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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.
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