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}i AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO HOUSE OF I G.o.ft. ttri2@U E THE pEOpLE - LOK SABHA (NAME OF THE HOUSE) FROM 05 - ZAHEERABAp PARLTAMENTARY CONSTTTUENCY (NAME OF THE CONSTTTUENCY) PART - A I, EHE[$$IU, **son/daug6ls#wife of BHATTU BENJAMIN Aged 49 years, $ resident of Plot No. 6, Friends Colony, Allipur Village, Mandal, District, State - Pin Code : 502 318 (mention full postal g address), a candidate at the above election, do hereby solemnly affirm and state on oath as under: 0)r am contesting as an Independent Candidate. $ lxxstrike out whichever is not applicable) e). My name is enrolled in 038 (SC) Zaheerabad. Telangana within 05 i{ Zaheerabad Parliamentary Constituency, Telanqana (Name of the E constituency and the State), in Paft No. 21e. tfrds?€fit 2 +

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(3). My contact telephone number(s) is/are 09849767929 and my e-mail id (if any) is : [email protected] and my social media account(s) (if any) is / are (i) In Facebook BENJAMIN RA!U. (ii) Whatsapp : 09849761929. (iii) Not Applicable.

(4). Details of Permanent Account Number (pAN) and status of fiting of Income Tax return:

st. Names PAN The financial year for I Total income shown No. which the last In Income Tax return Income-Tax return (in Rupees) for the has been filed last five Financial Years (as on 31't March) 1 Self AJTPR2655N 2018-2019 i) Rs.4148,25O=00 2017-201a ii) Rs.4,21,80O=00 2016-2017 iii) Rs. 3,91,559=00 201s-2016 iv) Rs.3,O2,660=O0 2014-201s v) Rs. 1151,754=O0 2 Spouse ATEPG7158A 2018-2019 i) Rs. 9,45,757=00 2017-20t.a ii) Rs. 8,08,520=0O 2016-2017 iii) Rs. 7,37,531=OO 2015-2016 iv) Rs. 5,03,721=00 2014-2015 v) Rs. d21,529=O0 3 HUF (if the No PAN Not Applicable i) Not Applicable Gndidate is allotted Not Applicable ii) Not Applicable Karta / Not Applicable iii) Not Applicable Coparcener Not Applicable iv) Not Applicable Not Applicable v) Not Applicable 4. Dependent-1 No PAN Not Applicable i) Not Applicable allotted Not Applicable ii) Not Applicable Not Applicable iii) Not Applicable Not Applicable iv) Not Applicable Not Applicable v) Not Applicable 5 Dependent-2 No PAN Not Applicable i) Not Applicable allotted Not Applicable ii) Not Applicable Not Applicable iii) Not Applicable Not Applicable iv) Not Applicable Not Applicable v) Not Applicable 6 Dependent-3 No PAN Not Applicable i) Not Applicable allotted Not Applicable ii) Not Applicable Not Applicable iii) Not Applicable Not Applicable iv) Not Applicable Not Applicable v) Not Applicable EE is mandatory for PAN holder to in case of no PAN it should be clearly PAN allotted". $fEtr + NOTARY "No Govl O Tclangant o 3 G.o.fla ri - I tl'" ( -'*'1 )a11 ll)52,2t fl ?s LLTT ADVOC,'.Tfl N OTAITT,CAH EE iTASAD CeU Fho.ro:8500056087 D s1 ,. ?.. (5) Pending criminal cases l- (i) I declare that there is no pending criminal case against me : v (Tick this alternative if there is no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ii) below),

OR

(ii) The following criminal cases are pending against me : NOT APPLICABLE (If there are pending criminal cases against the candidate, then tick this alternative and soone off alternative (i) above, and give details of all pending cases in the Table below). Table

(a) FIR No, with name and NOT NOT NOT address of Police Station APPLICABLE APPLICABLE APPTICABLE concerned (b) Case No. with Name of the NOT NOT NOT Cou rt APPLICABLE APPLICABLE APPLICABLE (c) Section(s) of concerned Acts NOT NOT NOT / Codes involved (give no. APPLICABLE APPLICABLE APPLICABLE of the Section e.g. section ...... of IPC etc.) (d) Brief description of offence NOT NOT NOT APPLICABLE APPLTCABLE APPLICABLE (e) Whether charges have been NOT NOT 1{OT framed (mention YES or NO) APPLICABLE APPLICABLE APPUCABLE (f) If answer against (e) above NOT NOT NOT is YES, then give the date on APPLICABLE APPLICABLE APPLICABLE which chaEes were framed whether any AppeEl I NOT NOT NOT (s) Application for revision has APPLICABLE APPLICABLE APPUCABLE been filed against the proceedings (Mention YES or NO)

(6) Cases of conviction (i) I declare that I have not been convicted for any criminal offence : ly' (Tick this alternative if the candidate has not been convicted and write NOT APPLICABLE against alternative (ii) below). OR (ii) I have been convicted for the offences mentioned below : NOT APPUCABLE (If the candidate has been convicted, then tick this alternative and score off alternauve (i) above' and give details in the Table below) Table

(a) Case No. NOT NOT NOT APPLICABLE APPLICAELE APPUCABLE (b) Name of the Court NOT NOT NOT APPLICABLE APPLICABLE APPLICABLE EE Section(s) of Acts / Codes NOT NOT NOT involved (give no. of the APPLICABLE APPLICABLE APPLICABLE NOTARY f e,g, section Section Govt O Tdangan, of IPC etc.) p'f; ESTED G.0.No. E} 4 ltl5z20tt !! t? r{ ,3 Nl!u41 4 (d) Brief description of offence NOT NOT NOT for which convicted APPLICABLE APPLICABLE APPLICABLE (e) Date of orders of conviction NOT NOT NOT APPLICABLE APPLICABLE APPLICABLE (0 Punishment imposed NOT NOT NOT APPTICABLE APPLICABLE APPTICABTE (s) Whether any Appeal has NOT NOT NOT been filed against APPLICABLE APPLICABLE APPLICABTE conviction order (Mention YES or No) (h) If answer to (g) above is NOT iloT NOT Yes, give details and APPLICABTE APPUCABLE APPLICABLE present status of appeal

(6A)I have given full and up-to-date information to my political party about all pending criminal cases against me and about all cases of conviction as given in paragraphs (5) and (6). a PPU?.*LLP ^Jor [candidates to whom this item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6 (i), abovel.

Note: 1. Details should be entered clearly and legibly in BOLD letters. 2. Details to be given separately for each case under different @lumns against each item. 3. Details should be given in neyerse chronological order i.e., the latest case to be menuoned first and backwards in the order of dates for the other cases, 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying atl information in comptiance of Hon'ble Supreme Courfs judgment in W.P (C) No. 536 of 20u.

(7) That I give herein below the details of the assets (movable and immovable etc.) of myself, my spouse and all dependents: 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 / Investment, the details including Serial Number, Amount, date of deposit, the scheme, Name of the Bank / Institution and Branch are to be given. Note : 3. Value of Bonds/Share Debentures as per current market value in Stock exchange in respect of listed companies and as per books in case of non-listed companies should be given. EE u 4. 'Dependent' means parent, son(s), daughter(s) of the candidate or + spouse and any other person related to the candidate whether by blood + NOTARY or marriage, who have no separate means of income and who are N Go{t Ol Tolangan' :3 G'O'[o' q deponent on the candida ihood. t051lt01t 5 r7 UI 5 s ADVOC/IITE/HOT,t FI,?A|{ ES RnsA 0 q;:i f':r{::,+:fIi;t,;:i:z ::5::

Note : 5. Details including amount is to be given separately in respect of each investment. Note : 5. Details Should include the interest in or ownership of 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 @untries' :

st. Description Self Spouse HUF Depeo- Depen- Depen- dent-1 dent-2 dent-3 No. (i) Cash in hand Rs. 10,000 Rs. NIL NIL NIL NIL 10,000/- (ii) Details of Deposit in Bank Saving Bank Saving Bank NIL NIL NIL NIL Account 1{o. Account No. accounE (FDRS, Term o49o1oo11qra5 62109762126 Deposits and all other types 52 of SBI, Branch of Andhra Banlt zaheerabad of Deposits including saving Blanch Saving of accounts), Deposits with Rs. 5,00O.0O Financial Institutions, Non Saving of Rs. ps 12,960,u ps Banking Financial Companies and Cooperative societies and the amount in each such deposit (iiD Details of investment in NIL NIL NIL NIL NIL NIL Bonds, Debentures / shares and units in companies Mutual Funds and others and the amount. (iv) Details of investment in NIL NIL NIL NIL NIL NIL NSS, Postal Savings, Insurance Policies and investment in any Financial Instrument in Post office or Insurance Company and the amount ( ) Personal loans/advance NIL NIL NIL NIL NIL NIL given to any person or entity including firm, Company, Trust etc. and other receivables from debtors and the amount. (vi) Motor Vehicles Aircrafts TVS Star Sport TVS Scotty Just NIL NIL NIL NIL / bearing Regd. No. bearing Regd. Registration No. etc, Year of AP23P8882 No. Purchase and amount Model 05/2009 TS15ED1300 ) Purchase lYodel Rs.42,000/- 2015 FFfr Purchase 0"\ Rs. 50,000/- + NOTARY s7ED GoYt Ot Telangan, () 6 :' l-l 5' G.0.llo' l& t052t201t :8 AEVOC; t7 DI Ge lJ !:ito 6

(vii) Jewelry, bullion and 3 Tolas 10 Tolas NIL NIL NIL NIL valuable thing (give details of weight and value) Rs, Rs, 99,O00/- 3,30,000/-

(viii) Any other assets such as NlL NIL NIL NIL NIL NIL value of Claims/interest R5. Rs. NIL NIL NIL NIL (ix) Gross Tota! value 1,63,960,17 ps 3,95,0OO/-

B Details of Immovable assets: Note : 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated. Note : 2. Each land or building or apartment should be mentioned separately in this format. Note : 3. Details should include the interest in or ownership of offshore assets.

sl. Self Spouse HUF Depen- Depen- Depen- Description dent-1 dent-2 dent-3 No (i) Agricultural Land NIL NIL NIL NIL NIL NIL tion(s) Survey numbe(s) NOT NOT t{oT NOT NOT NOT (Total measurement in acres) APP|.ICAALE APPLICABLE APPLICABLE a APPLICABLE APPUCABLE APPUCABLG t{oT NOT IoT NOT NOT r{oT property (Yes or APPLICASLE APPLTCABTE r inherited APPLICABI.E APPLICABLE APPLICABLE APPUCAALE No t{oT NOT noT NOT NOT ]{oT purchase in case of self APPUCABLE APPUCAALE Date of APPUCAALE APPLICABLE uired IoT NOT NOI NOT IIOT NOT (in case of APPLICABIE ADPLICAALE APPLICAELE APPLTCABLE ost of Land Purchase)at APPUCABLE APPLICABLE e time of urchase NOT t{oT t{oT IIOT 1{OT NOT on the land bY waY APPLTCABLE APPITCABLE APPLICABLE Investment APPUCAELE APPUCABLE APPLICABLE f develo en construction etc. NOT OT ItoT ltor tloT floT proximate market APPLICABTE APPLICAALE APPUCAALE Current APPUCABLE APPUCABLE lue (ii) Non-Agricultura I Land NIL NIL NIL NIL NIL NIL Location(s) Survey number(s) NOT NOT NOT OT NOT NOT (Total in sq. ft. APPLICAALE APPLICABIE measurement ) APPLICAILE APPLICABLE NOT NOT I{OT NOT NOT ttoT (Yes or APPLICAALE A'PLICAALE APPLTCABI.E hether inherited ProPefi APPUCABLE APPUCABLE o NOT NOT I{OT or t{oT t{oT purchase self APPLICABLE APPUCABLE APPLTCABLE te of in case of APPLICABLE APPUCABLE uired ro NOT NOT noT NOr NOT NOT (in of purchase) at APPTICABLE APPLTCABTE APPUCAALE APPLICABLE Cost of Land case APPLICABLE APPLICABLE the time of purchase NOT NOT lloT NOT NOT NOT land bY waY APPLICA'LE APPUCABLE ny Investment on the APPUCABLE APPUCABLE develo ment construction etc. NOT OT t{oT noT t{or NOT mate Current market value APPLTCABLE ;EEi. N*i APPLICABLE APP]ICABLE APPUCABLE t' + 7 o .)" G.}8l*Y* o l1 GO'tlo' tU ni.sHArffi!"lDDIN \ t052n0tt RA9rr0 ADVOGATF^Ift{; Cetl Fho $ ,DI 7

(iii) Commercial Buildings NIL NIL NIL NIL NIL NIL (including apartments) -Location(s) -Survey number(s) NOT t{oT OT noT t{oT t{oT (Total measurement in sq. ft.) APPIICABI.E APPLICAB(E rea APPLICABLE APPLICABLE APPUCABLE APruCABLE t{or NOT t{oT l{oT Or t{oT (Total measurement in APPLICABTE APPLICABIE Built up Area APPLICABLE APPLICABLE APPLICABLE APPLICABLE sq. ft.) NOT t{oT NOT flot IIOT NOT inherited property (Yes or APPTICAALE APPLTCABIE hether APPUCABLE APPUCABLE APPUCABLE APPUCABLE o NOT t{oT OT OT noT NOT purchase in case of self APPLICA'IE APPLICIBLE Date of APPLICABLE APPLICABLE APPUCABLE APPTICAALE acquired properW NOT t{oT flor OT I{OT NOT of property (in case of APPLICA'IE APPLTCAAlE APPLICABLE APPLICABLE APPLICABLE APPUCABLE urchase) at the time of purchase t{oT NOT ,{oT T{OT NOT proPertY bY APDLICAILE APPTICABI.E Any Investment on the APPLICABLE APPUCABLE APPLICAALE APPUCAALE way of development, construction etc. t{oT NOT NOT rlor OT pproximate Current market Value APPLICABIE AP9LICAAIE APPUCABLE APPUCABLE APPLICABLE APPUCABLE

House NIL NIL NIL NIL NIL over Plot (iv) BesirlentiaLSttilttincs o.6in (including apartments,) Sy.l{o. -Location(s) t7tdal\^ - Suruey number(s) st t{oT IIOT llor I{OT t{oT sq AP'TICIBLE a (Total measurement in ft.) L499.94 APPLICAALE APPUCAALE I{OT NOT t{oT tor 1{OT APPLICAALE ilt up Area (Total measurement In 1000.00 APPUCABTE APPUCABLE APPUCABLE ft NOT NOT noT 1{OT APPLICIBIE r inherited property (Yes or No APPUCABLE APPLICABLE APPIICABIE APPUCAALE NO 03-06- t{oT NOT noT NOT OT Date of purchase in case of self APPUCABLE APPUCABLE APPLICAILE APPUCABLE 2016 u ired 1{OT IIOT NOr t{oT 1{OT 2,00,000/- APPI.ICIAtE of propefi (in case of APPl.ICAALE APPUCABLE APPL!CA8LE APPTICABLE rchase at the time of urchase r{oT NOT t{or I{OT NOT rl{) Lakhs APPLICAAlE Investment on the land bY waY APPLICABLE APPLICABLE APPUCABTE APPUCABLE developm ent, construction etc. NOT tloT NOI I{OT NOT APPLICA!LE APPLICABTE proximate Current market value 70 APPLICABLE APPUCAALE APPLICABLE Lakhs NIL NIL NIL NIL ( ) Others (such as interest in NIL NIL NIL (vi) Total of Current Market 70 NIL NIL NIL NIL Value of (i) to (v) above Lakhs

(g). I give herein below the details of liabilities/dues to public financial institutions and government:-

: please give separate details of name of bank, institution, entity or individual EE ount before each item). f"i""d"ESTED 'I + NOTARY 2A\7 8 Govt Ol Telangana G.0'No. t052201t A.jVOG.dT#t{OTART,ZAHEEft,:raa0 Cell Ftrtne:85'iC035087

".) B

st. Self Spouse HUF Depen Depen- Depen- l'lo. Description -dent-1 dent-2 dent-3 (i) Loan or dues to Bank/Financial NIL Rs. 30 NIL NIL NIL NIL Lakhs SBI Institution(s) zaheerabad Name of Bank or Financial Highway Institution, Amount Branch outstanding, Construction Loan Nature of loan Loan or dues to any other NIL NIL NIL NIL NIL NIL individuals/ Entity other than mentioned in (i) above. Name(s) Amount outstanding, Nature of loan

Any other liability NIL NIL NIL NIL NIL NIL crand tota I of liabilities NIL 30 LAKHS NIL NIL NIL NIL (ii) Government dues : Dues to Departments ) Has the Deponent been in occupation of V Dealing with accommodation provided by the Government y{srio Government accommodation at any time during the last ten years before the date of notification of the current election? (B) If answer to (A) above is YES, the following declaration may be furnished namel

1 fne address of the Government accommodation: NOT APPUCABLE NOT APPUCABLE NOT APPUCABLE

i) There is no dues payable in respect of Government accommodation, towards (a) rent; (b) electricity charges; (c) water charges; and (o) tercpnone iharges as on 31d day of December 2018 (date) [the date should be the last date of third month prior to the month in which the election is notified or any date thereafterl.

Note : 'No Dues Cetificate' from the agencies concerned in respect of rent, electri charges, water charges and telephone charges for the above Government accommodation should be submitted.

+ 9 o -324 )7 o ,qFEEI'DDIN 1!l F.ASAO -uS* ""It]$ft'* AOVOC AiTE/NOTARTS,qHE il\t r0512011 Cc!l Phone:8500055e8I

i4 nl 9

self Spouse HUF Depen- Depen- Depen- dant-1 dant-2 dant-3

(iii) Dues to department NIL NIL NIL NIL NIL NIL Dealing with Government transport (including aircrafts and helicopters) (iv) Income Tax Dues NIL NIL NIL NIL NIL NIL

(v) GST Dues NIL NIt NIL NIL NIL NIL

(vi) Munlcipal / Property tax dues NIL NIL NIL NIL NIL NIL

(vii) Any other dues NIL NIL NIL NIL NIL NIL

(viii) Grand total of all Government du NIL NIL NIL NIL NIL NIL

(ix) Whether any other liabilities are in NIL NIL NIL NIL NIL NIL dispute, if so, mention the amount involved and the authoritY before which it is Pending

(9) Details of prcfession or occupation: (a) Self : Advocate, Notary & Legal Practice (b) Spouse : Govt. Medical Officer (Homeo)

(9A) Details of sources of income : (a) Self : Legal Practice (b) Spouse : GoW. EmPloyee (c) Source of Income, if any of dependants : NIL

(gB) contracts with appropriate Government and any public company or companies

(a) details of contracts entered by the candidate : NOT APPLICABLE (b) details of contracts entered into by spouse : NOT APPLICABLE (c) details of contracts entered into by dependents : NOT APPLICABLE (d) details of contracts entered into by Hindu Undivided Family or Trust in which the candidate or spouse or dependants have interest : NOT APPLICABLE details of contracts, entered into by Partnership Firms in which EEU o candidate or spouse or dependants are partners : NOT APPLICABLE + entered into by private companies in which rt N o Details of contracts candidate or spouse or share: NOTAPPLICABLE Govt UJ GO.t{o' q ...10 20tt 10521 ,-"17 5 LJ \*d4 n,ot TE€RABA, \\l$N- OTAKT,ZAI A0liocATElt{ 35087 L:'i, ' :: 10::

(10) My educational qualification is as under :-

B.A. tLB, PGD-PMIR

(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).

i) Post craduate Diploma in Personat Management Industrial Retation through College of Social Worlg Hyderabad Affiliated to Osmania University in the year 1999.

ii) Bachelor of Arts through External Osmania University in the year 1995.

iii) Bachelor of Law through Shadan College of Law, Hyderabad Affiliated to Osmania University in the year 2002.

PART B

11. ABSTRACT OF THE DETATLS GMN rN (1) TO (10) OF PART-A:

1. Name of the candidate Sh./SrnUKum. BHATTU RAIU 2 Full postal address Plot No. Q Friends Colony, Allipur, Zaheerabad, , Telangana State - Pin Code : 502 318 2 Number and Name of the Constituency 05 ZAHEERABAD PARLIAMENT and State. CONSTITUENCY AND TELANGANA STATE 4 Name of the Political Party which set up INDEPENDENT the candidate (othenarise write 'Independent) 5 Total number of pending criminal cases NIL

6. Total number of cases in which NIL convicted

PAN OF Year for which Last Total 7 income shown Income Tax return filed (a) Candidate AJTPR2655N 2018-2019 Rs. 4,48r25O=O0

(b) Spouse ATEPG7158A 2018-2019 R:s,9,45,757=OO

(c) HUF NO PAN ALLOTTED NOT APPLICABLE NOT APPLICABLE (dIDependents NO PAN ALLOTTED NOT APPLICABLE NOT APPLICABLE

ATTESTED ...11 + N,r$ry .3.2.17 sr.s BALLIS EERABA' :: 1l ::

ils of Assets and Liabilities (including offshore assets) in Rupees B Description Self Spouse HUF Depen Depen Depen dent-1 dent-2 dent-3

Rs. 1,63,960.17 Rs. ]{IL . NIL NIt NIL A Movable Asset ps 3,9tmo/- (Total value)

B Immovable 2,OO,OOOl NIL NIL NIL NIL NIL Assets I Purchase Price of Rs. NIL NIL NIL NIL NIL Self-Acquired 2.O0 Lakhs immovable lt. Development / Rs. NIL NIL NIL NIL NIL Construction 40 Lakhs Cost of immovable property after purchase (if a licable III. Approximate Current market price - Rs. (a) Self-Acquired 70 lakhs NIL NIL NIL NIL NIL Assets (Total Value) (b) inherited Assets (Total Value) q Liabilities

Government dues NIt NIL NIL NIL NIL (Total)

Loans from Bank, NIL Rs. 30 NTL NIL NIL Lakhs Financial Institutions sar, and others (Total)

10. Liabilities that are under dispute NIL I Government dues NIL NIL NIL NIL (Total) ii. from Bank, NIL NIL NIL NIL NIL I Institutions AT' ir::qTl :n

I 2Dl, M.SIIAFEEIN fNeftrtfr ...12 AOVOCATE'NOTARTTAI i EET* -.€ ST.S C$:l t'h::e:8€iSo5rcg7 :: 12::

11 Highest educational qualification : B.A. LLB, PGD-PMIR

i) Bachelor of Arts through External Osmania University in the year 1995. ii) Bachelor of Law through Shadan College of Law, Hyderabad Affiliated to Osmania University in the year 2OO2. iii) Post Graduate Diploma in Personal Management Industrial Relation through College of Social Work,.Hyderabad Affiliated to Osmania University in the year 1999.

(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).

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief, no paft of it is false and nothing material has been concealed there from. I fufther declarethat:

(a) There is no case of conviction or pending case against me other than those mentioned in items 5 and 6 of Part A and B above'

(b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 7 and B of Part A and items B, 9 and 10 of Paft B above.

Verified at Zaheerabad this the 20th day of March 2019

AITESTED DEPON

+ [r. *t1 ADVOCATE/NC?ART,A.-". ;,: ; fl f+EAD €etl Phons:890&$,55u&7 BooKNo = I p*3e-rto= 1 Seil^[ 6{'o ' L1a DotC * zo'a-2-o\q