FORM 2A I I (See rule 4) NOMINATION PAPER Election to the House of the People
Da,si ^. -- "i-- I E I
STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PART I (To be used by candidate set up by recognised political party)
I nominate as a candidate for election to the House of the People from ttrel:.).i.-rYr.4l{..&. .U.V..C4.e.l!.)...... Parliamentary consrituency. candidate' ,u*.P-Ai€L-.14!!!.?.!!!!. n$!!\tl r*her'vme*he+:sar*bend-s nu*"...L0.T.9.1...... jarcu;:l!11.?.0.(..fr.,J1eRl.hq7(3i .E .Pi;.PHi.1.... nr. ?.1/N.6h^.t. .ff.lll,Khcttt4v,NANt 0".,,r D#f;il His name is entered at S.No...l.}}...... in Part No...?.g...... of the electoral ,ofi for1:2if,lHJ.3.DI.(({f!),twin).....Parliamentary t"ilYi::: h.H*lll-l ?tti:ilt11^R.'3l',L1.n.,"0 at sNo*9f in part No...ill....or the elecroral roll for 1:.)AlYl.tN..A.D..l..u-..CA..€.d1...... 'le*..*ury-"""*ie,*.v comp+ised*i+hin)...... Parliamentary constituency
o"" ek[o!l?zl? Si of Proposer
PART II (To be used by candidate NOT set uP recognrs ed political party)
We hereby nominate as candidate elcction to the House of the People from the...... ,...... Parli tary Constituency Candidate's namc ...Father's/mother's/husband's n4me...... is postal address......
1 His name is entered at S.No ...... in Part No... the electoral roll for ..l(Assembly constituency comprised within) ..Parliamentary constituency.
We declare that we are electors of the above Parliamentary ons tituency and our names are entered in the electoral roll for that Parliamentary Consti cv as indicated below and we append our signatures below in token of subscribing to this omlnatlon:-
Particulars of the proposers their signatures S[.no Name of Elector Roll No. Full Name Signanrre Date component Proposer Assembly Part No. of fAIo. in Constituency Electoral / rhat part Roll / 2 1/ 4 5 6 7 I l. 2. 3. 4. 5. 6.
8. 9. 10. N.B.- There should be ten electors of the constituency as proposers.
PART III I, the candidate rnentioned in Part Ula#t (Strike out which is not applicable) assent to this nomination and hereby declare- (a) that I am a citizen of India and have not acquired the citizenship of any foreiga state/country. (b) that I have compteted...... 6 3-...... years of age; ISTRIKE OUT c(i) or c(ii) BELOW WHICH_EVER IS NOT APPLIq.AELEJ (c) (i) that I am set up at this etection by the.BH.AMI1.Y.A..'{AN.4.!.1. Pn.8.Tf pany, which is a recognised National Party/SrareIa*+y in this State and that the symbol resen'ed for the above party be allotted to me. OR
2 t $
(c) (ii) that I am set up at this ele by the ...... party, which is a regis -unrecognised political partylthat I am contesting this election as an ind ent candidate. (Strike out which is not applicable) and that the symbols I chosen, in order ofpreference, are:-
(r.. (il)... . (,i, (d) that my name ald my father's/mother's/husband's name have been correctly spelt out uUou. in....EX.6l !.fH (name ot the language)r (e) that to ihe best of my knowledge and l-,elief, I am qualified and not also disqualified for being chosen to fill the seat in the House of the Peop)e.
tl * +Caste/tribe further declare that I am a of the.. . which is a schedul ed * *ca be of the State of...... in relation to...... ,...... ) in that State. 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 House of the People from more than two Parliamentary Constituencies. -+{v"M D.t".skl.o-qhc l9 Signature of Candidate
lScore out the words "assembly constituency comprised within" in the case of Jammu and Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep. *Score out this paragraph, ifnot applicable. +*Score out the words not applicable. N.B.-A "recognised political party" means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State concemed.
PART IIIA (To be filled bythe candidate) (r) whether the candidare- (i) has been convicted- (a) ofany offence(s) under sub-section (l); or (b) for contravenrion of any lau, specified in sub-section (2), ofsection 8 ofthe Representation of the People Act, 1951 (43 of 1951); or (ii) has been convicted for any other offence(s) for which he has been F^" sentenced to imprisonment for two years or more. 3 If the answer is "Yes", the candidate shall fumish the following information: (r) Caseifirst information repon No ,4\,tos. . N AT ..4.??.1 9|:n.!F. . ... Pol ice . gT (ii) station(s). . N . . .*.P.?.L-t.94.12 * ...... District(s).lf{.07.AP.1.49W56- Statelsy..t-(.0_f .zt?.P.1!-t?.+9...... (iii) Section(s) of the concerned Act(s) and brief description ofthe offence(s) for which he has been convicted. ..l-{ 07. . 4 nnl_t.sf.!}.qq......
(iv)Date(s) of conviction(s) . N0.7. .A-P.8.L.1 CABLo (v) Court(s) wh ich conv icted the cand idate. . . lt 0.7. . . . 4.? !.1..t.9e h k (vi)Punishment(s) imp,osed [indicate period of imprisonment(s) and,/or quantum of fi ne(s)1..r:tOT..A.l !.!-.t.9t.k!.9.....
( 1..<.q.?.1.9.. v,r) Dare(s) of re lease from prison. . A(0 T. . . *.?.?.+ (vri:)Was/were any appeal(s)/revision(s) filed against above conviction(s)...N.9...... )dNo (,,) Date and particulars of appeal(s/application(s) for revision filed..Np.L.a.f ?.!.1.:1l*G
(;r) Name of the court(s) before which the appeal(s)/application(s) for revision fi|ed...... t( e.T. .. 4 .?.?.?.1 1.8 !:9...... (.ri) whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending..N.qT. LtaF{|,tE (-rii) If the said appeal(s)/application(s)-^?P for^revision has4rave been disposed oF_ (a) tE Dare(s) of disposat. .. . df 7. .. A.?.?. ll SIB (D) Nature of order(s) passed..lY0.7...A I.?!:!:fte!8. (2) Whether the candidate is holding any office of profit under the Govemment of lndia or State Govemment?. ld i.. ()e'slNo) -If Yes, details of the office heta...N.?I.A?2+).S.OB!? .., . .. (3) Whether the candidate has been declared insolvent by any Court?..N.E.. (yltrlNo) -If Yes, has he been discharged from insolvenc y..Nl.T..h?pLt eARLe ' (4) whether the candidate is under allegiance or adherence ro any foreign country?. 1.10..(te,sfNo) yes, -rf give oeta1ts... N.0. 7. . .Ap.P. u _*rv.+f .... (5) whether the candidate has been disqualified under section gA of the said Act by an order of the President?...N.0...... ff/sNo) -If Yes, rhe period for which disquatified...N7f ..A.?.?.Lt.9.?.q.{..... (6) whether the candidate was dismissed for com:ption or for disloyalty while holding office under the Government of India or the Covemment of any State? . N0,..ty.srXol -tf yes, the date of such dismissal..NCf l.?.?Ll?AllLE ' (7) whethcr the candidate has any subsisting contract(s) with the Govemment either in individual capacity or by trust or partnership in which the candidate has a share for supply ,.r,llti,
of any goods to that Govemment or for execution of works undertaken by that Govemment?...1$.0..... ryAnvol -If Yes, with which Govemment and details of subsisting conractlg.l(QL4?P!1.:1.0.19..
(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 Govemment has not less than fwenty-five percent share?..N0... (Y{stno1 -ity".,wlrniuhichGovcmmentandrhedetaitsthereof...dQ.T h.Pl.+.t.9?.F.k....
(9) Whether the candidate has been disqualified by the Commission under section l0A of the said ect... .N.0 ...... g/stlol y. -lf yes, the date of d isq ual ifi (I ...0. P. !. ! S 4 P LE "ution..N.
Ptace,l-4ftry. Signature of Candidate Date' ..?.q g.q.l}.?l I 7
PART IV (To be fifled bv the Returnins Officer) Serial No. of nomination pa p., ....t51..4.?.1. ry.l.:t.l.kJ lq This nomination was delivered to me at my office at. r) ongdt.:9-1-:.?fll.(date) by rhe +candidaf,e/pro poser. (name of proposer.. H * LPmt...O!l +v t k W,.t *< .51t4.!97!.t-W....)
out"...... fl...:..n' W) Returnrng offi
PART V Decision of Returning Officer Accepting or Rejecting the Nomination Paper I have examined this nomination paper in accordance with section 36 of the Representation ofthe People Act, l95l(43 of l95l) and decide as follows:-
Date....-..... Returning Oflicer . (Perforation) 5
Govt. ftg- Press, Damao. 03/2019 - 150. COMMIJI'lICATION wlIH RTGARD TO AUTTIOiISED PERSONS IO INIIMATE NAMES OT CANDIDATEs SET UP BY RECOGNISED NATIONAL OR STATE POLITICAI PARIY or i€GISTCRED UN.RECOGNISED POLIIICAL PARIY,
lke go@qoph 13b, ld) and le)al the Ete.ti@ svnbols lR.teNotioh ohd A othent)Otuea 19681
The Chi.f Electoral Ofii@r,
U:-7,. .0F-..}J.M,ll1...*..-!.rs ...... (rra.a/u.ioh r€ntrory)
Ihe Retur.ing orrcer tor rhe
t-.?itu{ t.}111.(r.qd..P..a3!.,att€ .-7.4RL.... coisrir!encv. subje(. Gen.,.r/+F u",'.* t. +Ic..fl49...q1{11141f, (s€t€/Union Ieritorv)- Allotmenr ol SVnboG-Aurhorkatio. ofpe6ons ro lntlmate namer ot 6ndidatet.
r. purruance of p.rasr.ph 13k), (d) and (e) ol the Ele.tion svmbotr (Beseru.rion and Allormen0 ord€r, 1953, r hereby commlnkdte rhar rhe rottowing peRo.G) has/have been alrhorised by rhe Pany, wlrich k N.rional pafty/gt re--.p6.i1, in the Srate ot U. r. .t D(i.qE^ {;c . ./re36tered Un .ecosn scd Paftv to 'ntimatc the n.m.!oftFe(and'ddlesp,opo\edro b.5eruobyrhe pJdyJ! rhp.le abovp 'onaled oisi dG)/a@a(t constrtuen.y/ Name ol pe6on .urhorited .o8tru€ncier in r€sp€d of which h€ h.s b€€n aurhorised
ttrEL sr$e lRErtne(-r, v t ir?ALaqAt K:f )rr.ri.r rlru P,qalEn/ 2.Vryfl< P. (1,Ul) )A){^KA( EN.le.pt'r^q\ 1-)il4^d llu TARLTAM€,r ) nr4 a t'tu PRxneit
l Th€ {Eimen sigralures olthe above mentio.ed personh)so aurhorised are given betow: 5p.!-en 's.al-e! ofsh, 4.0 P4Li+/4.t o 9?lz4.r1*i n (iii) e-rJ n !. Spftn€n rEnatorej oI Shn ...... _,, l) .W o"t.z.c-lo-l)z-c_11...... . lse:lolthep&ry) l tum,n3 officer ard thG chier atectorat off,Ler not taler tndn rp m onrhetar date for n.t,ns nofr,nanons ro.n msr b! s4rcd,n,nk by rt,e orf,@ beJre4, menLoned.bote or vSn.lur€ bym.an!o.ruober$anp. No ta.\m,te n3ldrJ'e et.. oranyotti(e bearer ina.. bedc.epl.d No forn rranshilt.d by far shal b. acc.pted fORM '8' NOTICE A5 TO NAMT OFCANOIOATI SET UP AY T8' POIIIICAI PARIY [srE PARAGFAPH5 Ia(B), (C)ANO {E) AND 13A OF TH! ELtCT|ONSYMBOLS (RE5rnVATtON ANO AILOTMENT) OROrR 19681 rhe Returnlnc Offlcs lor the 1 e:.6"..+ +e,) rrh/edi Ge.eDr / E{. Er.ciion . .tig..fic.[-J{...q7...t{9.. r,o. r.:.!*.tu*,qisi.T",rs lt e.'{a*/.9* !h!.!!1:. t INam€ ol the coannuehcy) .".6la'I4..f,Ajll... {5..r. / rhion l.rrftory)"r€ttins up ol candidrte. si, ln pucuance ol paEgraphs 131b), {.)ahd(e) a^d 13A ofthe tlecrion Synbots lResenation a.d Allothe.t) Orde., 1963,lhereby give noric€ on behattot Oharativslanara parry- (i) that $e pe6on whose pa.ticulas arc turnGhed in .olumns (2) to 14) betow ir rhe approved candidate o, the party abovs nam€d, and (ii) the person wh6. paniculd, are mentioned in.olumnr (5)ro 17)below is theslbsrrture candid.te of the pant, w[o willsrep-in on rne appr@ed ondidate,r nomination beinB .ejected on sutiny or on hi5 withdEwinsfroh the conresi ir the $bstitute candidit€ k still a contestin8 endid.r., atrheenslincGener.l /rr!-elecrior nom $is con{ituen.y l PATCL l' ILL tt.,t-7 4 D rtJ TARr^,r,1 €^/ LALUBIIAI d1 3ltrtL 1 12. The nouce n Form 'B'3 e(y's approved candidaE ure candidate 6 heroby re5 rr 6.ertifi.d rhat e.c,, ot rhe candid.tetwtose nane is mentioned above 6 a membe, of thB polilicalp3ny and his name i5 dulv born. on the rolG of hembels olrh6 pany. C'14 rl J-] lName and S snaiure ortho rl Pr"* ?l9.ll. .. *..r{.qi/.*pir ' s.o.e oll I not oppti.obte Ihis mltt be deliGr.d to the Returning Officer noi larer than I p.m on tne l.n d.t. tor malin8 nomination5. Form mun be ra.ed i6 ink br/ the offic. beare(s) mentioned above. Nolacaimile sig..tu.e or sisnaiure bv means oa rubb..stlmp, etc, or any office beare.shallbe a.cepled l No iorm ran5mlrted byfax shall be .ccepted. P6r. 2 of rhe Form o!5t be lcored off, if not appii.able, or o$t be properl, lilled, il AFFIDAVIT of PATEL LALUBHAI BABUBHAI H. No. 206-G, Sabri Kutir, Dungri Falia, Kachigam, Nani Daman, Dist-Daman, k6 d Eqi ,{ Rs. 100 ii;ii. I ., ONE. . ti,tr i iIUNDIiED:BUPEES INDIA I JUDIc A L t,tgt +td. dtq. qqq 3lR +s DAMAN AND Dlu 187991 I z\rY t Senal No E I fj.ii.,s Y+. I PAPER BEFORE TEE RETT'RI{ING OFFICER FOR ELECTION AO TIIE IIOUSE Or I TIIE PROPLE II-OI( SAAITAI FROM 1 . DAIdAN & DIU PARLIAJtrENTARY ! II, PATEL BASI'SEAT, SOI/'IE€hK+I*[C Of PATEL BABT'BIIAI 'ALUBIIAIAg€d yetrs, Falia, TGATDAaAAT 63 r.sidenr ol H. No. 2o6-(i. Sabri l(utn, Dungn l(achiam. Ndi Ddd. DisrDMd (UT)(nfltion tull postal ad&ess), s c didat. lar thc aboE election. do hcrchv $leErlv al6lT snd state ATTESIED 6Y lf t-bt I I senar No li2!5 oa6.n Trcae.y dabd ajr!{a:2!l! Varw or sbmps Pap€c Rup@s oNE HUNDRED FeedFq, EACUIGAIr-IANTDAIIAA sdvw re or- &enl !44X!BqHA!PAlr Pulp6o Afl idarG Nare or Psniesro tt TBn$dlm sdghl- q),}. ?"v IAA!*t ATTESTEO BY oor.,r-nP;.,, "o.,, i{Jn:,tiloB} {r, I d a (s(!'raLE xr up b (",rM. of th. p.liticsl r€rry)/"m colbstins s s IndeFnamt .adidat'' f'Bttik our whichc@ b tot appticabL) (2) My nd. i3 cmU.d in t _ D@d & Diu Psli@entarv consltu.ncv, U.T. ot Ddd & Dru {NM. ol th. Cotutitu..cy ad th. srd.l a! S€nal No. 127 in Pan No. 70. (3) My @ntet TcLphon€ Nos. @ (o) 0260-2230789 (Ml 9a25122a58 dd My E-m.iI IO is d.lj:ra@@c.lirf@n om dd My sdisl Mcdia accounl(sl [l oyl is/m (i) Facbook - dmMdiunpesma .@m (Lalubhai Patell ln) Tpirt.r' [email protected] (@!a1ubhaio07) {iiil Nil (4) Detsils ol P.md.!r amunt Number (PAxl dd thc statuB ol tuing of ln@mc Td F1 2017 l8 10,20394 l0l5 16 5,.r 1,064 2013 t4 l9,5l,al5 l , l(t l I 6 \r Ar Tas ilo By *'i\'J,t. w , ols' n4 ll l-oe,t"1 'ra t DY i\k 2015-16 N A 1\r .li'.o r!r P\N Lt 'i, should be cl.arlv srated "No PAN Allintcd" ls) P.n.tbg crtah.r c-.3 lil I d€cL.c that tbcre i5 no pctrdinA .rihiral .ace a8niu8t a! artetuttve if ther. is tro crihinal case P€ndirg against th' carttidat€ NoT aIPLICABLE asatnst alternativc ltil bclowl ag tritm': ltl) 'Dre fou.slna Crtoinrl cas€s are P'ndtng petrding c.iEinal cas.s agaisst the catdidat., ca3'3 aft.rutiv. scor. ott slt.aative lil give d'Mils of aI ua 'bow€' 'od 'elding .-, NOT A?PIICABLE ' NA \.\ N\ Section(sJ or concenrcd Acts i',volv.d lgi!e No. .r lh. Srlrr'' c !: Sc.r(,n . .. ol l|C. c! I 1\ . '1.,,,ii:,::r, ::r': 'L :.,: ! rls.t i.(l N\ Iti NA rot b"r f6r ctidlr't (Tlcll thL It) I de.r.r. th.t I h.v6 'ottl't'd 'uv 'ffeac6 ;.tudv., It tb. ..!dd.te trt rot t"i co!'tct'il ed "tt' NoT APPLICABLE as.iet .lt Frdv. ltt) !.ro,) OB b'low: lnl I haw6 bc.t @avtcted fot tL. ott'n'cs beltlon€d ATTESTEO BY .. !- w "4fi{;te\ ^'. {l'.r,:*?.. U..,, t (lr iL l:\.li s Gitl It iIDEL this rnd scor' oft (Iftt. catrtltalat€ h* beetr colvt.t€di th'n tick 'Itcrnative art€rlative (i) abowe, .nd giwe deta s in the taue telo{) ... NOT APPLICABLE (. N\ {rl \^ (l sections ol Acts/codes involved lgrve no. oi the Section, € g. secrion ..... ol NA ldl Briel des.iption of ofien.e for shi.h f-NA f N\ 1.r Drres ol odc.s ol c.nvl.lon NA. II Whether my ApPeal/Application .evision has been filed agal.st pio.eedinss (Mention YES o. NO) g\e NA th) t, (gl abort 's \Es parlv about arl pendins (6,{) I have siven full md up-to dale infomation ro mv Political criminal eses asainst me and about all cases of convicrion as given in peagaphs [..rdidat* to whom this tt6E ts not apPtcabre, should cl€arlv otte NoT aPPLICABLE lN THE VlEw oF ENTRIES IN 5(i) an.l 5lt, abovel 1 Details shouldbe enter€d clearly and legaily in BoLD letteE' under difetetrt Det. s to ie given selaratelv for each cas€ 'olumns 3 Detaik 6hould he Aiven in r€verse .hronologi.al ordcr' t e , tte latest case o tc mentioned fiist and backwa.ds it the ordcr of datcs for the other 4 Additional sheet m.y be added ifrequired. Candidate ts rcslonstble fot suPplvilg aU iafoim'tion in compllan'€ ofth€ Eotr'bl€ suP.eme court'. Ju.tgment in w.P {c)No 536 of20r1' etc or (7) That I sive h€.ein below $. details of the asscts (molable dd imovabl€ ) mysc6 Ey spouse ad all dePendents: A, pstaltE olao€ble a*.13: a]so have to Noter 1. Assets in ioint nme inrli.a[ra thc exrelr ofloini oM'rshiP ril] N.n 2 ln ctue ol deDo- .nvrstac'', thc dcrd].In'I'drt *nal rrmbq d'tnr N"m_ ur Bdk n{rlrron dBrs'r # ob_ i,'. .r..p..i. ',. "+"-". -rE1/-.!* AIIESIEO 6Y 'ft,""' W i ,l '.11 1{ GGI A-rTECTEO BY A,I, E) .^:, r TAN'EL 'i""",1",;;,lYJ5 H"':: """i':11il1 ;l::: *. " J""#;: f*:liT,T.TiH;L1". ;.","#-:fl conP{tics should bc gtlcn' *' " t"''.**,.*..-"."t,"ffitrlr""si'rj,{i1{-ii}}ffi #::}3-dil##x[1 s'pdalelv Deiails includ re amounl 1s to bt srv.n of ofishore Neir the intetesr ir or oNndship Noa: 6. DcEils sbould in'ludc "otr'hor' For th' pui,G of thir F d th' 'xpr"ttoo ""t" &phstion: tnvlstoert! in For'la! bsnk' lDclr'Uni d'ia[' of dePositi ot 'U det'Ut a$'t' ooo" ard !r 'U noa -vl'o- - 'o=trtudon 'lrord and ltablutid in fo'€tg! corntrtes'; l ATIESTED BY k,,., 1 "#l#r:.i u" i { l"o- '.- ')r l]r t "i 44 I 't i* .-109 ---t--T -,,t L *. ;-"-,' 'n,. r"L.'.-d -Ll --;-bn".., - sur rddre or or! Ed5, bi I lHlE[$UnpolPek)Y.E,o'l lHdd]ns&bn,qL!P&k)Ye{tr0u9 i{-hDk.Do3s3, Y"-:o'o orjoint oEersiiP will tlso Pr.peftres injoinl owne.ship indicatins rhe extnr B1il'"ilTLiilii;-.. .retmcnt shour'r be menlioned sepdaierv in this or ollshore ass'ts' ,jl#,T"n"ru ,"r"u. ,n. -terest in or oMe'ship :J'ES1E' EY {+tLt Ll J" ..,. , . t: -1. ,{ 1+1,\- I lrEsr(iD It u : o;r \i F : + I II -,h+l_ -+_l t -+ = l a -' 1- -rr t l -1-14 + -a- 44(,1,t ,;: 16Q"1",' ii: .ss.\ l t f I I - t-l -f ]- -tr t l l += 1-f )s AIIESTED BY W r , i _i-rEL J^4K" l] AlIESleo BY ,/_ ru;"fl,otx;' l l - I = -t-,7 =+_ j- = l-- T J F =: t- = + + ------r -- --l = +$R'ii a, 44{L'ia AlTFsrr:, Ey t4 "d ,,iit A .1tt s6 _1= - --f +f: I -+ t r_l= l I l ,l BV 4+r*L AITESIEO '.:., ',i - k. '.-' "' 4SnrE BY ATIESTE9 8" tt i!: nrr' ^,i.!i ^13,gar 1',lllll:"ou*o. E I t = = L = I ; L lll l = = l I 1 ,l -1= I ,( gY $IESIED W a -1rc[a t ri. -*; '\* -, 4- ) I + r r-1 *-* f ,,.ia.ltr a 1 I I f I ffi + F- 4+++"tt't l1i ',..' 'ii.r : iI; i- \ i Gl.liL \$ ai Fr l.r. ri ,;,;i;* instjdtions 5d d'6il3 of L,bilities/dues ro Pul,lic tisdcial {S) I Srv. h@in b€low th' oi bMk iisdruuon' enti' or i'dilidu'l rN.te: Ple# sr!c scPsrtr€ derails of nd€ ;"d bclorc ireml 'mounr 'a'h f&T-D.'.,htb" l,ill- [ -.-"' 1 r,' 't-Ni- rme du'r o,ouded bv theGove'nmenr ar abv i-n* t" aa" "t". t,.u...t,t'" '""r n'v b€ (.nsEr !o (Al.bde G YEs, the rolrowine de'laation of the 60v.rnh"l Ih€ lddr€s "comodition: rh.rc k no du.r pav.bl' in r'rp'ct of abov€ Gw€In6'nr _ .._ _ld'rel {d)r.l€phon..na4es., on llh.lh|dp'olblhem@ ; dd r.ddonBmtied o d're rh€r"r€r 'nY (o(ern'd n r^'.. N. DuE\ Cen'l{'r.' nom rhP asP(6 id'r I harg4 dnd rehphom *. .w o,'e', b' "i,", .. "r""*-" c-.'-"nr d(orn odatiol 5hou'd t ".-."".,,;;;.;; l *izrSt ii .t. , A-ap[,r 64 .rt:oji i,',rjj. I^:,, LL'iot f -.1 l (9) D.t.il, of prof€ssio! oi o'cuPatlt': lbi Spous AEiculturisr / Bus'ncas (9A) D.t l!. ol .ourcelsl of rnoD': Business (cl sources oi incode, if mv' o' D'p'nd'nts - dv pubL ! pdv o' compdlca: rsBl contra.t qfi aPptoPnar' CovFmm'nr do ^n (dnddd'e (a, D.bns ol.onrads €nr'rcd bv lhc .NlL into bv lh' spous' NIL Fl Dchils of conlracts 'nt'r€d d€P'ndenrs (c) D€tails oI contacts dt'red imo bv th' h6 entetd into conEacr virh _ on. ol the d€pdd'nt shn caurea Patel' pctrolam prcducls' llindu'ia PeEol'um Corpor'lion Ltd For dading of undivi'ted Fdnv o' hst in wlxch Dd, s or conracts ent'r'd into bv Hindu {tl) NI! spou* or d'P'rd'tr16 hav' illerest rh. cddldates or o' bv p-!'rrslnp llms in {hich ddidatcs {.) DcEils of contiacts into 'nt'r€d {lL sP.ux ord'P€rdenrs d' Pe ners cddidatcs or *"!c ;,. llr .-ai l:. "r4 -+c{l L BY .iT IESIEO \,.1 ,,1 I , ' lii'ooe "' CIVEN IN (I),1O (TOIOF PART - A: 1ll) ABSIRACT OF T1IE DETAIIS Patcl rllubhai Ba6ubhai Dunsri Falia, Ka.hiBAm NaDi Daman - 396 230 Nuhber an.l Nam. otthe conslitu Parliad ntary co.sttuencY, tl1 01 l).ma. & Diu Noe of th. Political partv ahi'h st up Total Numbci orP.nding dimnrrl I its's Total Numbcr ol@ses in $hich coovict (a) Cadidarc - L€lubhai lbl Spou'. Trufaben LilubhJi HUF 1,,1 HUF - L:JubhAi B, PATCI -2017 l8 d)Depend.nl l caurrs Pcttl (el Dep.ndef,t 2 Shivmgini Patel N,\ (0 Dependcnr'3 N A Nr\ 'h. t-.rG\; *ntll Ir u"nl in Rqpccs il .ud thbnti.r 0ndldtDs ofth'rc I ! f-+ I Gr *tt..q' -a ^** r""t rEdunoE (1d'MrlroErl h5.ru.iosr rtrr6 [,tnr l ,",,.,, ,,, , (HSCI Enm ',lilllr .:rrl :lr:',:;.1::":'lllll il',,,,,, ' ' or 6' edou/d'dod/d'gr' A#fi -ktt,Ut ATIETTT:A EY W .:,,DEt VEEIFICATToN nnd BABUBIIAI. rh. rlcponcrl. r'l"r'c ! r\i .tu h.reb! verfl to Lhc tEct of mv ldloal'dg' d€cle that th. conteots of this altidavt de ttue ud 'orect has n@ @ncaled ih@ to6' I .nd tEli.f sd tro tet oI it is t'le dd mrhins mat'lal LrliLrsrf,roiinrrlr'rrrl)ls'E'rrfu!11 is,r).rvolco.\nrrnrrn lrr'rdnrl 'rs in itcmr 5 6d 6 of Pan A dd B abNei not haw 6v aset or liabililv' olh€r tba tho* lb) I, 6y spou&, or Bv ri.p.nd'nr's do tO of Pan B abM' ffition.d in il@s 7 sd a oa Pst A md irds a 9 dd DJ'rJ rhLStlL.f i 1 2rrlr) !ennednr 'laPrl -Isew on rhe1151dn] olnlnrnl'n'ndLons Not€: 1, Alidav should be nl'd lrt'sr b] 3:0o PNI C''inDissio'er Mrgisrut ofrh' Firsr Not€r 2. Afi.l.v should be s$'rn lcfo'c 'n O'nr 'r cla\s or b.lore a lioitrv }\1bl'c c' l r' '''e'_ i' Nore: 3. All ,vl"'n!. IoJlo L' r'.1,, ca'l ""''" "'i'r """ *,;;;-;';,.",'-,.h,.,'\,",' '.' 'r ' \L''' I'i \r'nr ''re"'i I .as. nJJ b., should be nr'nrlrned L('!rlnr dnd ntrll) Note:4. The alli([v,l should be .irhrr r]?ed or Nrrcn o ''r nI"r''\''o'\rr '' L' **N.t€:5lrnr',:ruirl'e - ln''i II ;;-, ,,-; ,; p:! 'r"di' h.ftm $hom rlre |Jhd.! r s\ro l ,! t; ,l u-. =jl : ft'lw, wtdm I P.e..liy (n0,. 6i t), I;: I ch..t &t ol d@llr* h .dre.to. drh fii{ ot [email protected] ,j,.meor.onnituenry !..:. M*I!.....1- a! aL Nam.of rhe @hdidate...ra.r.c.(. -.-LAu-e*+ !... u@At42- o, ,i,i.B ndmination p,p", ..1.y)3::1. Pl1 Lrr.drl s. No or romiration paoer . ...1d,k ?1.1P1j 1 ln wh.therfired Snte Ye,/No) f th.re B any defed /shod.onins ihedocum€nrs the€mc 'n arfidavi in ron 26 \1es, tNCOUP@Ie la)wherhera r.orufrnr ar. r' red up 1bllriot, whkh are b anr co uni(r lpt€:e speory) 2ak7.4tt.'L;),6t;) G)whether rh. afiidavll r$orn hq a -A U, bt"o" 9 €'t ro.mrA3nd s laonlicable i. the case of.and d e!Fr 14 coov of can. cenifi.are lif the candidabs daiff ro 9+ t- ye\ documents whi.h ed rhourd betied 1Jl - shou lb) Above nention€d columns n rhe Arid.vit youmunsubmir h3v. b&n reli bhnr .fr.!h alfidavir wlth.otuf,ns duty rjled up b.for. !h. .ommencm€nt or {.uliny ot.ommait6nr, railiBwhirh rh€ noninarion paper wi be riabrs to U-t Reruhinsoricer l.Dadad& Diu Pan amenbry constnueicy Revised Affidavit AFFIDAI/TT of PATEL LALUBHAI BABUBHAI H. No. 2O6-G, Sabri Kutir, Dungri Falia' Kachigam, Nani Daman, Dist-Daman, ! frt ) , J .E I J 0 E NE I r-"t rt El ! -l?ai F] I l,l E ES l la 1 001 0€- 1 (-rc) 1 ()c) I -NON*JU Ieltrfl ?tA 6tq. 3:H"tl-&*fi]iffir RAJNII j rc'iA;iDEt tlO'e " Partiqrlar Attestatioh 1U r 1 I FORM 26 I (See Rule 4A) I AFFIDAVIT TO BE tr'ILED BY TIIE CAITDIDATE ALONGWITH NOMINATION PAPER BEFOR"E THE R.ETURITING OFFICER FOR ELBCTION TO THE HOUSE OT THE PEOPLE (LOK SABHA) FROM I - DAMAN & DIU PARLIAMENTARY CONSTITUEITCY PART A I I, PATEL LALUBHAI BABUBHAI, son/deughterlr*ife of PATEL BABUBHAI GAIDABHA I Aged 63 yearc, resident of H. No. 206-O, Sabri Kutir, Dungri Falia, Kachigarn, Nani Daman, Dist-Daman (UT) (mention I full postal address), a candidate at the above election, do hereby solemnly alfrrm and state on oath as under:- --W*Dl ATTESTED BY 11 , *orn,*ffiu. ronor,- Advocab & Notary Daman (U.T.) tNDIA Reg. No. DMN-009 Serial No. 73284 Daman Treasury, dated 25-Mar-2019 Value of Stamps Papers Rupees ONE HUNDRED Name of the Purchaser LALUBHAI B PATEL Residing at KACHIGAM. NANI DAMAN Son/Vvife of _ Agent MAYUR D HALPATIPurpose Affidayits Name of Parties to the Transaction Sought _ A"t (' Ar^J Signature of Treasurer Signature of Purchaser .rdt INlKAT . OFDA DtsT. I .rg. \\ Yr ATTESTED BY A)^ nn Ntxlhr e mHogL -wfi #"tru!i'itli'l Ptrtt ll) I m a cdddore e, up bv Bh*sbvr JraB ' (*n@. ol lhe politicd panv)/t'*eonte.li!*"_raC'r"a'u''edid'!&_ (_6tik our shich*r i3 not appli@bL) -s of & (2) ;y trec is orcIled in I - Dmo & Diu PT lime't, ConsEtu'nc,' U't DaM ll+ ...' Du lNm. of U. consurudryud th' sBt'l sr s€nat No 12?nPanNo'70 ' T.l.phon. \06. m lot O.?oO')210?aa (Ml9a25l22a5a d tii,.."I t3J Mvconuct ir My o_oail ID is [email protected] ud . My seul M.du 5@m(!l (,1a)) is/F li) F@tek - daBddiud@gman.@d (l-srubho Pat'l) it) lvitrcr - da@@.difioan.com (@hrubhai0oT) (nrl Nil (4) Details of PcrMenr &count Number (PANI sd tle sratus of fi1ing or Incomc T Rdun: Total lncom. 6hom i! In6m. Ts Rcom (i. R3-) rot the ldt ,iE [email protected] Ya3 @pleEd la on 3r{ Md.hl 1 I tA[0Et l{& Dd, 1n) rrL ,rL. 1.,1.," aQAPPr66'rR 2017 la 2ol4 l5 NotApplicable r,i 2013 l4 NotAtph.abl. l 2017 13 N.lApplicabl. ML 2016 l7 NolADplicable 2ol3 14 NotApplicablc NoL: It is mudaio.y for PAN hold.r to mertion PAN and in €s ofno PAN. It should b. cl.sly stared 'No PAN Atlott.d' BY ^flE9IED 4tw-[^ *i|$hifl$:" o.*"il'o*;,", + fb ki aer.e z :iE1sE EEEE q t .,- #/-e-a=Z=i\h lsl Pcndtns clhinal ca&3 )I d.clar. tlr.t th.e t5 ro !.!dr!a cdrrnal e.. .gain r o.. (Ttct til. .ltcF.tiw. (r r tn B L no crltbar 6!. r.ndt g .g.rn t th. tudi.Lte ad *itt. nql APPITCAILE .g!t rt .lt6E.tiw lill h.lowl *b foUo-lls c.tDra.r cae. & p.!ill!8 .g.ln.t r.: $t _ llt) at. llf t!.r. are !.Eilt!E cdEhd cas.. ag.tttt tte cudt&te' tll.n tt t tlis altGm.tlre rrd i.oE oll alt.Eatlv. (ll aboE, ed give dot.Ilr oa at1 }.n.iiaa ca.'E - ltor aPPucAalE -.- FIR No. wirh n@e and addess ol Polie sr,rio. mnem.d ll Case No. with Nme oI the Court section(s) or conerncd Acts/cod.s involve.l Giw No, of thc Se.tion, c.A. S€ction...... of IPC, etc.). iril Brief description oI o[.n.e wletncr chaises havc been frmed (rl ll ds{.r i. YEs, thcn siv. the date ol which charse. rere tramcd whethe. dy Appeal/appliation to. l dision has ben f .d aAainst th. t procedings (Mentio. YES o. Nol 16) cr..' of convt.tlon d.cla.. tLat I hav. not n6.n .on!'tctcd for cly cdhhel ofi€n... (ltck tnis qlt.erttw., tf tho 6.tldate h.. rot b.e! c6vtct.d ard wdt6 XOT APTLICABLE )f'w ,.salr.t rn m.ttv. lx) bcloB) OB Ittl I b.ec h66! .orvt t.d for th. ofi.lc.s D.lttoled tel6P: lif th. c.ldidate h6 6.€n .onvt.t.d, th6, ttck thts altemativ. sad !c.& olf .It.E.ttee ltl abov., ard aIv. d.t.I. t! tbc t.ble beld) s{ all€sJEo -il""r$ lU - rrxogL **:'HF"'$$'x, W. )ir?fo S.ctiors of Acts/Codes involv.d .o- oI the Serion, e.g S€ction.. Bri€f descnption oI o,Ien.e lor which Dalcs ol orde.s ol conwictio. wh.th€r 6y Appeal/APplicariof, revision has be. nled against procedinss (M€ntioo YEs or NOI I b (sl above is YEs, MLAeerdL L MLAeet@d. (6A) I haw siven fun ad up ro-date inJo ation to mv political partv abour aI peding oiminal cass against me and abour all case6 of.onviction as siven in pBraeraphs [6rud.t.. to ehoa tht tt D t not aPpltc.D|r .hodd cr.ury wdte lIoT aPPucAlLE Irt TEE vIEv oF ExarElE€ rr 5{i} 6d 5lt)' .ho@l 1. Detelt. .hould De e!t!&d cledly 6d legslv h BOLD Ltter.. 2. D.trlL to be gtv.n eDaFt ly fot ..ch c.* ua.iei dilteeat .ohn. agih.t e..h it 6. 3. Det I. .nodra D. gIED tr tdetu .hEEologlc.l ord.r, t e,! tn Lteat ca* to D. mertiote.t Otst .rd b.cLwd& ttr the ord.t of datc. for th. otlrer 4. Ar!.UUon r 3n.Gt d, !G add.d tl EqulFd s. C6dd.tc tE E.tD tbt. for $pplyt g.[ b6t@tloa lD coaDll.!@ of tL. Hor'bt. SupreDG courtts Ju.lgm.nt h VP lc) xo.536 oa2o11. (7) TtEt I givc hein t€loc lhc detans ol th. a.&t3 (n@ablc dd imB@U. ctc.) ol mr*U, dy .Pou* md alt dcPcndots: Notq l. Ai6er. in joi.t nme i.di€ting th. crldt of joint Me.ship wiu al& haE to be Not : 2- !n s* or d.Fsit/lnresd.nt, lh. detans includins sial nuEb.r, @omt, &t or d.posii. th; d1d., Nu. ot Ban*/ID.tituti@ dd Bmch @ to b. Not!: 3, Value of Bonds/She Dcb.niurcs de pet lh. .uEelt ffikct value in stock dchose i! rq;1or list€d @6pani6 od I pd rioks in ca& of nm-lbt d @Dpei6 .hould b. 3i@. -.cO O.{ lsrJ^ "'"'{-.^*oi" ""ri*)1,."""i",-fl!os rro " 'a/.'-o i 4 -., 4sci:" Notc 4. D.p.nd.nt E.es paEnt3, &n(sl, daueht rls) or rhc.eddate o. spou* and e, ott!. !.mn Elated to lrE cddidalE vtEthr. by blood or aaria8., *ho hav€ e *pamt Deans ofin@d. ald who m d.p.ndcnt on the.alrdidat for rlsir liv.lilbod Not :5, D€raJs includiox afroEl is to b. Srven epaEtely in rcsp..t of .ach inv.stm.nt. Nore o. Debns should n lude rh. inr.r3r D or oM.Bhrpol ofishoF asls. E pr@d@: ror tlE prEpe of tiL Fotu, thc .rEBlo! "or.hoE et " I!.lsalra, d.t L o{ dl .t.po.ltr or trE.toat tr ForcLr bolr ud uy ottcr tody ot lutltrtto! .bo.l, ad a.t ll. pf dl B.t .!d ltr6lrlde b foElt! .o6t'tc.'i 1 AlbsiFtdEr'34E6 ,- _T_--- !aan6/ Mled hna rd 066 f -Lar$, ATTEATED BY M <.1 4s('v ATTESTED BY 0-T e &t 1..6L d D&, qb& !!!&,&,dEfud. ,:;.1 0l&[s!F|}Idl,Yd2ol3 ofuD$!Fl,F4)Ycr]m ':- :: :::l ;r I :: ] t-lt*,*t I t-l Not.: l. P:.operti.s in joinr Msship indicatins the.xr.nt drjoinl omcrship vin al$ har€ to be irdicatcd, Note: 2. Each lsd d building or apadm€lt should b. m€ntioned spdar€lv in thjt I'loG: 3. Dctail .hould include the int.(3r n or omeBhip of on hde assls i<+.rc ATTESTED BY *,*#;.ro"o.. .-- \T. gY A1IES1EO -*--.4lsml ^ \ +?P$r E EO BY a +4(I ATIESGD 9Y ry,#*,**. l ,,.ft:*-. 1L\ ATTESIED BY i: L *",*k i( ATTESTEO BY h ! "! L 444'J^ AIIESTED BY .tt At I \) L: a'. 4-scl^ w I rilu irq ATTE5TED BY 4cr-F lu/ , "^,",*nft "o" ?t:"ll'#,11"J' a I ATTESTED !]' 44Ql; t\1r a )i - -l 4Irrs,lED keJr 8y Hm#;r*" ATTESIED BY 4r,rJe ftr { ,( AIIESTED Bf, *rr--La r" I I tP/4 ATTESIEO 16x-.;; BY ?l{,#f[{.{iJ' I 13) I si\e hddn below lhe detans of liabilities/dues ro lubli. fi.scial insiitutrons ad Note: nea* erve sepdate details oI nde of bdk, institution, entily .r individual dd mount be{ore each item) Bak, vchi.r. ban lrnnova Has rhe D.poie been n ortupanon ol accommod io. provided by the Goverim.nr at abytime durnsthe la*r.nyea6 rl her.rerhe d*e oriotifi. io^ ofth L0l rfanswerto (A)above isYtt lhe folrowlru dedahtion may be (l) rhe addre$ orthe Governmentacdmodation: {lll lhere is .o due5 paFhh ii €sp.ct of abfle Goverim.nt acmmmodation.t wards {d) telephone charses as on - (date) fihe date shoold be the hsl date oJ the rhhd pnor to the month inwhrch theeledion is notified oranvdate therearrerl Note 'No Dues &niticare' from the agencies oncemed in res@d ot rcnr, electricltv .harEes, waEr chaBes and ielephohe chaEes ror the above covernment ac.ommodation should be iddudDs airdts and 4$u, AITESIED BY \, I ATIES-'ED BY M -|6r:If, 1r) n n!di+ut.'if$'[mdontn. l9l Dct.iL ot prof€3td or o..uPrtion: la) SellAericultu.ist / social Wolker (9A) D.t t , ol [email protected].) ol lrco6.: (a) s€lf Asidlrure sd salN f.om Pdrim.nt lb) soou* Aqidltuc / Busi.ess inM. lc) SourEs or h@m., f any, or D.p.ndents - 4 tra.t witn appror.iatc GoEmment dd dv public 6Ep&y or compafles: (a) Details or @nt.act. .nt.r.d by the cddidat. NIL F) Derejls orcontact..nt red into bv th. spou3. (.1 Der6ils or conkact. .ni...d into bv the deped.nt.-Nlt-. One of th. d.pcnd.nt, Shn G rmg Par.l has cnttrd ilto cmua't wirh Hindust& P.nol.uh Corp.rrion Ltd For rndins olpeEoleum Products' (d) o.tans or mtract3 .ntd.d intd by Hindu Uadivid.d F6milv or trusr in {hich thc .sdidate. or srou* or dcp€ndents haE i,t€61 -!!L. (€l Dera s or contra.t. .ntered into bv Pstn.Ehip fms in snich cmdidat's or spduse or depend.nb a.e p,in.E-NlL. vhi'h o' 0 Delails of cont acts cntd.d into iy prival. coopmv in 'sdidat's ,poxse or dePtnJ(nr\ hr ( lo) Iy .iher,@.! qultiettd L u rrLt Qrirriettoa sccondary sch@l c.tifrelc lsscl Ex@ FaiLd &toUE t6tt, sht. somnath K.tvdi Msdal ha.h schdl, Dabh't DMs' Y6 olk*ttng 1974 ssc Ex@ raned d.lals ot h'eh.sr School/ Un'veBD edudLon mcnronng thF tuU lom ol tll' li"iji"".ia'rr.-"i.o-'Giv. he sthool collcs'/unne s'w dd rh' v' in whi.h th..ou.e vas cotuPl.t"**1.,-".t d.) -+4€*A TIESIED BY .*$Yii$.i:'' %'i;rl:uiiril oo'! ,rr; i ATTESIEO iY U*, 1]I) OF THE DETATI,S CIYEN IN (1)TO (1O]OF PARA - AI 'SSTRACT Hou* No 206 C, Sah.i (utn, Dungri F,lia, Kachigm Nani Daftan - 396 230 Nuhber and Name of the constitucncv Parliam€ntary ConstituencY, IJT oaDama. & Diu Nee of thc Political party shich s.t up Toral Number ol pending cnmrnal.dics I .1 1 (a) c&didarc - L€lubhai (b) Spous . Tmnab.n Lalubhej Irl HUF Lalubhai B Potel HUF 2At7 |\ (dl DependenLl Gaurang Patel 2017 llJ (e) Dependent 2 Shivmgini Parcl 3,50,127 {0 Depend€nt-3 Not ApPlicabi. ll -[6 a"0 ATIESTEC AY a BY AIIESIEO -A-$f.f4 .*,*ffqq5;'. X'""'l'i";"tu"* I . ofttole rrltlr! R!r... E ! I G) *naqurd n$.6 OoEr I R I Hider s uu rdm or ihr eru'Eb/dPb /d.F ;,* *-. dd; *-r, c.n */ u ;E ry ud d. r h sh(h,h.our Er .*Fkrd ) ATTES I tu "ilif}l3^'j]3., i'#"tJK.Ill",# ATIEATED BY +{1'r-,a "$ir#,1,,ii,ryi vERS.rCAarcn ,, IATEL LIITESAI aAAUEEAI, the dep@e!t, ahove @ed, do hdeby veri& @d de.rart 6at the conrents of this a6davit de lrue ed @aect to the lest or ay lrrwledep &d beli€l dd no part of it is Ials. ed nothing materiar lEs been concealed the.e 6on, I turther la) there is tu c6e of conviction or lending c* asainsl ae oth.r thm those m.ntioned in item6 5 dd 6 of P.rt A dd B abovel (b) I, ny +ouse, or ay depdrlenls do not have dy ass.t or liablity, othtr rhd those hatided in itds 7 ed a of P6it A dd ftds a, 9 dd 10 of Pa't B above. Vsin.d at Dmd, rhis the 4'h day ofApril,2Ol9 4r,ftQ N.te: 1. Allidavit shoxld henled latest by 3:00 PM on the lasl day ol frlins nominations l[ot6: 2. A{idavit should b€ smm before on Oath Commissioner or Magistral. ol rhe First Class or befoie a Notary Publi.. 3, All .olumns should be nlGd up and no column to be lett bldk lr th.re is no inlornation ro tumish in respect oI ay item, either "Nll" or "Not Applicable', as the ff... c6e may be, should be mentioned. The .lfidavit should be eirhd typed .i Eitt.n leAlbly dd neatly Ea.h pag. of the Afiidavil should be siened by the deponeat end the Afidavit should f bed on €a.h pag. lhe stmp oa the Notary or Oath Conmissioier o. @giskate ber.r. wh.m tn. Amd,vii is sw.m 1't t, 6aao7 whotsidentifi.d whoh I P.&.aily l(ncw, h. Irtl