urQQO453365 r2a Ver*el4.r.EnEad(s12 v€otaE Purain H'O LanHaloderu Pdardu{Iaid:rl \i&d Godwan A ii E ttlt.r;l.2 I ) > ke*f r,.d, iao : ois i-O a;a 6dba'5 G6-6 176. }i61p ':*€ ad-a +. r.ihe. s l.t* :t6-r litit, 1351 7A wq E ho t?7 9-sto +o A" c) .: f ,1,, t}'de1 ;)::1i.-:.(J ,, , tuqo;DsJ 6J5sd€?, u 6-'9o-495) 6rbeOo r.5 gS erao8*rs Lrwvvtr lll rr-"t!" .,1 lI)trl.-l i.^r,:1. ir.lii, I n olnrL.rri i\r,) irrzl,'a1,1)'Ll{j.llt) I To $q oas Nalli Raiesh S/Oi Narasimha Mu(hy is proof of identity, not oi citizenship venkalap!ram palakollLr mandararn To establish identity, authenticate online Palakollu Wesl Godav6.i AndhE Prad€sh 534250 8099415515 !lillll|mililt0ututfltl M1480878232FT :r ,rr"/a 6l5Jo6QJ' eJaJ"6o,Jg)dJ.l)o6 . I 'rrvi; 65'^\5+ry O4odS sroo5JJ OdJ6Sdd sse! ero6'3o5r4o.t xr;ro! irdJ6Jo6 b *r*6 (ro$5 / Your ',.rr ilianr' No. : I r-l:r:r?, is valid throughout the country ' 2730 3171 4632 :i(ii,,:rii, will be helpful in availing Government and Non-Government services in future . ere"6 - JA:.S:5S XrSt5 .>< -.--><.. trdd O4odso Governmenl of lndia Unique ldentification ALlthority o{ ln(lia nQ e8s _28 aooo6grD: ndbob irq. l S/Oi Narasimha llurlhy, 1-28. "{46 A6 / OOA : 10/08/1983 bos 66,. iostriDd., JoSiD main road, venkalaPuram, $c6e., eeaoEa6, ,,tJs) d.r$o, o"soseao, ood O6E, Lankalakod€tu WestGodavar, 5142S0 Lanl€lakoder!, Andhra Pradesh 534250 2730 3171 4632 2730 3171 4632 era"6 - $ars5s;ro5 a a OUR SCHEMES .+ Abhaya Saving3 - Accidental lGsuranca cov€tage upbt- 25,0fiy- .. AbfEyasavlngs Plu3-Ac(ir€nlal lnsuraDcaooveragslSo?. 5O,OOO/- .o Abhaya Gold -Accidernd lnsurancccovefage upb ?.l,m,o(xy- .. AB Jaevan Abhay. -Accidentd & Natural Death insuranco coverage Wb {.1,00,000/- .o AB Xjddy Bank SchomG (Kids Xh.zan ) -Accidontallng/rancE@verag8upb {.1,m,oou- .o lnsurod CunEnt Dcposlt, PattabhiAgd Cad Schome -Accireotall.lsuranco covel-ags r4(o t.l,Oo,om/- Eligibi:ity f*- 4.tu1. Sayl$, Abtraya qavirqE Plus, Abhaya Gold, tnsg|td Cureot Oeposit apdhabb b onl) lndividuals ag€d b€tweeo 5 and 70 Fars. ForAB JoovanAbhaya, apdicabh b q y irdiviluals age betweeo 18fo55 years. Kirs Khazana. apdicabh to kits aged betlweo 5 and I I years, Guadian aged less tian 70 years. i A.ogyadaan : A unhue Health Insurance Sdreme - Ellgiblliry: lndividuals Completed age of 5 years and have completed the age of 60 years. AB Rocurring Deposit Plus - A No\rel sch€rne - A doposibr can stap up tE install nen{s) up io 10 tirn€s of core ins-tallrneot during any or all ns{hs before rnaturity oftl€ RD pllls dapcsit acEounL * Andhra Bank is / facilitator for the lGsurance and is no liabb forany cLaill. Fortho nanr6 oftl|e l lsl er&apdieueterrnsandcondilio.E of lnsurance, d,rsbrErrEy qaodt tlg &Eaclr oa refga Banfs www-andhrabank-in * For th€ applicable retBs ofintor€st cootaai tl|e Brard oa rofur BanlCs urob6ito www.andhfabank-in Ncte: I'lhib Fes€llbd Ioa Lgdadon oftB Pass Bod( a n€rf, lino app6r errery trtle at th€ erd oftransac.tirB. Acro,ryrr6 / AbbrevblixE lrsod ar9 frovir€d in the la6t pago. clr€I /Branch Comp. o. 11302 arqr t7 O34T LA}II(ALAKODERU Andhra Bank ErPh :0881423851S f /here tnda BailE IFSC C00E: AN0B00003rtl hl[ifli{l:fF*, ,i;:It\ HICR C00E:534011663 LANKALAKODERU . ,.T* crg 16 PASS B{X)K ANoHRA PRADESH- 1 :[g+2b0 ! 9. Nalre of Arc HdddrR'tlql{ R&JESH um :ir< &s. xp34l 10100038693 *.TqnEnnsrrni iijnrry H N0 l-28 vENKArApu RA , Schene Code: SB06p fr iIANXALAK0DERU PALAK0L r,tAN0AL HEST 600AVARr CUST.I0 pr,o,. : 42500303 r{di$r0Ar$ffi }- s s+ z s o t{omi nat I on Regtstered *ffi,lilil' $ fr /oe/2014 Int. Fd:21041 to 310811 7 00 507.00Cr /03/201s Int. Pd:01091 to 280215 0 00 /os12s15 Int . Pd:01031 310815 , 517. 00Cr to 0 00 /a3/2016 Int. Pd: 01091' to 290216 527. 00Cr I 00 538. /06/20r6 Int.. Pd: 0103 310516 00Cr to 5 00 /09/2016 Int. P* c051 to 310816 54i. 00Cr 5 oo /09/2016 csot SMS 548. 00Cr Chrgs Jul-Sep I 00 / 12/2016 Int. Pd: 01091 531 . 00Cr to 30i 116 5.00 /72/2016 csol SMS Chrgs Oct-Dec 536. 0ocr I .00 519. 00Cr /03/2017 Int. Pd: ot12t 28021 ,- to 00 /a6/2017 Int. Pd: 01031 to 310517 524. 00Cr 5 00 529. 00Cr /09 /2017 Int. Pd: 0r061 to 31081l 5 .00 53+. 00Cr / r2/20t7 Int. Pd: 01091 to 301117 5.00 5S9. 00Cr /03/?o18 Int . Pd: 0i121 to 280218 5.00 544. 00Cr /06/20t8 Int. Pd: 01031 to 310513 5. 00 549. OoCr /09/201A Int. Pd: 01061 to 310818 5. 00 554 - 00Cr / 1?/?Ot 8 Int. Pd: 0r091 to 30i 118 5. 00 559. 00Cr /03/20t9 Int . Pd: o1121 to 280219 5. O0 56+. 00cr 'ate:21-03- 19 CIr BaI : P.s. 564.00 .{vai I Amt RS 5-i 00 Eff Bal: Cr .564.00 ssadS*) t crnq€c4Atud /fu, qTqA fu{rrr rfliad tft Frt q{f{ffi,ri\Eagd INC0ImUXD[fAXmlBfr C,OW.OFINDIA nlgdFrdti,Aqi'rdt*6dcri. 5ol-arl 016. AEPPN9871D f thit .o'd is l6t / w@e's la', co irloo4 L-r pleatei$M/dwnk':' I!fllcTrr P.r S.rvi6 Utr4 NSDL 5th 0oor, Mdri stqlil8; Ph. Xo. 3al , Surrry No. 9E78, Modd Colcay, N.rr D.? Buot bs CholA NARAS'EHA TURTIIY }IALLI o20a?o18 T€r: 9l-Z!2721 8m. trq:9|-ar2n I 8081 €p' c-mlil thilf€ 'o-.o.i! rnee $_va & *"p"H - (i( )VIrltNl\I IN'l' Ol'- ANDHRA PR \rfrBl6 47 C00817 It hY I'. N t r l'l l)E I',\li'l'M IIN'l' Applacation No i il llllllillll lillliillliilllit ccco1192144s694 Date:2OlO3l2019 rii.rrilli,'ll'l\.\,\ll\ll\'&l),\.!'trol"llllll'llcl'ltt'l'll"lc'\'ll'l j ,'., \ri,/Srrr,r.',llirr'i K,)rlirr NALL! RAJESH 5/r) I D/o i Yla i | /() / Wlo I d/') / lir,.; ,r 1,. ri 1!r-11 tlrc "i() t,.iiAl-lIliAlLASrMHAMUETLlYof!=ANKALAXODE-BUvrllaqi"l:r''"rrofP3!-acaleiulirndalofwestGcdavert ( a:; II:,1!(:l 0l i;1,. .rtilt,r Air(jhi., PradCsl tiirirn(J!, to l4ala:i5C) aonLlllrlnlty / aste which 1'; 1q6'1qr11"r'rJ :; Ir !i't :iiir{r-1riuc..1)rirri!,, [y /' (-;r't( ulld(:r h(] Closiltutron .:lcir(lduiel Tribes) Orde'r' 1t150' S'C5' -rrl,.rr (/",,rlcrrllrlr(l;rl) Lil/{r A-lrl"rdc(l frorn tlrlril to lirnfr l!lt,rlti,.ar.r,rr I lrl:,ir.r,.l S. is 'tr:r 'rq '-v'ENff AT.4 2U ni M -'il ,.. .,,rr,L, tlril! ilrr 5rr1:jrrrrri,'i'r, l(iri)r.rrr NALL-I BAJESH rt d rl'rtivc ol i)l llii] L..1ri!,,,i ,,,.n| ,1.( o: LANKAT-AK9DEI\u v,l1,,rlir i' lo!rn oi Pnlacale M,lndal of ![qgco--da-Yari L)rst'rci ,|: L-AKoDERU v' 1,t.lc l.it i! .crtriic(i li.i 'rhc irla(.'-'of BrrtlL srr,/srinrathi/Kurnarr !14-L!I-841-ESH rs of !Au!( r)rstricl n ndhra Pradesh I r).^ rr (rl Piiaq.l!!: l"1,rir.idr (/f yJl*,G-9dal4ql! of th(: 9t'lt' rs 5,,, l{oirri' 1 :, r. L:{r,, rj,,t ti,irl itr( ,);r, ol Urrttr SrLi,Sr, ratlr/Kuflr.r NA!-LI R.AJES!1 1,'l 1!q4r-9r -l9a:l as pcr tile de( laratiorr qtvi:n t;;' hrslh|r ..il ,.)rlq 4qlq : -Alrgrllt QlrL t!!!e liSillllge 1,11.1['rl]ria)rirL,,,' ,:,Jr(irari ,.lir,l ds entcrcL rr ille -Sahool r('cor{l: v'rlr('re he/she Sludrecl Csrtified BY \ Desiqnation t TAttSILDAR Mandal : Palacole rliln) ntl,rrbcr IIrc::lro ]r! :t llrc Ccr[iflcnl(] 6,'f ,,,v,''r', .,.,,.,',,,r,".,.,,",.,,,'r rrr frrr'rshrn'l tlr( 'r;rprri llll fl Note : This signalure rll at the mentioned in the Certificate. ANNEXURE 21 (CI{APTER 5, PAERA 5.29.U FCRMAT FOR SPECTMEN STGNATURES OF CANDIATES AND THEIR ELCNON AGENTS Nf..g.)!...:-:..r..)...... (i.vronrh ./vear) , J\N&AcSCliA..-'1.. i - i eiete is ot applicablei ',',hatever iire s,:eci ren signatures of contesting candidates and their Elections Agenis are gi'.,en l;eirw :',:' the purpose of 'rerif;cation of their signatures by the Presiding Officer in the ;i::els ii aprrurirrtment cf Polling Agents at the time of poll: his her Specimen specimen slgnature Narne of / signature i eiestion 1 K6Ll 6trt ,\) LL R Es S!ryry gArrvrv-AjU t.$ EABB E NFLL\ ESH str D H AR{*RA1\J A Eqt, $P I SIGNATURE RfiURNING OFFICER Declartion by candidate / Election agent/ proposer while submitHng the photograph of the Candidate Sulrjeci; A xrl Election to h. R. A.P.Agn E9.h.'.. srPr. At :.tt#Sri.,,, rhe n arnc oi the House) from (name of the Council of States/ l,egislatir.e Council b1, Assemblv , o* ryL!_-.i...f:'.F.T.g--S.fl...... :...... (name and acrdress). son/dau-ghter/u,ife of shri r*. r+llltt". r-1. 9:>&.?r:M-i.r"t"d as ca;rcliriatc 'Jie for above mentioned election, I am submitting herewith my photogr.aph for cre p:.uDose of prir:ting the srure on the ballot paper. i declare that the photograph has tr,:en taken during the last 3 months before the date of the norification of election. lirli up this part when the cardidate himself is submitting the photograph). OR (name), election agent;/ proirrise: ...... (name and adclress of the cancliciiitrl. s,;n./Caughter,/wife of Shri a candidate for tfie abo.,..r: menioned election, hereby submit the photograph of the said candidate for the plrrpase of printing the same on the ballot paper. I declare tlat the photograph has bt.e;r taken during t]-e last 3 months before the date of the notification of elcction. iilll ui:r this part u,hen the election age.nt/proposer: is submitting the photographi N9P x,,,", N.ft .!.ki . { F.L.q_ 5rt a.ir j,.,.\<- \ ^t- 6 cnf f rs R.o 6j '* pO{LAm. J e ( i,,'fo, .'F#ffkft"fs\qtts?rltft rel. No.: fl .3..v.\.S.:ttI.b t : rrJo6 bao: Ztl.6e5 er;ou5 ps aI b6s.: 6a go6 b65S$ D6irn" Be$Oor5ffdrcbpr;1r:& F) e-uri: A o T- 4-J '1 ? TtrNGLISH N hLL r R.ATtrsH ereISO P boe3Siu, N€Rt15 AYL'Fott - 1 ,,A:p.N\\EIfrfttd*n.,1,1,,..; trs uua Q.AT€S++ i,. ,.,.,,, , ,,..,,' l{eriqlTTiPiNlVnS .,,EL€.cT',tND4\Er,.7-',,e,:i.,,.: ., : ,: j T.S o-lqJ*+ ^/ )-q4-\ l $vq i accefrl tlle ahove aptNnrlrent ,'5J9.n4lo-ptr- 15-j -\) ',,. l.rse I iglrlture o! eiection agent j\ppr.)\'ed :iignnture and S,r:r, i'l'tlrr lisrurninq Oifieer. ,, i{iii r:'r:iill .,r..',:itltr iirililii'.te iiltct'lll.Llil es as ltrn b.r apl)ft'pt'ia1c.- I r ; llouse {lf tlie People iu$ tho.. consllltreriev .li !-.egisia1ivg.{ssenrbll. lionr Llru rt0nstlluel'icv , :,1 Council oi'Slatss hr the elected nrerubers oi the Legislative Assernbil,' .(State). ,.i) founcil of States hy the mcmber of the electoral college ot'.... -...... r rerritory). ljnion -: i.ii ...... -,.....t-egislative Cu.runcil by dre nrembers of the LegislatiYe Assembly- i',ir i.ec clatir.,e Council from tlie...... ,...... -...... -...... constitusncy. FOR\I 9 [Ser rute I2(2)l RE}'OC.{TIO\ OF APPOIiYTMEI\-T OF ELECTION AGENT Election to the*-.-. Trr Thc Retuming (-)t{icr_t .- ... a candidate above election, here bi. at thr rny election :','' N.q\A+4flD r^i r,r,, D-5*::\.) ii u,@ " Hsru insefi on oftlre t.'ii()\r itrg i:;rtmflli\'es as In8! hc appropriate:- r, !!,'urr:,,i lhcper:p;1 ;i,.r- . - , :, Legisl&ti\ E.r,ssclniri r :r. ,:. : r hu t1 Coilncil ofStates b.*- thc Eie€tcd mcmbers ofthe Legislative dssembly rr1...... _ ...... ,Siat,.; Council ofStatrs b-,.. tftc r:rcnrbers ofthe electoral collegc ot ...iLinion !er,.irorr...... LcgrslativcC.orurcilbythemembeBofrheL€gislariveAsscniol, OriginaV duplicaG (Original to be kept with nomination paper and Duplicate to be handed over to candidate) n Name of constituency . . .. N.. .+_ R hf.+S. P.g. . . . R. Eg.tr SrrvC_^rT Name of the candidate :\ fi. FrFs v Date and time of filing nomination paper ..)=_5.:3=.I ) Sl. No. of nomination paper SNo Documents Whether filed (write yeVno) (if there is any defect/shortcoming in the documents, the same should be specified. I Affidavit in Form 26 (a) Whether all columns are filled up @) If not which are blank column(s) (please specify). (c) Whether the affidavit is swom before an oath Commissioner or Magistrate of First Class or before a notary Public Certified exnact of electoral roll (when candidate is atr elector of a differert constituency) J Forms A and B (applicable in the case ol- candidates set up by political parties) 4 Copy of caste certificate from competent authorify (if the candidate claims to belong to sc/sT) ) Securlty depos t (whether made) 6 oarh/a ffirma () ti n ( hether taken ) Cond- I The following documents which have not been fired should be fired as indicated berow: (a) should be filed late,st by (b) Above mentioned columns in the Affdavit in Form 26 have been Ieft blank. you must submit a fresh affidavit with columns dury filed up before the commencement of scrutinv of nominations, failing which the nomination paper w l be liabre to be rejected. (c) should be filed latest by_-- Ileceived (Signature of candidate) Signature of RO/ARO Date & time: Place: N.B. I The Affidavit in Form 26, Forms A & B have to be fiIed latest by 3.00 pM. on the rrst date of fiIing nominations. , If columns have been reft brank in the affidavit in Form 26, this shourd be specified against item I, and candidate should be asked to submit an affidavit complete in al| respect, latest by the time fixed for commencement of scrutiny of nominations. Fa ure to submit revised affidavit comprete in a, respectg even after reminder by Ro wilr be a ground for rejection of the nomination paper. 3 oath has to be taken after fiIring nomination paper and before the date fixed for scrutiny. 4 Ccrtified ertrect of electorel rol! can be filed up to the time of scrutiny. 2 FORM OF OATH ORAFFIRMATION (To be made by a candidate for election to the Legislature ofa State) I...... having been nominated as a candidate to fill a seat in the Legislative Assembly (*or Legislative council) do swear in the name of the God / Solemnly affirm that I will bear tnre faith and allegiance to the constitution of tndia as by law established and that I will uphold the sovereignty and integrity of India. Signature and name in block letters of the candidate Sworn in the name of God/Solemnly affirmed by Shri/Shrimati at (Place) at .(hour) this the day of .200 before me. Signature of authorized person Name and designation and Seal (CERTIFICATE FOR RECEIPT OF OATIT) (To be handed over to the candidate by the authorized person) certified that ..-. (name) a candidate for election to &e Legislative Assembly (*or Legislative Council) has made and subscribed the oath / affirmation as required by the Constitution of India before me at my omce at (hour) on ...... (date). Signature of authorized person Name Designation and Seal Date *Score out which is not applicable. N.B-: This Form should be supplied to rhe candidates both in English and in the official Language of the Statey'Union Territory. t - sdsreao do. $65 p{S d* g$er6 316o (e$a"$56{$ a:ofr tcg5o6: soaoOoo iFd Ji:r$p@djo ddr"o) SS...... edson o"ode5id6rece6d.Jsr.a,6SJd(*dcr+iS q,Oc $060) ds &0".J6.pB ;rtudc.S doooto.s. di{6or$o }&n /r6ss{rd o"a*5o6o be cd"sro go8 SeJod $oc5:56osdon e,.66 r$u'r6 $65e?$e"5s;s.$x6orc 6so.eao drgo"Jo. odjo So65o dr{5o6:s 561 516/ s65s*d & /8"bs (6""; (doe.:er ) e 6aer 3e.r 20 5o56;6o o.f,.: o" 5u:o66 @6roo da"6r. 6o56o $oao66e6so ad) rdo ($Sweo $5+6 g5S6ea Sq6o) (5oao66 e6s-o e{jo3 eoddot O;Sa ) (66) a.S$sd (*a.r$ $o60)ed5p ar66 s$E665 eew5o6o Ss-6o $50"a S5*fio / 365S6 a. ir:o66, o" se5oof:od ...... 6o€co$c daa.Oda"xr. d6, 5o66o 5oao06 sOs.O ;F 6b *6Eo.JS eS$ SBdoS:oe, N.B.: 6 &esJeds6o$ eo0& S:odr e cn$ ,rdoglo6 go6 s0s6 aitd 6obd dA:.o. PARTry (To be filled by the Retuming Officer) Serial No. of nomination paper .24 f. *efJ w.t.1...1.M This nomination livsed to me n,: Yt w .o).11 at my office at... .ftour) on f (date) by the * ) *,.....f-:.9?.:ul1 PARTV Decision of Returning Oftcer Accepting or Rejecting the Nomination papar I have examined this nomination paper in accordance with section 36 0fthe Representation ofthe People Act, l95l(43 ofl95l) and decide as follows:_ Date...... Retuming Officer @erforation) PARTYI Receipt for paper Nomination and Notice of Scrutiny (To be handed over to the person presenting the Nomination paper) Serial No. of nominxliel ps The nomination paper a candidate for election from the...... Parliamentary constituency was delivered to me at my office aL (hour) on. (date) by the *candidate/proposer. All oomination papen will be taken up for scrutiny at. (hou) on (date) at...... (place). Date...... RehrmingOfficer *Score out the word not applicable. 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J$)st Be-^l't' qo6' +dlo So5trra se.l$$D p65gs)nr35 h--J'tt-'ca- ,L-.1l '4\^ \A g.5- 3- afe 5o, t \\b O$ \\" f)S{rPa. eoAx3 a.$ 6o$dlJis6' dor$ S60ol>il)s:. 36dr tr5o€ e51ot5 aeS; s5 trqg5o. nr>uui 0-fr95F7 O) 0010)06 a9OyO So.9 SdliDdo $garo0J6 So:rag5* 66, S.$ 5o.9 ,$d,$erdo $ga)oer6 iofrars$f,o *oa qo| P"z"1x )gtl{68rr / n56og od5prr. $66gxr1s. 5.9"6 Sts)E: u 5dr qo6 B66o.t &D6od3,i5o$$6rp 3,tr $o**;ar. F- dr$r06o$d,.) (SeldorD oC$ $ocrso) 6lbsoo*ag:sa zz oooyo6 3o.9 $6$Qdo )garoe)6 soltas$fo $oo(I) toolDg ser56, !)b$ drr$o agn, Seud;. To The Returning of{icer No.9 Narasapuram Parliamentary Constituency Sir I am contesting candidate from No.9 Narasapuram Parliamentary constituency as Pafiy caadidate/independent candidate. I request that my n.rme may be printed in the Ballot paper as shown bellow. English Yours faithfully (Signature of contesting candidate) / /Attestedl / Returning officer No. 9 Narasapuram Parliamentary Constituency and Joint Collector, West Godavari, Eluru ' Declaratlon by Candldate I Election Agent,/ Proposer while submittlnB the photograph of the candidate: Subject: Election to .. +*..c.. (mention the name of the House) from ...... N.+ g-.fi.s.8...F-t?...2A ( name of the constituency ) / election to Council of States / Legislative Council by the Assembly Members. t...... N.H.L.1,,I E.,S.T!, name ald address), son/ daughter/ wife or Shri ..?!.{r. A.A. S..ll. .t4 4+, A"' /"' }L7-'AI?J.Inominated as candidate for the above mentioned election, am submitting herewith my photograph for the purpose of printing the same on the ballot paper. I declare that the photograph has been taken during the last 3 months before the date of noti.ficadon of election' (Fill up this part when the candidate himself is submitting the photograph)' OR I ...,.,,,....,...... (name), election agent / propos€r of Shri ;""" ;; ;; ;;*;;;' f" # "*'*;;;;,a candidate for the above mentioncd election, purpose printing the hereby submit the photograph of the said candidate for the of during the last same on the ballot paper. I declare that the photograph has been taken 3 months before the date of notification of election' photograph (Fi.lI up this part when the election agent,/proposer is submitting the )' Signature of the Candidate/Proposer/Electlon Agenl oate:7{lo}'f uo lt Name: ....t$..ft 4*L .L.R.N1...C s"t4- aoa,"rr, Vg.nn.K4 *.g.gLz*.ra,.$ql o,Eq (f'y u.N.,...f..f,.Q..$. t"6,4Aa-+. .' E OUR DEPOSIT SCHEMES AT GLANC rom t 1nl( 1n 5,00,000 YaaG A,ccidontal D€alh Cover S8 Diamofd 05-75 10,00.000 Linkod sB Accounts 05-75YeaIs Dealh Cover SB PLatnum I 75 1 l Cover 18-55 i 0-1 Bank (K ds Ktrazana) 1 AB Kiddy . 3Months-70 Yrs D€posit. AB Depo D€posit, Kal pata Oeposti AB Saver RD 0 Dspo!itSchomss AB rms and conditions ofl not on due dales 2 comp. No. t1302 flI€n /Branch cb BrPh : 0S814133 5'19 0 l4 I I-A\I\.{-AKODERC ffi#,e*x IFSC IIODE: ANDB00003+ 1 I{ICR CODE: 51401t66-l qrs BOOK 5-6 PASS bnlo 34lGiandhrabank. co ' rn I AN\ \l .'\l\OT )l'lFlI' ,." . (:. ir] s'|. Ai) qr*dt5.*r,4hQr)FRI srfl if{ -:l-l :50 AJc. No. xsjf$$fi$;fi$$nlsH .'1R 03+ 1 1 0 L 00084'116 N,AI L, I RAJESH q.rll Addr.t. SBERT ROAD Schenre Code: Sr) NARAS l tllH.A MLm,TIn H NO 1-18 l\,t\lN d" i.. tliisT. 1Lr : -l I500 -.i0 -l \EMGTAPLRAM LANKAI-AIir)DERI NorninaL 1on Regl stel cd PhoneNo L.\\\.1r-.\i.'cDr.RL rqrR /Modo AtiuHF,A PRADESH- -r -1.i:50 qur{ E qtfiq. tqrqrE, ttlarcrE - 500 004 :toc)cl+ l:51: * - 004' ftqiar /Date :..-, ,. Hoad Offlce, Sallabad, Hyderabad 500 / No ature ;#i t4ffitr11€l llomination Resr3tored :Yos ' l:-li-l--llll'r /\ -...-.--. ar{ srTr *s 3rrdR'd {rfil qfl d {Ifn 6ffieT{ ft-qrsr to r. lnitial ft-{i6 Amount OePosited Balance Cheque No. Amount Withdrawn Date Particulars No 0.1.11 10100034+ 1 Account 000 . 00 i 000 . 00Cr )5./r)3 / z1le CASH REC},I PT Ral;a Rs . 1000 .00 \1' L r -\ llr Cr Rs. 100(). 00 Ffi {Date::5-0 -1019 Clr B;rl: Cr Rs. i 000, {)