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\\?~~J;.T from 20-BERBAMPUR I ""' '\ r- 45AA 797147 (39~I 3f4+-il s~~'rTT1100 ISHA No."....A..lb,l ;;~ ~,~\..q,l)/q Oate...tJ ~y,.. If M Time ,&a..:}!~ I .1 R Form 26 (See rule 4A) ~=:;:-- • BEFORE THE NOTARV PUBLIC, BERHAMPUR, GANJAM ~aT"\R~ FFIDAVITTO BE Fl,'LED BY, THE, CANDIDATE ALQNGWITHNOMINATION */... * PAPER BEFORE THE RETURNING ,OFFICER F'oR ELECTI'oN ~ (\",~:~~HI0Y I ro THE l\_ffiMBER,OFPARLIAMENT (LOK SABRA) , \\?~~J;.t FROM 20-BERBAMPUR"CONSTITUE.NCY ~~ PART A J. " , . 1, SRI CBANI)RA SEKHAR SAHU, son of Late Bipra Charan Sahu, Aged 68 years. resr~nt of Bijipur M~in Road, PO: Berh~mpur- 760003,.PS: Gosamnuagam, DistrIct: ,GanJam, Odisha, candidate at the above election, do hereby solemnly affirm and state on oath aSlnder:- (1) [am a candidate set up by BIJU JANATA DAL (2). My name' is enrolled in AC-133, BERHAMPUR, at Serial No. 1021, in Part No. U6 (EPIC No. KDN2100725). (3), My contact telephone rmmber(s) is 9437072119 and my e-mail id (if any) is sah,[email protected].~,~ ~ present and my social media accouut(s) (if any) is no I " romlS I'"ar~~, ",:' ...",..... )Os account. CJ ~\j./(~ ~~ q,c> ( e~ # L 4" c ~ J I NOTARY, BRAHMAPUR (I .1 1 rvv---4\D"- ~......__,.... ~v:,_.._. s.L._.~~ ..._...\. ~ ~r)LDTo <:. · ~. 5,~ 'JT.· 1 J ~LQ 201Q I(RUSHNlt~HM~ , .' STMf.P ;. r.:. T r- \. K1SSA fI' ,'- '. -"..-,_- (4) Details of Permanent Account Number (PAN) and status: of filing of Income tax return: [The financial year Total income shown in for which the last Income-tax return (in Rupees) SI.No. Names PAN Income-tax for the last five Financial return has been Years (as on the 31$tMarch) filed Rs.2,40,000.00 (i) 2013-14 Self Rs3,15.,600.00 (ti) 2014-15 1. Chandra Sekhar AGCPS1705N 2017'-18 Rs.3,15,000.00 (iii) "2015-16 Sahu Rs.3,24,.OO.00O (iv) 2016-17 Rs.3,45,00O.00 (v) 2017-18 I (i) I t, (u) NA .2. Spouse Not Applicable (iii) (iv) (v) (i) HUF(jftbe t: (ii) NA 3. Candidate is Karta Not Applicable (iii) or Coparcener) (iv) (v) (i) P- (ii) 4. Dependent-I t\\A Not Applicable I (iii) (lv) (v) (i) (li) 5. Dependent-Z N4L Not Applicable Cw'.) (iv) (v) (j) (li) i--- 6. Dependent-S Nfr Not Applicable (iii) (iv) (v) Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be dearly stated "No PAN allotted", 2 ----- --- --- .. (5) Pending criminal cases (i) [ declare that there is no pending criminal case against me. (Tick this alternative if there is no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (til below) OR (0) The following crimlnal cases are pending against me: (H there are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give deta_ilsof all pending cases inthe Table below) Not Applicable Table (a) IFm No. with name and address of Police No No No ~tation concerned (b) K:aseNo. with Name of No No No ~he Court (c) ~ection(s) of concerned ActslCodes involved give .00. of the Section, No No Nb e.g. Section ........ of IPC, etc.). (d) Brief description of No No No offence (e) IWhether charges have been framed (mention No No No ~SorNO) .(t) lIT answer against (e) I above is YES, then give I No No No the date on which charges were fra.med (g) Wbether any Appeal/Application fOT revision has been filed No No No against the proceedings (Mention YES or NO) I crms h~lt~.1k~~._. lIP\q \\)\}J~ O~ NOTARY, BAAHMAP~\ M.l (6) Cases of conviction (I) I. declare that I have not been convicted for any criminal offence. (Tick this alternative, if the candidate has not beeD convicted and write NOT APPLICABLE against alternative (li) below OR (U) 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) Not Applicable Table (a) ~aseNo. No No No (b) !Nameof the Court No No No (c) Sections of Acts/Codes involved (give no. of the No No No , Section, e.g. Section ....... of IPC, etc.). ~ - I (d) Brief description of I offence for which No No No convicted (e) Inates of orders of No No No conviction (f) Punishment imposed No No No (g) IWhether any Appeal ~'as been filed against conviction No NQ No order (Mention YES OJ" No) (h) Ifanswer to (g) above is YES, give I No No No details and present .status of appeal ~ (6A) I have given full and up-to-date information to my political party about all pending criminal cases against me ahd 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 SCi)and 6(i), above] Not Applicable in view of entries in 5(i) and 6(i) above Note: 1. Details should be entered clearly and legibly in BOLD Jetters. 2. Details to be given separately for each case under different columns against each item. 3. Details should be ,givenin reverse chronological order, Le., 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 of Hon'ble Supreme Court's judgment iuW. P (C)-No.536 of2011. (7) That I give herein below the details oftbe assets (movable and immovable etc.) of myself my spouse and all dependents: A..Detailsof 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 Bank/Institution 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), daughterts) of Ute 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 Of~s~~re acssets~. 4\ Fcrrns f drl O~.~ ,. ~, \U~o'? 5 NOTARY. erAn .II t;,""'u;?t .JMJ ~~~~ Explanation> 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'; S. No. Description Self Spouse HUF Deponent- Deponent- Deponent- Chandra Sekhar 1 2 ~ Sahu i) ~ash in hand Rs. 86,500.00 Nil Nil Nil Nil Nil Kii) petails of deposit in 1. Andhra Bank Bank accounts (FDRs, S.B. AleNe. 0.11210.01100.0. Term Deposits and all Qo.6balance other types of deposits Rs. 1,474.0.0. including saving 2. State Bank of accounts), Deposits IndiaS.B. Ale with Financial No. 300.60.469;569 ~ompanies and balance Rs. iCooperative societies 2,695.00. ~d the amount ineach 3. Slate Bank of such deposit India S.B. Ale No. Nil Nil Nil Nil Nil 10.0.23822545 balance Rs.. 72,.10.3.76 4. Andhra Bank Ale No, 017210.100.0.70. 325 balance Rs, 5,217'.60 5. HDFCBank AlC. No. 5o.JQo.2712a42 44 Rs.25,o.o.o..Oo. I,iii) Details of investment in Bonds, Debentures/Shares and units in Nil Nil Nil Nil Nil Nil companies/Mutual I Funds and others and he amount. _. (iv) betails of investment in NSS Postal Saving, Insurance Policies and nvestment in any Nil Nil Nil Nil Nil Nil Financial instruments ~n Post offiee or Insurance Company Form'lP" t~~ and the amount _" "t'~l.MI\PlJi\(GM.l j'l)ti rMn, .... 6 (v) Personal Loans/advance given .0 any person or entity jincluding. firm, I Nil Nil Nil Nil Nil Nil company, Trust etc.. and other receivables from debtors and the amount. I/vi) Motor IVeh:icles/Aircraftsl IVachts/Ships (Details Nil Nil Nil Nil Nil Nil IOfMake, registration number, Etc. year of purchase and amount) ! vii) ~ewellery. bullion and 480 Grams Ivaluable thing(s) {give Worth Nil Nil Nil Nil Nil ~etailsof weight and ~s.15,26,OOO.OO [value) :Cviii) !Anyoilier assets such las value of Nil Nil Nil Nil Nil. Nil claims/interest I (ix) IGross Total value IRs.17, 16,989.76 Nil Nil Nil Nil Nil B. Details of Immovable· assets: Note: 1. Properties injoint 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 offshvre assets. S.No. Description Self Spouse HUF l)eponeJlt'l Deponent-2, Deponent-S -'""' (i) lAuicuJtural Land Location(s) Nil Nil Nil Nil Nil Nil Survey number(s) ~ Area (total measurement in acres) Nil Nil Nil Njl Nil Nil , _., Whether inherited I Property (Yes or No) No No No No No No Date of purchase in Case IOfself- acquired Nil Nil Nil Ni] IProperty ~,- ilpa~~~ 7 NOTARY.
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