SOMBIR SANGWAN Number ana nimEif

Name of State / UnionTdri Nature of etection @Gise GERNALELECTIONM mention whether General Election of State Assembly/Lok

Date of dectaraEoi oFEiltt Name analaares] ofJtre

If candidate is set up byi-- political party, please mention the name of the Whether the party is a

Date:15-11-20L9

Place: CHARKHI

,.rn $ry7 Signature of the Candidate Name

9o-n A; n PART III: ABSTRACT OF SO ISED BY CANDIDATE S. No. Particulars Amount fin Rupees) L 2 3 I Amount of own fund used for the election campaign 2s62421- fEnclose as per Schedule -7') II Lump sum amount received from the party(ies) in NIL cash or cheque etc. fEnclose as per Schedule-9) III Lump sum amount received from any person 33se00/- /company / firm / associations / body fEnclose as per Schedule-9) Total 592t42/-

' -Jrrbt\Signature of the Candidate Name -surnr)R. CI,ONN Before the District Election Officer ffii@ Affidavit of Shri Satpal Sangwan S/o Shri Mange Ram I sombir sangwan son of shri Rishal singh aged 42 years, r/o vPo charkhi rehsil & Distt. charkhi Dadri (Haryana) do hereby solemnly and sincerely state and declare as under: _

That I was a contesting candidate at the general election to the General Election Legislative Assembly Haryana 2019 from 55- constituency, the result of which was 24 L0.20L9. declared on

That l/my election agent kept a separate and correct account of all expenditure incurred authorised by me my election agent / / in connection with the above election between """" fthe date on which I was nominatedJ and the date of declaration of the result thereof, both days inclusive.

That the said account was maintained in the Register furnished by the Returning officer for the purpose and the said Register itself is annexed hereto with the supporting vouchers/bills mentioned in the said account.

That the account of my election expenditure as annexed hereto includes all items of election expenditure incurred or authorised by me or by my election agent, the political party sponsored which me' other associations body of persons / and other individuals supporting me, in connection with the election, and nothing has been concealed or withheld/suppressed therefrom (other than the expense on travel of leaders' covered by Explanations 1 and 2 under section TT (L) of the Representation of the peopre Act, r.951J. That the Abstract statement of Election Expenses annexed as Annexure II to the said account also includes all expenditure incurred or authoris.q political me, my election agent, the party which sponiored me, other associations !, individuals / body of persons and other supporting me, in connection with the election.

That the statements. u foregoing lt paragraphs. [1) to (5) are true to the best knowledge and belief, llthat nothin[ of my ir ririu an"a n'ottririg"nrt.rirr has been concealed. 1{;b,o- Solemnly affirmed/sworn by sombir at 15th this day of Novemb er ZlLgbefore me, (signature and seal of the Attesting authority, i.e. Magistrate of the first class or oath Commission or Notary public). ACKNOWLEDGEMENT FORM lo THE RETURNING OFFICE& <7^- D-^-rl;

Sir,

I acknowledge receipt your of letter No ...... dated ...... along with its enclosures containing among other documents, a Register bearing serial No,...... ,,.... for maintaining of my accounts of election expenses. I have noted the requirements of law for maintenance of account of election expenses and lodging of true copy of that account with the District Election 0fficer / Returning officer.

yours faithfully,

(Signffire of Candidate with date)

* Strike off whichever is inapplicable.

ACKNOWLEDGEMENT (To be filled up by Office) The account of the election expensss in respect or....fh;.9.-0..4::f .... (Constituency) result of which was declared on .+*i.l.fLl,l..l..1oate; has been filed by him /on his behalf on tDate) and has.been received by me today the ..1a...... (Date) of .. N.9.U...... guron*l . -.,2... :.. t n.. -... fv"rrl. oistrict Chq-l.i & taa n DirtriyEl%-" officer ($p9' 0ffice Seal Xe6*orQ *e .r-qtd ftqfi rrtqT FEftfi schedule-1- gat,vr.urf..riture r ulof LallqloateCandidate sion etc. Political party) [i.e.: o S.No. rtdLure ..- I or Expendlture Total Amount I L.lqurce of Expenrliture in Rupees I Amt. incurred/ Amt. Amt Auth. By incurred/ by incurred by Candidate/ Pol. Party ot}ters qgent 7 2 -with nrmo 3 Vehidcc f^ 4 5 L .vr Lr qrrDUur LtIlB, vlslEors 6 NIL NIL NIL 2 Erecung Stage, pandal & NIL NIL NIL Furnifure, Fixtures. nolec prr NIL NIL 3 Darrtcaoes etc. NIL NIL NIL NIL 4 Flowers/ garlands 960 NIL NIL 960 LIi 5 r.u rrrE, Luuq spgaKgrs, NIL NIL Microphone, amplifi ers, NIL NIL comparers etc. 6 Posters, hand Uitts+arnptrtEi NIL NIL Banners, Cut-outs, hoardines NIL NIL 7 Beverages like EaTater, cold NIL NiI drinh juice etc. NIL NIL 8 t r y -Doaros dlsplay, 'r6rLdl -boards, NIL NIL Projector display, tickers NIL NIL 3D display 9 Expenses on celebrities, NIL NIL payment to musicians, other NIL NIL artists remuneration etc II 10 .rururlldLruu trems uKe sertal NIL NIL lights, boards etc. NIL NIL 11 Expenses on I transport,.- NIL NIL Helicopter/ aircraft / vehicles/ NIL NIL boats etc. charges [for sel[, celebrity or any other campaigner other than Star Campaigner) 12 Powercon@ NIL NIL cnarges NIL NIL 13 Rent for venue NIL NIL NIL NIL L4 Guards & security charges NIL NIL NIL NIL 15 Boarding & Iodging expenses of NIL NIL self, celebrity, party functionary NIL NIL or any other campaigner including Star Campaisner L6 lers expenses NIL NIL NIL NIL 960 Nil NIL 960 al -->^ 4.t-- Schedule-z-

ef( wlm tne sta Campai gnerfs) candidate [i.e.: other than thoie fni as apportio nedto= rl""""l'^." ,r updBallqaj S. No Date and ffi Amountort@ Venue Campaigner(s) Remarks, if I & Name of meeting rally, procession Pr.ty eti. with any I the-Star Campaignergsl apportionea to the candidate (As other than for general party propaganda) in Rupees 1 2 3 5 Sou..u ofIni6ilE-- Amount by Amount by Amount candidate / Political by Agent Party 0thers Total Nil NiI Nil

Schedule-q I O"oilr of u* outs, gates & :::H'J:9,"1::f,t3llH,'-'Jft:.1Y"--*:,"::':"'.:l=;Tid; qeq,rvl board dispray,3D display etc. for -r Es rrr JLrrEuute- s. No Narure-f I 6l ZJ I Expinses Total Sources I of Expenffi Remarks, Amount in if Amt. By any Rupees Amt. By Amt. By candidate/ asen Pol. ParW 7 2 others 3 4 5 6 7 L Stickers Pamplate etc. 83226 83226 NIL 2 Lu Hreprauon NIL N NIL 3 Hoardings NIL l\tL NIL r o[€u 83226 83226 NIL )cnequle- 4

: and ellectronic media including SMS or internet or social caUte network Uu[- media, new item! fV Radio channels 7 7 etc., including the paid news so decided by MCMC or voluntarily admitted Uy ttre canaiaat, e. The ,details should on I include the expenditure incurred all guch news appearing in privalelv owned np, orc /TI/ /-^l elot t v/lqu io channels S. No Netr nf NI T+ etc. trame anc address Total Sources ofExpenditure medium address of of agenry, reporter Amount in (electroni media provider Amt. By Amt. By Amt. By ,stringer, company Rupees Col. c print) candidate/ Pol. / fprint or any person to (3) + others [a) agent and /electronic whom charges/ Party duration /SMS / voice/ commission etc. cable TV, social paid /payable, if

media I etc.) anv I L 2 3 4 5 6 7 2 Danik Social I Media Danik Services & 18000 18000 Services News Media & News Netword Media Network ur,ill 18000 I 18000 0 0

->o\b1'\-- Schedule -4A Details of e*p sMS or internet or social media, new itemi / Tv /Radio channels etc., including ihe paid news so decided by MCMC or voluntarily admitted by the candidate. The details should include ir,. .*punaiture incurred on.all such news appearing.in newspapers / Tv / radio channels etc. owned by the candidate or by the politi$l party sponsoring the candidaie. l\ame ano 'l'otal Sources of nditure medium address of address of Amount in Amt. By Amt. By Amt By (electronic media agency, reporter, Rupees candidate Pol. others / print) provider stringer, Col. [3) + / agent Party and (print company or any (4) duration /electronic person to whom /SMS / voicef charges / cable TV, commission etc. social media paid /payable, if etc.J any 1 t2 t3 4 s 16 7 I 1 ISTVEnL lSTVEnt. ST\/ E"t 11800 I rraoo NIL NIL Total -]-11800 11800 NIL NIL Schedule -S Detailsofexpenditureoncampaignvehiclec)'

5. Registratio n. Hiring Charges of ve ricle No. of Total Sources of Expenditure No No. of Vehicle Days for amL Rate for Fuel Driver's Amt. Amt. Amt. & Type of which incurred/ Hiring of charges charges By By Pol. By Vehicle used auth.ln vehicle / (lfnot (lf not candid Party others maintena covered covered Rupees ate/ nce under agent hirinsl L 2 3a 3b 3c 4 5 6 7 I t HR6LB-2444 1000 11 Days 11000 2 HR61A-2325 1000 11 Days 11000 3 HR19L-0135 1000 11 Days 11000 4 HR19L-4451 1000 11 Days 11000 5 HR19M-9315 1000 11 Days 1 1000 6 HR66A-2449 1000 B Days 8000 7 HRL6L-672L 1000 B Days 8000 B HR478.5468 1000 8 Days 8000 9 HR198-2521 1000 B Days 8000 10 HR88-3750 1000 6 Days 6000 11 HR6IC-2721 500 8 Days 4000 t2 HRB4-0456 500 8 Days 4000 t3 HR84-6306 500 8 Days 4000 14 HR6IB-2444 2000 558 5 Days 72790 15 HR6tA-2325 2000 558 5 Days L2790 16 HR19L-0135 2000 558 5 Days 72790 L7 HR19L-4451 2000 558 7 Days L7906 1B HR19M-9315 2000 558 B Days 20464 19 HR66A-2449 2000 558 5 Days 12790 20 HRL6L-6727 2000 558 5 Days L2790 {?"h4f -9 2L HR478.5468 2000 qR-?q?1 5 Days L2790 22 HR1 2000 558 5 Days L2790 23 nKUU-s750 2000 558 5 Days L2790 24 HR67A-7450 2000 558 3 Days 7674 25 HR6LC-2721 1000 558 7790 26 HR84-0456 1000 558 5 Days 7790 27 HR84-6306 1000 558 5 Davs 7790 26 HR61D-903 1000 558 3 Days 4674 27 HR55AA- 1000 558 3 Days 4674 9676 DRIVER 558 10 NOS. 14-L0-19 5580 HSD 52292 Total 343954 S.h".,t"t"- 6, Details of expenditr rre on Campaign wor)IAETase nts and on candida'tes' booths outside potting stations for distribrrtion of voter's slios lkiosks) I oate and Expenses on CamDaLign workerc Total Amt. Sources ofExpenditure I v"nu" l\aEure oI Qty. No. of incurred/ Amt. By Expenses Amt. Amt. workers / Auth.ln candida By Pol. By agents / No. Rupees te/ Party others of Kiosks agent I 2 3a 3b 3c 4 5 6 7 L Candidates' booths (kiosks) set up for distribution of voter's - slips 2 Campaign workers 3 Boarding 4 Rent 10000 5 Others 15832 Tent House 61760 Tea Etc. 12450 Water Camper 160 3200 Permission 20960 Security 10000 r o[.u 734202 C.h-rlrrI- I Details of Amount of own funa uGaEr tne etection campaign S. No Date Cash LrDl Cheque no. etc. Total Amount Remarks with details of in Rupees drawee bank 1 2 3 4 5 6 1 03.10.19 TO 21.10.19 L99032 393110 592742 Pre-nomination Total fin Cash) 592742

,j*,L Schedule- B Details of mmp Transfer ies)incashorch@ unt S. No Name polidcal of the I Date I Cash I DDi cheque Total Amount in Remarks j no. etc. with Rupees

I i:::.'.':^'l _, l 1. 2 3 4 - 5 6 7 I Total ll NIL Schedrrlo- O - I NIL

Detail:; of Lump sum a as loart, gift or donation etc. S. No political Name of the Date Cash DDl Cheque fM"ntion mtr- Remarks no. etc. with I whether details of lamount I loan, gift lrn drawee bank lor I Rupees i donation I et. L 2 3 4 5 6 7 B 7 Donation 03-10-19 5001 Donation 5001 2 16 Person 04-10-19 JU600 Donation 30600 3 10 Person 05-10-19 18600 Donation 18600 4 6 Person 05-10-19 10100 Donation 10100 5 14 Person 07-10-19 22800 Donation 22800 6 12 Person 0B-10-19 17500 Donation 17500 7 2 Person 09-10-19 2600 f)nnafinn 2600 B 5 Person 10-10-19 3600 Donation 3600 9 10 Person L2-10-L9 19000 Donation 19000 10 7 Person IZT-IU-IY 1r.500 Donation 11500 L7 16 Person 15-10-19 28400 Donation 28400 L2 21 Person 16-10-19 34000 Donation 34000 13 17 Person 77-L0-79 32700 Donation 32700 L4 4 Person 18-10-19 7000 Donation 7000

Total NIL 238400 5001 NIL 243401 NIL Jcnequte- IU Details of expund S. No Newspaper Television Mode of Name of Date of Expenses Name of Date & Time Expenses payment Newspaper Publishing that may Channel of insertion/ that may (electronic/ch have been telecast have been eque/DD/Cas incurred fin incurred [in h) [Pl. - Rs.) Rs.) speciff) t 2 3 4 5 6 7 B Total NIL NIL NIL NIL NIL Note: 1. In Schedule 5: - (a) copy of the order containing list of all vehicles for which permit issued by the Returning 0fficer to be enclosed. \. /7 (b) If the vehicle is owned by the candidate/his rerative/agent purpose' are used for erection notional cost of hire of atl such vehicles, excep-t one,vehicre d'i';;i',iil;;;.ri".'riil., ir ownea and used by the f:fli118*:Xilil::T#.1;lild sharr be incruaeJin totar amount 2' In all schedules if any,expenditure rn^g9:t_Tg,r"ryg"r,-prwided by the poriticar parry; or i##l;},:h:r'.f""'::t;l',irilJ,rn7r,,klTii.::ii3i*:T,":X""i:iiHlililr,i; 3' In Part the I'rtmp-sum -lII' amount of fynd received candidate's own funds, from the poritical party or others sioutaue m"ru#"g aate wisl. t'rii'ru.t or the to be first deposited in the bin[a.."*', ,uch ,r6unt, ,." required ri,r," for"rru, 4. Each page of the Abstract sr""_""iri;il;;;is*il;t:;rdidate."rnaia-Jr, ilffi erecrion expenses. *ln pursuance of Hon'ble Supreme court Judgment dated zs.og.zorgin wp(c) No. 536 of 20rL

s*...l*':z-, BART II: ABSrnlEi o piF aFFr,'i- S. No Particulars ANDIDATE lAmount Amount TotalElection incurred incurred I / / incurred expenditure authorized by / I authorized by authorized by Candidate [3)+[a)+[s) / political party others (in Election agent [in Rupees) Rupees) fin f,lrrnooo\ 1 2 3 4 I ExpensesGluEiliEGEi[ 5 6 960 NIL rally, procession NIL e60 etc: I. a: I Expenses in public meeting rally, procession etc. (other than the ones with Star Campaigners of the Political party) (Enclose as per Schedule- 1) t. b, expenditure inJibtic - NIL NIL meeting rally, procession NIL NIL etc. with Star Campaigner(sJ (1.e. other than those for general party propaganda) lEnclose as per Schedule_2) II I Campaign matu.iiii- 6S226 I NIL NIL other than those used in 83226 the public meeting, rally, procession etc. mentioned in S. No. 1 above (Enclose as per Schedule-3) III Campaign, through print 29800 NIL NIL and electronic media 29800 including cable network, bulk SMS or internet and Social media (Enclose as per Schedule-4) IV Expendituri on- 343954 NIL NIL campaign vehicle[s), 343954 used by candidate [Enclose as per Schedule-5) V Expenses ofCarnpaign t34Z0Z NIL NIL workers / agents 134202 fEnclose as per Schedule-6) VI Any other campaign NIL NIL expenditure NIL NIL VII Expenses incurred on NIL NIL NIL publishing of NIL declaration regarding criminal cases Grand Total 592142 NIL NIL 592142

z-r- 9*ht- Before the District Election Officer Charkhi Dadri, Haryana

I sombir sangwan son of shri Rishar singh aged 42 years, r/o charkhi Dadri H.o.:H:Ti,l"fl,,:.?l': 6rary,n,!do hereby soremnry ,nd sincerery

That I was a contesting candidate at the general election to the General Electiorn Legislative from 56-charkhi Dadri constituencv, ff;rT"tjl|y1;r3i{.e the resurt of which was

That l/my election agent kept a separate and correct authorised account of ail expenditure incurred by me, / election agent / y, in connection with the above erectir:n ...... (the date on which between I was nominatedJ and the date of result thereof, boih ary, inclusive. declaration of the

That the said account was maintained in the Register furnished by the Returninl; officer for ;;" ,.,**i hereto ;::.i;:',,fi ;, il1,'j;":,li,X1.;;:f with,he supp o*ing

That the account of my election expenditure as annexed hereto incrudes ail items of expenditure incurred or authorised erection by me or by my election sponsored agent, the poriticar party which me' other association s bady / of persons and other individuals supporting connection with the election, and me, in ,othing has been concealed or withheld/suppressed therefrom (other than the expense on travel of leaders' covered undersection by Explanations j. and 2 77 (L) ofthe Represent'tion ofthe peopreAct,1g51). That the Abstract statement of Eler:tion Expenses account annexed as Annexure II arso incrudes ail expenditure incurred to the said political or authorislq my erection party which sponsored *.,,'ottr.. .rro.i*iorr-/ !, T., agen! the , uray of persons individuals supporting me, in connection-;i;,ffi"l.i#: and other

That the statementsr'-i-rh" narr€,.rpr:. (1J knowledge and fglesgin-s to (5)-are true to the brsst belief, that nothinEir iftir and of my nothing mateiiar has been concearerr.

7'*tbr)ueponent Solemnly affirmed/sworn by Sombir at 15rh this day of Novemb er Z0L9 before me. (signature and seal of the Attesting authority, i.e. Magistrate of the first Commission or Notary public). crass or oath