E.Shanavaskhart Notary Ckjilonotstrtct KERALV^PUTO INDIA

AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG WITH Do m in a t io n p a p e r b e f o r e t h e r e t u r n in g o f f ic e r f o r ELECTION TO HOUSE OF THE PEOPLE (NAME OF THE HOUSE) FROM 18, KOLLAM HP CONSTITUENCY (NAME OF THE CONSTITUENCY). -

* PART'A I , I, K.N BALAGOPAL S/o P.K NARAYANA PANICKER Aged 55years, resident of | reenikethan , MAVANAL, KALANJOOR.P.O,PATHANAMTHITTA PIN.689694(mention full postal address), a candidate at the above election, do hereby solemnly $ffirm and sate on oath as under

*A) 1 am a candidate set up by COMMUNIST PARTY OF INDIA( MARXIST)name of the political party)/ **am cowtestina as nn (**strike out whichever is not applicable) My name is enrolled in 114-KONNI L.A. in Pathanamthitta HP Kerala State(Name of the Constituency and the State), at Serial No. 763 in Part No. 167, Section - 2 Kalanjoor My contact telephone number(s^i^ajeg4l446545577and my e-mail ID (if any)- is [email protected] and ip y s o ^ 6 6 ^ ^ ^ ^ in t(s )-(iT a n y ) is/ate. Face Book E.SHANAVASKHArt notary CKJILONOtSTRtCT KERALV^PUTO INDIA

V* \ \ F j r 3 3 7 - 7 7 k v v , fc.U jj.pJii U 4) Details of Permanent Account Number (PAN) and status of filing of Income Tax Return

The financial year for x Total Income Tax Return (in SI. which the last Names PAN Rupees) for the last five Financial No. Income-tax Year (as on the 3 1st March) return has been filed Self i. 2014-15 - 2,82,000 ii. 2015-16-3,63,000 1. K.N BALAGOPAL ALTPB6746P 2018-19 iii. 2016-17-3,67,000 iv. 2017-18-3,50,200 v. 2018-19-3,18,640 Spouse i. 2014-15- 1,85,410 ii. 2015-16-7,60,450 ANDPP4071 2. 2018-19 iii. 2016-17-3,48,440 Sri. ASHA PRABHAKARAN E iv. 2017-18-3,98,550 v. 2018-19-3,80,740 HUF (If the Candidate id Karta o f Coparcener) Not Not 3. Not Applicable Applicable Applicable

Dependent - 1 Kum. KALYANI BALAGOPAL No PAN Not 4. Not Applicable (Minor daughter age at 17) Allotted Applicable

Dependent - 2 Master. SRIHARI BALAGOPAL No PAN Not 5. (Minor Son age at 11) Allotted Applicable Not Applicable

Dependent - 3 Not Not 6. Not Applicable Nil Applicable Applicable

clearly stated “No PAN allotted”

E.SHAi NOTARY QUILON DISTRICT /KERALA, SOUTH INDIA K.N BALAGOPAL ^ 5) Pending Criminal Cases (i) I declared thaAthere is no pending criminal case against me (Tick this alternative if there rs no criminal case pending ag^inss, the candidate and write NOT APPLICABLE AGAINST ALTERNATIVE (ii) below) OR 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 give details of all pending cases in the below '

(a) FIR No. with name and address 423/2014 of of Police Station concerned Museum PS, Thiruvananthapuram Nil Nil

(b) " Case No. with Name of the CJM’s court Court Thiruvananthapuram Nil Nil

(c) Section(s) of concerned Sec. Acts/Codes involved. (Give no. 143,147,148,149,324 of the section, e.g. and 332 ofIPC Section...... of IPC,etc.). 3(2)(e) of PDPP Act, Nil Nil 38 r/w 52 ofKP Act Sec.9b(i)(b) Explosive Act (d) Brief description of offence Unlawful assembly and demonstration in font of Legislative Nil Nil Assembly Building

(e) Whether charges have been framed (mention YES of NO)

NO Nil Nil

1 P - S H A N ^ s k h a n NOTARY ' QUILON DISTRICT k e r a l a , south India t

(0 If answer against (e) above id YES, then give the date on which charges were framed Not Applicable Nil Nil

(g) Whether any Appeal/Application for revision has been filed against the proceedings (Mention YES of IV-O' Nil Nil NO)

6) Cases of conviction sy\\) 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 APPLICABLE against alternative (ii) below OR (ii) 1 have been convicted for th€\)ffences mention below^JNdt applicable (If the candidate has'oeen convicted, then tiekTthis alternative and score off alternative (i) above and give details in the tarole below

Table

(a) Case No. Not applicable Not applicable Not applicable

(b) Name of the Court Not applicable Not applicable Not applicable

Sections of Acts/Codes involved (C) (give no. of the section e.g. Not applicable Not applicable Not applicable. Section...... of IPC, etc.).

K.N BALAGOPA n o t a r y VS* /OUILON DISTRICT 'O jKERAUAt SOUTHiINDIA

;*ER*V - \x~ %

Brief description of offence for Not applicable Not applicable Not applicable (d). which convicted

(e) Dates of orders of conviction Not applicable Not applicable Not applicable

(0 Punishment imposed Not applicable Not applicable Not applicable

Whether any Appeal has been filed (g) against conviction order (Mention Not applicable Not applicable Not applicable YES or NO)

If answer to (g) above is YES, give Not applicable Not applicable Not applicable (h) details and present status of appeal

(6A) I have given full and up-to-date information to political party about all pending criminal cases against me and about all cases of conviction as given in paragraphs and (5) and (6).

[Candidates to whom this item is not applicable should clearly write not applicable in view of entries in 5(i) and 6(i) above]

Not applicable should clearly write not applicable in view of entries in

Note: 1. Details should be entered clearly and eligibly 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 mention first and backward in the order of dates for the other cases. 4. Additional sheet may be added if required. 5. Candidate responsible for supplying all information in compliance of Hon’ Supreme Court’s judgment in W.P(C) No. 536 of 2011. 7) That I give herein below the details of the assets (movable and immovable, etc.) of * myself, spouse and all dependent: 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 deposit/1 nvestmepLJ;he_detai 1 s including Serial Number, Amount, date of deposit this scheme^Srib H ^^iri^itution and Branch are to given.

K.N BALAGOPAL e,shai NOTARY / Quilon district KERALA, SOUTH INDIA - \3 - P

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, son(s), daughter(s) of the candidate or spouse and any other person related to the candidate whether by blood of 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 offshore assets. 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 counties.

E. SHANAtf&SKHAN NOTARY— ------QUILON DISTRICT KERALA SOUTH INDIA

: • - /

K.N BALAGOPAL % -I 9 "

SI. Description Self Spouse H Dependent Depe Dep ] No.. K.N BALAGOPAL ASHA UF 1 ndent end PRABHA KALYAN1 2 ent KARAN (MINOR) (SRI 3 HAR I (MIN OR) 0) Cash in hand Rs. 5,000/- Rs.4,300/- Nil R s.l,500/- Nil Nil (ii) Details of deposit in bank 1. SB1 Parliament 1.SB1 Nil Nil accounts (FDRs, Term House New Delhi Pattam, Deposits and all other Rs. 8,260/- TVM types of the deposits 2. SBI Jawahar Nagar Rs.54,977/ including saving accounts) TVM Rs. 23,139/- - Deposits with financial 3. SBI Jawahar Nagar 2.SBI institutions no banking TVM Rs. 1,63,569/- Kottiyam financial companies and (FD) .. Rs.l 1,581/ Cooperative Societies and 4. Federal' 'A Bank - the amount, in each such Pathanapuram ?"■, deposit ^Rs'l ,79,675/- --'. ^ 5/“ Central Bank .India \ - \ ) • r * Kalanjoor . J \ Vf* Rs-.:12,173. . . >* - Tot 4 .Total Rs': 391816/^' Total Rs. Total - Total al - ■.66558/- 1500 -N il Nil r *> «. ^ ^ V '- n * V • Details of investment in Shares, Bond, Debentures/Shares Debentures, and Units in Units, Bonds Nil (iii) companies/Mutual Funds Nil Nil Nil Nil etc..worth and others and the Rs. 15,20,000/- amount.

r. NOTARY ouii o n t o c t K.N BALAGOPAL / - r KERALA, SOUTH INDIA I S -

(iv) Details of investment in NSS, Postal Saving, Insurance Policies and Details Details Details attached investment in any attached Nil attached Nil Nil separately Financial Instruments in separately separately Post Office or Insurance Company and the amount. (V) Personal loans/advance given to any person or entity including firm, Nil Nil Nil Nil Nil Nil company, trust etc. and other receivable from debtors and the amount (vi) Motor KL 26 - 1441 Maruthi Vehicles/Aircrafis/Yachts/ Alto 2006 Model Ships (Details of Make, Rs. l,00v000/- registration number, etc. KL 01 - CJ 8200 Nil Nil Nil Nil Nil year of purchase and TOYOTO ETIOS VXD amount) Rs. 8,00,000/- Total — 9.00.000/- Gold Gold Jewellery, bullion and Ornaments Ornaments valuable thing(s) (give (vii) Nil 100 gm. 40 gm. Nil Nil details of weight and Rs. Rs. value) 3.00.000/- 1.25.000/- (viii Any other assets such as Nil Nil Nil Nil Nil Nil ) value of claims/ interest (ix) Gross Total value Total jlls.3,00,000/-^ N il) 1.25.000/-^ Nil Nil

12/f f $ U 9 6 5 55? 1.2LS** Note: 1. Properties in joint ownership indicating the extend of joint ownership will, also have to be indicated nr J o t s o o Note: 2. each land of building or apartment should be mentioned separately in this format

. *** * Note: 3 Details should include the interest in or ownership of offshore asset

SI. Description Self Spo HUF De Depende Depen No. use pen nt 2 dent 3 den 1 1

0) Agricultural Land SY 181/12 Kalanjoor Village Location(s) Survey Number(s) Nil Nil Nil Nil Nil

Area (total 23.80Ares measurement in acres) Nil Nil Nil Nil Nil

Whether inherited Yes property (Yes/No) Nil Nil Nil Nil Nil

Date of purchase in N.A case of self-acquired Nil Nil Nil Nil Nil property Cost of Land (in case N.A of purchase) at the time of purchase Nil Nil Nil Nil Nil

Any investment on the NO land by way of development Nil Nil Nil Nil Nil construction etc.

Approximate current Rs. 60,000/- market value Nil Nil Nil Nil Nil

00 Non Agricultural SY 186/13 Kalanjoor Village Land Location(s). Nil Nil Nil Nil Nil Survey Number(s) -2,aoer . i Area(total easurement 28.40 Ares •5 U \ ^ 5 in sq.ft) Nil . Nil Nil Nil Nil ’t Whether inherited Yes property (Yes/No) Nil Nil Nil Nil Nil

------/ o P i N A

'Mi WK j / \ |o NOTARY V/ aUfLONOISTRirr KERALA, S O U T H S A 17-

Date of purchase in N.A case of self-acquired property Nil Nil Nil Nil Nit

Cost of Land (in case N.A of purchase) at the time of purchase Nil Nil Nil Nil Nil

Any investment on the N.A land by way of development Nil Nil Nil Nil Nil construction etc.

Approximate current 15 lakhs Nil Nil Nil Nil Nil market value (Hi) Commercial Buildings Including Apartments Nil Nil Nil Nil Nil Nil Location(s) Survey Number(s) Area (total measurement in sq.ft.) Nil Nil Nil Nil Nil Nil

Built-up area (total measurement in sq.ft.) Nil Nil Nil Nil Nil Nil

Whether inherited property (Yes/No) Nil Nil Nil Nil Nil Nil

Date of purchase in case of self-acquired Nil Nil Nil Nil Nil Nil property Cost of Property (in case of purchase) at the time of purchase Nil Nil Nil Nil Nil /Nil

Any investment on the Property by way of . Nil Nil Nil development Nil 1Nil construction etc.

& E. SHANMftSKHAff NOTARY QUILONDISTR:'5 • KERALA SOUTH INDIA -I? - J

Approximate current market value Nil Nil Nil Nil Nil Nil

(iv) Residential Building Block 14 TP 18394 / (including Sasthamangalamjointly owned apartments_ by self and spouse * Nil Nil Nil Nil -Location Survey Number

Ar (Total measurement in sq.ft.) 2000 sq.ft. ' m Nil Nil Nil Nil

Whether inherited property (Yes/No) No Nft Nil Nil Nil Nil

Date of Purchase in

- case of self-acquired property 09.09.2010 m Nil Nil Nil Nil

Cost of Property (in case of purchase) at Rs.l 8,00,000 m Nil Nil Nil N il: time of purchase Any investment on the land by way of development Rs.25,00,000 lakfe being cost Nfl Nil Nil Nil Nil construction etc. of construction of house

Approximate current Rs 40 lakhs (value of land and market value Nfl Nil Nil Nil Nil house)

(V) Others (such as interest in property) Nil Nft Nil Nil Nil Nil

(Vi) Total of current market value of (i) to . Rs.55.6 lakhs Nfl Nil Nil Nil Nil (v)

K.N BAfcAGOFAL

E.shanavaskhan NOTARY i ' 9 QUILON DISTRICT ^ -fL ‘ KERALA, SOUTH INDIA •. - ♦' - J ? -

8) I give herein below the details of liabilities/dues to public financial institution and Government:-

(Note: Please give separate details of name of bank, institution, entity or individual and amount before each item)

SI. Description Self Spo HUF De Depende Depen No. use pen nt2 dent 3 den 1 1

(i) Loan of dues to 1. Vehicle loan from Federal bank/financial Bank, Paracode institution's) Rs. 5.5 lakhs Name of Bank or 2. Housing loan jointly with m Nil Nil Nil Financial institution, spouse-SBI, Jawahar Nagar Nil Amount outstanding, TVM. Nature of loan Rs. 22.5 lakhs

Loan or Dues to any other individuals/entity other than N il; m mentioned above. Nil Nil Nil Nil Name(s) Amount outstanding nature of loan

Any other liability Nil m Nil Nil Nil Nil

Grand Total of Liabilities Rs.28 lakhs PJ/»- N it- AN t_ Ai y*—

E. SHANAVASKHAN NOTARY Quilom district 4 KEftALA, SOUTH INDI4 ♦ - 2 0 -

(ii) Government Dues (A) Has the deponent been in occupation of Dues to accommodation provided by the YES departments Government at any time during the last (Pi. tick the appropriate dealing with ' ten years before the date of notification alternative) Government of the current election accommodation (B) If answer to (A) above is YES, the following declaration may be furnished namely (i) The address of the Government accommodation : o ■*- - \£P Tlftwtf*. &^New Delhi (accommodation as MP (Rajyasabha))

(ii) There is no dues payable in respect of above Government accommodation towards: (a) R ent; (b) Electricity Charges; • (c) Water charges; and (d) Telephone charges as on till (date) [The date should be the last date of third month prior to the month in which the election is notifies or nay dates thereafter]. Note - ‘No Dues Certificate’ from the Consolidated no Dues agencies concerned in respect of rent, Certificate issued by Additional electricity charges, water charges for the Director Rajyasabha Secretariat Government accommodation should be enclosed submitted)

£. StfANAVASKHAN K.N BALAGOPAL NOTARY QUILOtt DISTRICT KERALA, SOUTH INDIA *

(iii) Dues to department dealing with Government Nil Nil Nil Nil Nil Nil transport (including aircraft and helicopters) (iv) Income Tax Dues Nil Nil Nil Nil Nil Nil (V) GST Dues Nil Nil Nil Nil Nil Nil (vi) Municipal/Property tax Nil Nil Nil Nil Nil Nil dues (vii) Any other dues Nil Nil Nil Nil Nil Nil (viii) Grand total of all Nil Nil Nil Nil Nil Nil Government dues (ix) Whether any other liabilities are in dispute, if so mention the amount NO NO NO NO NO NO involved and the authority before which it is pending

(9) Details of profession occupation:

(a) Self Social Service (b) Spouse Asst. Professor, N.S.S Women’s College Neeramankara, Thiruvananthapuram (9A) Details of Source(s) Of Income _ _ c

(a) Self ■ ^ - 1 „ , Govt. P.ensiomas Ex. M.P v (b) Spouse - Professional Occupation (c) Source of Income, If any, of dependents - N.A'(Defendants are Minors ! ' . '. ” V i (9B) Contracts with appropriate Government *and any . public company are any companies: v*-\ W ■' * ‘ r S (a) Details of contracts entered into by the candidate Nil (b) Details of contracts entered into by spouse Nil (c) Details of contracts entered into by dependants Nil (d) Details of contracts entered into by Hindu Undivided Family or Trust in which the candidate are spouse or Dependants have interest Nil (e) Details of contracts entered into by Partnership Firms in which candidate are spouse or dependants are partners Nil (f) Details of contracts entered into by private companies in which candidate are spouse are dependants have share Nil

(10) My education qualification is as under:

(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)

1. S.S.L.C - POP Pius XlthHigh School, Bharanicavu - 1978 2. Degree-S.N College, Punalur-1983 3. P.G-M .Com- MG College, TVM -1985 4. LLB - Law Academy Law Col lege, TVM - 1989 5. LLM-Admin Law, Law Academy Law College,Thiruvanamthapuram 1993

E*SHANAWVSKHAN , NOTARY /QUILON DISTRICT ^KERALA, SOUTH INDIA

K.N BALAGOPAL 23 - *

PART-B

(11). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A:

1. Name of the candidate Shri. K.N BALAGOPAL

SRINIKETHAN, MAVANAL, 2. Full Postal Address KALANJOOR.P.O. 689694

18, KOLLAM HPC 3. No and Name of the Constituency and State KERALA

Name of the Political Party which setup the Candidate COMMUNIST PARTY 4. (Otherwise write ‘Independent’ OF INDIA (MARXIST)

5. Total Number of pending criminal cases ONE

6. Total Number of cases in which convicted NIL

Year for , which last Total PAN of Income Income Tax Return Shown filed

7. (a) Candidate ALIPB6746P 2018-19 3,18,640