DATE \S \O~\~'L..\ Te TIME ~: \5 Pt't\

$DATE \S \O~\~'L..\ Te TIME ~: \5 Pt't\$

FORM2B (See rule 4) NOMINATIONPAPE}~r "BE'/YthfoL Election to the Legislative Assembly off:!... ~1State)

7- Qinhata AC ":e OOt}..1LA/2021 I RO

DATE \S \O~\~'l..\ te TIME ~: \5 Pt't\. ~h

\\ ..-~~~~c0( ~~ \tiy:~~T I OR PART II BELOW WHICHEVER IS NOT APPLICABLE !(\\~ ~~ . ~e\V. 0\'(\'(\ PART I ~o:t (To be used by candidate set up by recognised political party) I nominate as a candidate for election to the Legislative Assembly from the 07 DINHATA (GENERAL) ASSEMBLY CONSTITUENCY Assembly Constituency. Candidate's name SRI NISITH PRAMANIK. Father's/mother'slhusband's :name.SRI BIDHUBHUSHAN PRAMANIK His postal address Vill-Kharija Baladanga, Bhetaguri, P O~abetaguri, P.S. Dinhata, Dist. Cooch- Behar ,Pin-736134 His name is' entered at S.N:?.~in Part No.234 of the electoral roll for.NO.7 DINHATA Assembly constituency. ',/ / My name is Gopal Chanda and it is entered at S1.No.H1 in Part No.234 ofthe electoral roll for the.7 Dinhata ,Assembly constituency.

~~~~ Date ..1~f!.~.I.Y11 Signature of the Proposer

PARTll We hereby nominate as candidate for elec on to the Legislative Assembly from the Assembly Consti ncy. Candidate's name Father's/mother's/husband's name His posta address .. "" His name is entered at Sl. No in Part No ofthe el toral roll for Assembly constituency.

1 We declare that we are electors of this Assembly constituency and our names are entered in the electoral roll for this Assembly constituency as indicated below and we append our signatures below in token of subscribing to this nomination: - Particulars of the roposers and th r signatures Sl.no. Elector Roll No. of Proposer Full ame Signature Date Part No. of S.No. in that part Electoral Roll 1 6 1. 2. 3. 4. S. 6. 7. 8. 9. 10. N.B.- There should be ten electors of the

PARTll I, the candidate mentioned in Part IIPart II (Strike out which is not applicable) assent to this nomination and hereby declare that- (a) I am a citizen of India and have not acquired the citizenship of any foreign State; (b) that I have completed 35 years of age; [STRIKE OUT cCi)OR cui) BELOW WHICHEVER IS NOT APPLICABLE] (c) (i) I am set up at this election by the BHARITYA JANATA PARTY, which is recognized National Party/State Party in this State and that the symbol reserved for the above party be allotted to me. OR (ii) I am set up at this election by the NIL party, which is a registered unrecognized political party/that I am contesting this election as an independent candidate, (Strike out which is not applicable) and that the symbols I have chosen, in order of preference, are: - (i)NJL (ii)NIL (iii)NJL (d) my name and my father's/mother'slhusband's name have been correctly spelt out above in English (name of the language); and (e) That to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly of this State.

...I further declare that I am a member of the Rajbanshi **Caste/tribe which is a scheduled ··caste/tribe of the State of WEST BENGAL in relation to COOCH BEHAR (area) in that State,

2 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 Legislative Assembly of WEST BENGAL from more than two Assembly constituencies. ~

Date ....!.9!??/'!1. ... Signature of Candidate

'10 ~ out this paragraph, if not applicable. '10'10 Score ont the words not applicable. N,B,-A "recognised political party" means a political party recognised by the Election Commission under the Election Symbols (Reservation tmd Allotment) Order, 1968 in the State concerned.

PARTIIIA (To be filled by the candidate) (1) Whether the candidate- (i) has been convicted-- (a) of any offence(s) under sub-section (1); or (b) for contravention of any law specified in sub-section (2) of section 8 of the Representation of the People Act, 1951 Not Applicable (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 shall furnish the following information: (i) Case/first information report No./Nos- Not Applieable (ii) Police station(s) NIL District(s)-NIL State(s) Not Applicable (iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted . ... Not Applicable "",. (t'V)Date(s)ofconviction(s) Not Applieable

(\I) Court(s) which convicted the candidate Not Applicable

(\';)Punisbment(s) imposed [indicate period ofimprisomnent(s) and/or quantum of fine(s)]... Not• Appliable. (vii)Date(s) of release from prison... Not Applicable

(viii)Was/were any appeal(s)/revision(s) filed against above conviction(s) (YesINo) NO

(ix.) Date and particulars of appeal(s)/application(s) for revision filed -Not Applicable (x.) Name of the court(s) before which the appeal(s)/application(s) for revision filed -Not Applicable

(xi) Whether the said appeal(s)/application(s) for revision haslhave been disposed of or is/are pending... Not Applicable (xii) If the said appeal(s)/application(s) for revision haslhave been disposed of- 3' (a) Date(s) of disposal... Not Applicable (b) Nature of order(s) passed... Not Applicable (2) Whether the candidate is holding any office of profit under the Government of India or State Government? (Yes/No) NO -If Yes, details of the office held . (3) Whether the candidate has been declared insolvent by any Court? (Yes/NO) No -If Yes, has he been discharged from insolvency . (4) Whether the candidate is under allegiance or adherence to any foreign country? (Yes/NO) No -If Yes, give details . (5) Whether the candidate has been disqualified under section SA of the said Act by an order of the President? (Yes/NO) No -If Yes, the period for which disqualified . (6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of India or the Government of any State? (Yes/No) No -If Yes, the date of such dismissal No (7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government? (Yes/No) No -If Yes, with which Government and details of subsisting contract(s) No (8) Whether the candidate is a managing agent, or manager or Secretary of any company or Corporation (other than a cooperative society) in the capital of which the Central Government or State Government has not less than twenty-five percent share? (Yes/no) No -If Yes, with which Government and the details thereof ... No

(9) Whether the candidate has been disqualified by the Commission under section lOA of the said Act. (Yes/No) No -If yes, the date ofdisqualification ... No

Place·_])llVtffI-nt p ~ Date:· COO CIf{!; £.1/fl Y\_ Signature of the candidate ) 8l3/2(}21 PART IV (To be filled by the Returning Officer) Sena. IN 0.0f nommation.. paper ..lo.'1'I(l1..jLA/'lOl.l!OO..... " , This nomination was delivered to me at my office at..~;JS.f.~(hour) on. u.LC??4?fdate)by the *cw;.didate/proposer(Name). ~I I. ~<6\O>I'U>2-1 Date ...\~.~t?'?'~k:Q~\ Returning.OffiC'Mffjcer ReturnIng u

.-, 9fFb1;q~ q~q csj411HWEST BENGAL AE 166951

~ Form 16 (See rule 4A)

AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO WEST BENGAL I LEGISLATIVE ASSEMBLY (NAME OF THE HOUSE) FROM 07 DINHATA (GENERAL) ASSEMBLY CONSTITUENCY ,WEST BENGAL.

PART A

r SRI NISITH PRAMANII( Son of SRI BIDHU BHUSHAN PRAMANIK Aged 35 I Years, resident of ViII.-Kharija Baladanga, Bhetaguri, P.O. Bhetaguri, P.S. Dinhata, Dist. Cooeh Behar ,Pin-736134(mention full postal address), a candidate i at the above election, do hereby solemnly affirm and state on oath as under:- e (1) I am a candidate set up by BHARATIYA JANATA PARTY. Contd.... P/2 .~ I ... ~ 1%-(.0,'),1 Ohirendra N. Adhikar I Notary Govt. of India: Oi hata :: 2::

(** name of the political party)/ ** am contesting as an Independent Candidate. (** strike out whichever is not applicable) (2) My name is enrolled in No.7. Dinhata Assembly Constituency. West Bengal. (Name of the Constituency and the state) at serial No. 308 in part No. 234. (3) My contact telephone number(s) is/are 76785-99227 and my e-mail id (if any) is [email protected] my social media account(s) (ifany) is/are (i) Facebook Ayc - nisithpl (ii) Twitter A/c- NisithPramanik (iii) Whatsapp-76785-99227

(4) Details of Permanent Account Number (PAN)and status of filing of Income tax return: SI.No. Name PAN The financial Total Income shown in year for which Income Tax Return (in the last Income Rupees) for the last five tax return has years completed (as on been filed 31st March)

SRI NISITH BESPP1197J 2015 TO2020 (i) Rs. 5,97,688.00 PRAMANIK (2015-16) (ii) Rs. 6,46,590.00 (2016-17) (iii) Rs. 9,12,140.00 (2017-18) (iv) Rs. 5,51,120.00 (2018-19) (v) Rs.11,47,670.00 (2019-20) 2. Spouse BFCPP401 Not Applicable (i) No. I.T.Return SMT. PRIYANKA PRAMANIK (iO Not Applicable (DAS) (iii) Not Applicable (iv) Not Applicable (v) Not Applicable 3. HUF(IfCandidate Not Applicable Not Applicable (i) Not Applicable is Karta/ Coparcener) (ii) Not Applicable (iii) Not Applicable (iV1 Not Applicable (v) Not Applicable

4. Dependent-I Not Applicable Not Applicable (i) Not Applicable Debanjan Pramanik (Minor (ii) Not Applicable Son) (iii) Not Applicable (iv) Not Applicable (v) Not Applicable t'oIotApplicable S. Dependent 2 i)

r-rot Applicable Nilanjan Pramanik Not Applicable rrot Applicable ii) (Minor Son) r-rotApplicable iii) <,O~'3N. ~ ~ot Applicable .~ NOTARY ~ iv) I.r:: Govt of India o Regn No 1B~~~ v) ~ot Applicable ~ ·k EL \f6':'-.q, . t'oIotApplicable . .,.-j!:_ Ber'3~ ------=- ~ . Dependent 3 ... i) t'oIotApplicable Not Applicable ~ot Applicable Not Applicable ii)

~ot Applicable iii)

t'oIotApplicable iv)

~ot Applicable v)

Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly stated "No PAN allotted".

(5) Pending criminal cases :- Yes

is no pending criminal case against me. (Tick this ~N;JCIJ·lllinalcase pending against the Candidate and write NOT APPLICABLE against alternative iiuTb1e19Jil1_

(u) 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 givedetails of all pending casesin the Table below)

~ 1 I~( ~I ~/~ Dhirendra N. Adhi Notary Govt. of India, (a) FIR No. with name l)Kotowali( Cooch 5) Dinhata P.S. 9)Dinhata P.S.case address of Behar) P.Scase case No. 322/18 No.459/13 Police Station No.136/19 dated dt.14/08/2018 dt.02/05/2013 concerned 27/02/2019 6) Dinhata P.S. 10) Alipurduar P.S. 2).Dinhata P.Scase no- case No.398/18 case No. 227/09 dt. 124/19 dt.16/03/19 dt. 09/10/2018 02/05/2009 s:. o~'O.N .~ NOTO ~ 3).Dinhata P.Scase 7)Dinhata P.S. l1}Alipurduar P.S. (c3 Govt 0f -< NO-155/18 case NO.1296/13 case no.243/09 ~R'90 N D'* dt.12/04/18 Dt.14/10/2013 dt.19/05/2009 Q Fi<::' 0_:0 Bel' e~~O" . ....-...... :;::~- r::o- 4) Dinhata P.S.case 8) Dinhata P.S. 12) Kotwali(Cooch NO.163/18 case No.605/14 Behar) PSCase No. dt.27/04/2018 dt.29/11/2014 214/2019

13) Dinhata P.SCase No. 464 /2020 dt.06/12/2020.

(b) Case No. with 1)GR Case No-206/19, 5) GR-307/18, 9)GR- Name of the court Kotowali(Cooch Behar) corresponding to 503/13,corresponding P.Scase NO.136/19 Dinhata P.S. case to Dinhata P.S.case Pending in the court of No. 322/18 No.459/13 Ld. C.J.M ,Cooch Behar dt.14/08/2018 dt.02/05/2013 pending before pending before Ld. 2)GR-94/19 Ld.A.C.J.M Court, A.C.J.M Court, corresponding to Dinhata Dinhata Dinhata P.Scase no- 124/19 dt.16/03/19, 6) ) GR-397/18, pending before corresponding to 10)GR-973/2009 Ld.A.C.J.M Dinhata P.S. case corresponding to Court,Dinhata No.398/18 dt. Alipurduar P.S.case 09/10/2018 No. 227/09 dt. 3) GR-157/18, pending before 02/05/2009 pending corresponding to Ld. A.C.J.M Court, before ALiPURDUAR I Dinhata P.Scase No- Dinhata 155/18 dt.12/04/18 Ld. J.M 1st COURT pending before 7)GR-1356/13, Ld.,A.C.J.M corresponding to Dinhata P.S. case Court,Dinhata 11)GR-1040/2009 No.1296/13 corresponding to 4) GR-168/18, Dt.14/10/2013 Alipurduar P.S.case corresponding to Pending before no.243/09 Dinhata P.S. case Ld. A.C.J.M Court, dt.19/05/2009 No.163/18 Dinhata pending before dt.27/04/2018 ALiPURDUAR ,Ld. J.M pending before 8)GR- 1st COURT Ld.A.C.J.M 690/2014,corresp Court,Dinhata onding to Dinhata P.S.case No.605/14 12) G.R Case No. dt.29/11/2014 362/19 pending before corresponding to Ld. A.C.J.M Kotwali(Cooch Behar) Court,Dinhata PSCase No. 214/2019 \ Signatul ~Authent cated pending before Ld C.J.M CoochBehar ~ ~ .-- . ( P-r b(~ ~~ Dhiren< ra N. Adt kary Notary GO\ . of India Dinhata ------~------~ 13) G.RCaseNo. 534/2020 corresponding to Dinhata P.SCaseNo. 464/2020 pending before A.C.J.MCourt, Dinhata

{c) 1)U/S-399/402/IPC, Section(s) of 5)U/S341/326/30 9)U/S-447/427 /379/ concerned R/W SEC25(1)/27/35 7/120(8) 341PC Acts/Codes ARMSACT. IPC.R/W-SEC- involved (give no. 25(f)(A)35ARMS 10)U/S-457/380/411. of the Section,e.g. 2)U/S-406/420/506 ACT IPC. Section •••••••of /341PC }PC, 6)U/S~27/506/34 11)U/S-461/379/411 fPCR/W-3/4 EX 3)U/S-148/147/149 IPC. ACT. /427/326/302IPC 7)U/S- 12) U/S 4)U/S.147/148/149 448/353/186 341/323/186/188/353 /448/327/379/506IPC /34IPC /332/506/34 IPC. 8)U/S-448/3 26/354 1427 IPC . 13) U/S 341/427/324/307/ 506/341PC (d) (1) U/s- 399 - Making (5)341-Wrongfully 9)447 - Criminal Brief description of preparation of dacoity, restraining one Trespass,427 - Mischief offence 402- Being one of five or person,326- and causing damage more persons assembled Causing grievous voluntarily,379 - for the purpose of hurt,307-Attemp to Theft,34 - Common committing dacoity.Rlw murder Intention Sec-25(1) 27/35- .120B-Criminal Possessing illegal Arms conspiracy,25(1 )A/ (10)457- Lurking house and dealing illegal Arms 35- Arms Act. trespass or house Act. breaking by night (6)427- Mischief 380- Theft in building, (2)U/s- 406 - Criminal and causing tent or vessel.,411- Beach ofTrust,420- damage Dishonestly receiving Cheating,506-Criminal voluntarily, 506- stolen property knowing Intimidation ,34 - Criminal it to be stolen. Common Intension intimidation, 34- Common Intention (11) 461 - Dishonestly (3) U/s- 148-Rioting, RIW-3/4(Explosive breaking, open or Armed with deadly Act) - Causing unfastening any clone weapon, 147- Rioting explosive in Receptacle containing or 149- Unlawful endanger of life supported to contain Assembly,448- House property, making or property,379 - Theft, trespass,427 -Mischief possessing 411- Dishonestly and causing damage explosive receiving stolen property voluntarily, 326-Causing substance. knowing it to be stolen. grievous hurt,302- Murder 7)448- House trespass 12) 341-Wrongfully 353- Prevent restraining one person (4)U/S-147- Rioting public servant 323- hurt, 186- 148- Rioting, Armed servant from dis Obstructing servant in discharge of his duty I Signat~re Aumenncated with deadly weapon, 149- charging his official Section 188- Disobedient duty, 186- Il_ './,.fI~/1 Unlawful Assembly to Order duly ..~i~(;;~71- 448- Unlawful Assembly Obstructing servant promulgated by any 327- Voluntarily causing in discharge of his Dhire idra N. A .hVary public Servant, Section public fimction,34 - Notary G I>vl:.of lnd a, Dinhata hurt,379- Theft,506- 332- Voluntary causing Criminal intimidation Common Intention hart to deter the Public Servant. 353- Prevent public servant servant (8)448 - House from dis charging his trespass,326 - official duty - Causing grievous o.~B< 13) 341-Wrongfully N.:: hurt,354 - Outrage 0~ restraining one person, .~ NOTARY ~ of modesty of a ~ 427 - Mischief and c3 Gave of Ind .... women ,427- Regn No.1& ~~'< causing damage Mischief and 1\ * \Q voluntarily, 506- \\ 0. .~ causing damage '~(i...' Criminal intimidation, 34 voluntarily ~~~;~~~ - Common Intention

(e) Whether charges have No No been framed No (mention YES or NO)

(f)

If answer against (e) above is YES, No No No then give the date on which charges were

(g)

Whether any AppeaJ/AppJicat No No No ion for revision has been filed against the proceedings (Mention YES or NO) (6) Cases of conviction

.~eclare that I have not been convicted for any criminal offence. (Tick this

) I have been convicted for the offences mentioned below:

(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) Case No. NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(b) Name of the Court NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

Sections of Actsf (c) Codes involved NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (give no. of the Section,e.g. Section ..•.... of IPC, etc.). (d) ~rief description of

Offence for which NOT APPLICABLE INOTAPPLICABLE ~OT APPLICABLE convicted

(e) Dates of orders of

Conviction NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(1) Punishment imposed NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE

(g) Whether any Appeal

has been filed NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE against conviction order (Mention YES or No)

.. ' 18 I 3, '--/. Dhirendra N. Adhl ary Notary (;ovt of India, Dinhata (h) Ifanswer 10 (g)

above is YES, give NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE details and present status of appeal

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. Candidate is responsible for supplying all information in compliance ofHon'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 depositlInvestment, the details including Serial Number, Amount, date of deposit, the scheme, Name of BanklInstitution 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, sonrs), 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.

~ , ,g-/r;)t)-_.{ Dnirendra tJ. Adhi Notary Govt. of India, 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. ---==::::::-Ex.....planation,- For the purpose of this Form, the expression "offshore assets" includes, o~aN.-';_q details of all deposits or investments in Foreign banks and any other body or , (Q~ O'...-s institution abroad, and details of all assets and liabilities in foreiga f NOTARY '* o Govt of India ~ countries'; * Regn NO.1 &58 '< \\'\C6 .;;'*!J \~CYl - ~ .•-»-h/ ~tf~.!!c~ Description ~elf ~pouse HUF lDepende ~ependen Depende lN--o.-" nt-I -2 nt-3

Cash in hand Rs.1.45.200=00 Rs. 25650=00 Nil Nil Nil Nil

ii) Details of deposit In Bam 1) S.B.I .Dinhata 1) )S.B.I Nil Nil Nil Nil accounts (FDRs, Term 13r.S.B Alc .Cooch Behar Deposits and all other types of 1N0- fBr.AlCNo deposits including saving ~1872273883 ~0364661796 accounts), Deposits with jRs.4200=00 tRs.4820.00 Financial Institutions, Non- ~) S.B.I Banking Financial Parliament ~ompanies and 1H0useBr. S.B . .. d th Wc Coopera~ve SOCIetIesan . e 1N0-38483170094 amount In each such deposit Rs.8,14.700=OO 3)Punjab National Bank S.B Alc No- 65660069000015 ~2 Rs.13089=OO

iii) Details of investment in Nil Nil Nil Nil Nil Nit Bonds, Debentures!Shares and units In companies/Mutual Funds and others and the amount. (iv) Details of investment in NSS, Nil Nil Nil Nil Nil Nii Postal Saving, Insurance Policies and investment in any Financial instruments in Post office or Insurance Company and the amount

v) Personal loans/advance given Nil Nil Nil Nil Nil Nil to any person or entity including firm, company, Trust etc. and other receivables from debtors and the amount.

Nil Nil Nil Nil Nil Nil Signatur~ Authenticated vi) Motor Vehicles!Aircrafts! ~~-- C / (<6/ 'j;)//4 Dhirendra N. AdQ!)

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

~No Description Self Spouse HUF Dependen Dependent- iDepen t-I 2 dent-3 (i) Agricultural Land ~ ~ NIL NIL NIL NIL

Location( s) Survey number(s) Area (total measurement Not Not Not Not Not Not in acres) Applicable Applicable Applicable Applicable Applicable Applica jble Whether Not Not Not Not inherited Not Applicable Applicable Applicable Applica ble property (Yes or Not ~pplicable ~pplicable No) Date of purchase in case Not Not Not Not Not Not of self - acquired property ~pplicable ~pplicable Applicable Applicable Applicable Applies ble Cost of Land (in case of Not Not Not Not Not Not purchase) at the time of ~pplicable ~pplicable Applicable Applicable Applicable Applica ble purchase Any Investment on the Not Not Not Not Not Not Applicable Applica land by way of Applicable Applicable Applicable Applicable ble development, construction etc. Approximate Current Not Not Not Not Not Not market value Applicable Applicable Applicable Applicable Applicable Applica ble (U) Non-Agricultural Land Mouja- Mouja- NIL NIL NIL NIL Dinhata.L.R Baladanga,L.R Location(s) Khatain no- KhatainNo- Survey number( s) ~939 ~308 & 3309

Area (total measurement 1800 Sq.Ft. 1800 Sq. Ft Not Not Not Not Applicable Applicable Applicable Applica in sq. ft.) ble Whether inherited NO NO NO NO NO property (Yes or No) ~in ...-."'~ 1\ .:O[ ~ _J ~ - '\ ~<3' r~ ,'V), ~ <" . Dhirendra N. Adhikar, Nota,ry I"'uovt 0,f India 0 hata Date of purchase in case Deed No-2299 Gift deed 3618 Not Not Not Not of self - acquired property dated 28/6/17 dated 3/9/2013 Applicable Applicable Applicable Applica ble from Mother- in-Law Cost of Land (in case of 20,41,875.00 Value of the Not Not Not Not purchase) at the time of ~ift property Applicable Applicable !Applicable Applica ble purchase iRs.70,456.00 Any Investment on the NIL NIL NIL NIL NIL xn. land by way of .development, construction etc. Approximate current 25,00,000.00 2,00,000.00 NIL NIL NIL NIL market value ~U!l Commercial Buildings NIL NIL NIL NIL NIL NIL ~a N.~~~Dding apartments) ~ -Location(s) It NOTAl-<~ Gov!. cf In ta i) ..... urvey number(s) ~.(egn. No.1 p58 '< * ~ (total measurement Not Not Not Not Not Not "'-- ~plicable iApplicable Applicable Applicable Applicable Applica ~ ~Beha\ q. ft.) ble Built-up Area (total Not Not Not Not Not Not measurement in sq.ft.) Applicable Applicable Applicable Applicable Applicable Applies ble Whether Not Not Not Not Not Not inherited property Applicable Applicable Applicable Applicable Applicable Applica (Yes or No) ble Date of purchase in case Not Not Not Not Not Not of self - acquired property Applicable Applicable Applicable Applicable Applicable Applica ble Cost of property (in case Not Not Not Not Not Not of purchase) at the time of !Applicable IApplicable Applicable Applicable Applicable Applica purchase ble

Any Investment on the Not Not Not Not Not Not property by way of Applicable Applicable Applicable Applicable Applicable Applies development, ble construction etc.

Approximate current Not Not Not Not Not Not market value Applicable Applicable Applicable Applicable Applicable Applica ble

{Iv) Residential Buildina:;s ~ NIL NIL NIL NIL (including al!artments}: K.M.C,Ward- -Loeanon (s) 107,Premises no-1956, -SurveI number!s} Kolkata-l07

Area (Total measurement ~50 sq.ft Not Not Not Not Not in sq. ft) ~plicable Applicable Applicable Applicable Applica ble Built up Area (Total 550 sq.ft Not Not Not Not Applicable Not Applicable Applicable Applicable Applicabl measurement in sq. ft.) e

Whether NIL NIL NIL NIL NIL NIL inherited property ~ignature~hen icated (Yes or No) ,-,.t~ I r«,». )_ j- Dhirendra N. A<.1~ary Notary Govt. of India, Dinl1ata Date of purchase in case ~l/06/2016 Not Not Not Not Not of self - acquired property jApplicable Applicable Applicable Applicable Applica ble Cost of property (in case 11,00,000.00 Not Not Not Not Not of purchase) at the time of !Applicable Applicable Applicable Applicable Applica purchase ble

Any Investment on the NIL NIL NIL NIL NIL NIL land by way of . development, ' construction etc. Approximate current 18,00,000.00 Not Not Not Not Not market value iAPplicable Applicable Applicable Applicable Applica ble

,v) Others (such as interest in NIL NIL Not Not Not Not property) Applicable Applicable Applicable Applica ble

~vi) Total of current market 43,00,000.00 2,00,000.00 Not Not Not Not value of (i) to (v) above Applicable Applicable Applicable Applies ble

~:?:)~:o.N. AO'~~. f!! \,\olt:>: '{. . ~ • I give herein below the details of liabilities/dues to public financial institutions and ._ ~1\(\d\3 ...::: .c GO'll. NO \ c5S * government:- o ~eg(\· ...... *C6 ~ 'f}; (Note: Please give separate details of name of bank, institution, entity or individual and vCh Be'n~ amount before each item) -

So Description ~If Spouse HUF Dependent- Dependent- ~epende No. 1 2 nt-3 "i) Loan or dues to Nil Nil Nil Nil Nil Nil BankIFinancial Institution(s)

Name of Bank or Financial Institution, Amoun outstanding, Nature of loan

Loan or dues to any other Nil Ni Nil Nil Nil Nil individuals/ entity other than mentioned above.

Name(s), Amount outstanding, nature of loan

Any other liability Nil Nil Nil Nil Nil Nil

Grand total of liabilities Nil Nil Nil Nil Nil Nil

Signature Authenticated 1 jL~AA

-e- ..~~1~(~,Yl ~;- Dhirendra N. Adhika Notary Govt. of India ' 'nhata ~ ~ix) Whether any other liabilities Nil Nil Nil Nil Nil Nil are in dispute, if so, mention the amount involved and the authority before which it is pending.

(9) Details of profession or occupation:

(a) Self -Assistant Teacher of a primary School & Member of Parliament, Cooch Behar

(b) Spouse -Housewife

. ) Details ofsource(s) of income:

Self- Political Activist

Spouse -Nil.

Source of income, if any, of dependents-Nil

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

(a) details of contracts entered by the candidate-Nil

(b) details of contracts entered into by spouse -Nil

(d) details of contracts entered into 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 Finns in which candidate or spouse or dependents are partners -Nil

(1) 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:

Madhyamik Pariksha -West Bengal Board of Secondary Education (Bhetaguri Lal Bahadur Sastri Vidyapith,Bhetaguri,Dinhata,Cooch Behar)

(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.)

Signature Authenticated

- I !?51'J/)y Dhirendra N Adhikr:.y Notary Go /t. -r ii" .::.Dinhata - . o~aN.'sq q;~ %. .~ NOTAKY '1'- --c:- . ti) I PART-B * Regn. No.1 &58 ':;; . Q (l.a . ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A: °OCh r-c , _ ri{;:)'~ ~t::II' --...;:: p~ame of the candidate SHRI NISITH PRAMANIK

~. Full postal address Vill-Kharija Baladanga,P.O-Bhetaguri'p.S-Dinhata Dist-Cooch Behar ,Pin-736134 ~. Number and name of the 07D~TA(GENERAL)ASSEMBLY constituency and State CONSTITUENCY ,WEST BENGAL

~. Name of the political party which set BHARITYA JANATA PARTY (B.J.P) up the candidate (otherwise write 'Independent' ) 5. Total number of pending criminal 13 Nos. (Thirteen Nos) cases

6. Total Number of cases in which Nil convicted 17. PAN of Year for which last Total Income Shown Income Tax Return filed

"a) Candidate BESPP1197J 2019-20 Rs. 11,47,670=00 lib) Spouse BFCPP4019J Not Applicable Not Applicable Ire) HUF ~ot Applicable Not Applicable Not Applicable d) Dependent ~ot Applicable Not Applicable Not Applicable ~. lDetails of Assets and Liabilities (including offshore assets) in rupees Description Self Spouse HUF lDependent- lDependent-2 iDependent- 1 ~ ~. Moveable Assets 11,78,099.00 3,95,907.00 Nil Nil Nil Nil (Total value) ~. Immovable Assets Nil Nil Nil Nil Purchase Price of ~ 31,41,875.00 70,456.00 Nil Nil Nil Nil self-acquired immovable .property Development/const ~I Nil Nil Nil Nil Nil ruction cost Nil of immovable property after purchase (if applicable) II Approximate Nil Nil Nil Nil Current Market Price - (a) Self-acquired assets (Total ~3,00,OOO.OO ~,OO,OOO.OO Value) (b) Inherited assets (Total Value) ~. Liabilities Nil Nil Nil Nil Nil Nil

(i) Government dues Nil Nil Nil Nil Nil NH (Total) Signature Au nenticated f All t'--/1 ~. A

~v r- A !"D 12; I ~f.LJ~ Dhirer.dru N. Adhikar ~ ~ti) Government Dues: (A)Has the Deponent been In occupation of IYESINO Dues to departments accommodation provided by the Government at any ~Pl.tick dealing with time during the last ten years before the date of Ithe Government accommodation notification of the current election? NO appropria e (B) If answer to (A) above IS YES, the following alternativ declaration may be furnished namely- e)

(i) The address of the Government accommodation:

...... Nil. .

(ii) There is no dues payable in respect of above Government accommodation, towards- (a) rent; Nil

(b) electricity charges; Nil . (c) water charges; and: Nil

(d) telephone charges as on ...... (date) Nil

[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 Not Applicable Not Applicable Government transport (including aircrafts and helicopters)

Self Spouse HUF Dependent-I Dependent- 2jDependent- I 13 ~jv) If_ncomeTax dues Nil Nil Nil Nil Nil Nil v) GSTdues Nil Nil Nil Nil Nil Nil

!r i) I'VI Municipal/Property tax dues Nil Nil Nil Nil Nil Nil vii) Any other dues Nil Nil Nil Nil Nil Ni1 viii) Grand total Nil Nil of.Signa~ullre ~il Nil Nil Nil Government dues ~u enticate~ I A/A

r-- r~r~>~ D~hirendra N'./Ardh1~. ary ,~ Notary Go'!t of Ind a Dinhata ii) Loans from Bank, Nil Nil Nil Nil Nil Nil Financial Institutions and others (Total)

10. Liabilities that are under dispute (i) Government dues Nil Nil Nil Nil Nil Nil (Total)

I,ii) Loans from Bank, Nil Nil Nil Nil Nil Nil Financial Institutions and others (Total) ~ ;;.- ""~ ~ ~ ~Q'~ Highest educational qualification: Madhyamik Pariksha -West Bengal Board of NOTAK' .t. Secondary Education (Bhetaguri Lal Bahadur Sastri ovt. of ill g'1. No.1 }~8-

VERIFICATION

J, 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. J further 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)J, 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 Dinhata .this the 18th day of March, 2021

vl;N)A-r~4v'(\~L DEPONENT

Identified by me, No. 0 5;. Date I <6 .3·2 I . I Solemnly affirmedand d clare beforE¥ll on oath ~~~f~ TAPAS CHANDRA PANDIT ADVOCATE

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 com;:issio~er9:r Magistrate before whom the Affidavit is sworn. ~X---

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