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U0420190404075257.Pdf 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...
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