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B& (SEE RULE 4J R1 I NOMINATION PAPER O the 89 HUZURNAGAR Legislative Assembly of Tetangana State

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B& (SEE RULE 4J R1 I NOMINATION PAPER O the 89 HUZURNAGAR Legislative Assembly of Tetangana State FORM-28 q \b& (SEE RULE 4J r1 I NOMINATION PAPER o the 89 HUZURNAGAR Legislative Assembly of Tetangana State. SIR/KE OFF PART I OR PART II BELOWWHICHEVERIS NOT TTTHLIOAELE PART I (To be used by candidate set up by recognized potiticat party) I nominate as a candidate for Election to the Legislative Assembly from the 89 HUZURNAGAR Legislative Assembly Constituency. Candidate,s name PAREPALLY SHEKHAR RAO ,s/Mother ,s/Husband,s [Father name] tate pApA RAO. His Postal address: H. No 10 _ 64/1, Raghavendra Colony, Janapahad Road, Nereducherra, suryapet Dist. ce, No. 94900 98358. His name is entered at sr. No: 374 in Part No: 31 of the electorat roil for 89 HUZURNAGAR Assemoty constituency. My name is NAGATAH K.DAMAGUNDLA and it is entered at sr. Nolln part No).3'of the erectorar ro, for the 8g HUZURNAGAR Assembry constituency. F h, ' u\a-qa,L,&-r Date: 30.09.2019. (Signattrre of (fie proposer) PART II (To be used by candidate NOf sef up by recognized political party) we hereby nominate as candidate for erection to the Legisrative Assembry from the HUZURNAGAR Legislative Assembry constituency (89). candidate,s Name Father's / mother's/ husband's Name Nor AppLTcABLE His postar address Nor APPLICABLE. His name is entered at sl. No: NorAppLlcABLE and it is entered at Sl. No: NOT APPLTCABLE of the etectorat roll for the NOT APPLICABLE Legislative Assembly Constituency. \-= We declare that we are electors of this NOT APPLICABLE Legislative Assembly Constituency and our names are entered in the electoral roll for this Legislative Assembly Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:- PARTICUI.ARS OF THE PROPOSERS AND THEIR SIGNATURES Sl. No. Elector roll No. ofproposer Full Name Signature Date Part No. of S.No. in Electoral Rool that part I 2 ) 4 5 6 NOTAPPLICABLE N.B.: There should be Ten electors of the constituency as Proposers. PART III l, the candidate mentioned in Part I / Part ll (NOT APPLICABLE) assent to this nomination and hereby declare that - (a) lam a citizen of lndia and have not acquired the citizenship of any foreign State;. (b). that I have completed 52 years ofage: [sTRlKE OUT b(0 OR b(ii) BELOW WHTCHEVER tS NOT APPLTCABLE] (c). (i) I am set up this election by the Communist Party of lndia (Marxist) (C.P'|.(M) 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). that I am set up at this election by Not applicable party, which is a registered unrecognized political party / that I am contesting this election as an Not applicable candidate and that the symbols I have chosen, in order of preference, are:- (i)... Not applicable (ii).. Not applicable (iii)... Not applicable ( d ). my name and my fathe/s/mother's/husband's name have been correctly spelt out above in English ( name of the language ). ( 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 Not applicable '*caste/tribe which is a scheduled tribe of the State of Telangana in relation to Not applicable (area) in the State. I P r=--[ I also declare that I have not been, shall not be nominated as a candidate at the present general election / the bye-elections being held simultaneously, to the Legislative Assg.,rbly of Telangana (State) from more than two Assembly Constituencies. \ Dote: 30.09.2019. ( Signolure of the Condidote ). *Score out this paragraph, if not applicable ** Score out the words not applicable. N.B.: A "recognized political party' means a political party recognized by the Election Commissioner under the Election Symbols ( Reservation and Allolment ) Order, 1968 in the State concerned. PART III A ( To be fiiled by the Candidate ) Whether the Candidate - (D has been convicted - (a) of any offence(s) under subsection (1); or - No - (b) For contravention of any law specified in Sub-section (2), of Section I of the Representation of the PeopleAct, 1951 (43 of 1951); or- - No. (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. - No - lf the answer is "Yes", the candidate shall furnish the following information: - Not Applicable - (i) Case /First lnformation Report No./Nos. - Nil - (ii) Police Station (s) Nil -............. District (s) .....- Nil -........... State (s) .....- Nil (iii). Section (s) of the concerned Act (s) and brief description of the offence (s) for which he has been convicted - Nil - (iv). Date of conviction (s): - Nil - (v). Court (s) which convicted the candidate. - Nil - (vi). Punishment (s) imposed ( indicate period of imprisonment (s) and / or quantum offine (s), - Nil - (vii). Date (s) of release from prison: - Nil - (viii).Was / Were any appeal(s)/revision(s) filed against above conviction(s) - No - (ix). Date and particulars of appeal (s)/application (s) for revision filed: - Nil - (x). Name of the Court (s) before which the appeal (s) / application (s) for revision filed: ' Nil - Y7-4- (xi). Whether the said appeal (s)/ apptication (s) for revision has/have been disposed of or is/are pending: - Nil - (xii)-..tf the said appeal (s)i application (s) for revision has/have been disposed of: - Not applicable - a. Dates of disposal ..................... -Nil - b. Nature of Orde(s) passed ....... - Nil - (2) Whether the candidate is holding any office of profit under the Government of lndia or State Government?.......... (Yes/No) - No - - lf Yes, details of the office held .. .. .. .. (3) Whether the candidate has been declared insolvent by any Court? .. (Yes/No) -No- - lf Yes, has he been discharged from insolvency (4) Whether the candidate is under allegiance or adherence to any foreign country?............. (Yes/No) - No - - lf Yes, give details. .. ... (5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the President?........... (Yes/No) -No- - lf Yes, the period forwhich disqualified....... (6). Whether the candidate was dismissed for corruption or for disloyalty while holding office under the Government of lndia or the Government of any State?............. (Yes/No) -No_ - lf Yes, the date of such dismissal.. ... .. .. .. (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 - - lf Yes, with which Government and details of subsisting contract(s) ...... (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- - lf Yes, with which Government and the details thereof P\: (9) Whether the candidate has been disqualified Commission under section 10A of the said Act.. .. (Yes/No). -No- - lf yes, the date ofdisqualification...-......... Ploce: Huzurnogor. D--*-- P \:t Dole: 30.09.20'lt. ( Signolure of Condidote ). I PART IV ( To be filled by the Retuming Offrcer ) Serial Number of Nomination Paper . This nomination was delivered to me at my office at ..... (hour) on ........ (date) by the * candidate/proposer. Dote: ( Returning Officer ) *Score out the words not applicable. PART V Decision of Relurning officer Accepling or Rejecling lhe Nominqlion Poper I have examined this nomination paper in accordance with Section 36 ofthe Representation of the People Act, 195 I and decide as follows:- Dote: ( Returning Officer ) Perforation PART VI Receipi for Nominotion Poper ond Notice of Scruliny ( To be handed over to the person presenting the Nomination Paper ) Serial Number of Nomination Paper ..'... ..... ... The Nomination PaPer of a candidate for election form the (hour) . ....... (date) by the Assembly constituency was delivered to me at office at . ..... on *candidate/?roposer. All Nomination Papers will be taken up for scrutiny at .............'.. (hour) on at ................ (place). Dote: ( Returning Oflicer ) *Score out the words not applicable. FORM OF OATH ORAFFIRMATION [ARTICIE 173 (A) OF THE CONSITUTION OF INDIA] (To be made by a candidate for election to Legislative ofState) having been nominated as a Candidate to fill a seat in the Legislative Assembly (*or Legislative CouncilJ do swear in the name of the God / solemnly affirm that I will bear true faith and allegiance to the Constitution of India as by law established and that I will uphold the sovereignty and integrity of India. t\r Signature an d name in block Letters of the Candidate PRFaP,rrlT -3Gtc\{AR RAc . Sworn in the name of God/ solemnly affirmed by Shri/ (Place) at ....fhour) this the day of .2019 before me. Signature of Authorized person Name Designation and Seal (cERTIFICATE FOR RECEIPT OF OATH) (To be handed over to the candidate by the authorized person) Certified that ............. (name) a candidate for election to the Legislative Assembly [*or Legislative CouncilJ has made and subscribed the oath / affirmation as required by the Constitution oflndia before me at my office at .................................(hourJ on ." ' (dateJ D Signature of authorized person Name, Designation and Seal Date *Score out which is not applicable. N. B.: This Form should be supplied to the candidates both in English and in the official Language ofthe State / Union Territory' Place:-Huzurnagar.. N, B. 1.. The affidavit in Form 26 and Forms A& B have to be filed latest by 3:00 P.M. on the last date of filing nominations.
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