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T/Tu^ LA^}R^ B FORM2A (See rule 4) NOMINATION PAPER Election to the House of the people P yr ft sil hr STRIKE OFF PART I OR PART II BELOW WHICI{EVER IS NOT APPLICABLE PART I (To be used by candidate set up by recognised poritical party) I nominate as a candidate for election to ttre House of people the from the. r . coocrrBEHAR (sc) PANLIAMENTARY CONSTITUENCY CANdidAtE' NAME SRI NISITH PTUMAMK. Father's/mother's/husband's name sRI BIDHUBHUSHAN PRAMAMK His postal vill'-Kharija Baladang4 address Bhetaguri, P.o. nrretaguri, p.S. Dinhatq Behar Dist. cooch- 'Pin-736134 His name is entered at s.No..2gl .in part T(Assembly No.234 0f the electoral roll for'No'7 DINITATA constituency comprised within) r ,coocrrBDrrAR Parliamentary Constituency. (sc) My name is' , Hem chandra Barman and it is entered at sl.No.3l3 in part No.243 the electoral roll for No-S,sitalkuchi '(Assembly 0f constituency comprised within) r, coocHBEHAR tscl Parliamentary constituency. ,t/tu^ LA^}r^ Date 25103/20219 b"zr^% Signature ofproposer -- PART I (To be used by candidate NOT set by recognised political party) We hereby nominate as candidate election to the House the of the People from Constituency Candidate's name. Father's/m name other,s/husband's postal address.... roll for I#*:*:,,I"*"#H::H;: within) we declare that we are electors of the above parliamentary constifuency our names are for that partiamentary cor,rtito.o.; below append:::.-Tj our;1- fl:l.ctoqal .roll . ffi;7 and we signatures below in token of subs*ibingio this nomination:- Particulars of the and their Name of component Assembly S.No. in Constituency that part ten electors of the coostituency asffiiiers PART III I' the candidate mentioned in Put (srike wutll 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 foreign State/country. (b) that I have completed 33.years of age; ISTRIKE oUT c(i) or c(ii) BELow WHICTmVE&]p,ALOT APPLICABLEI (c) (i) that T am set rrp at this elecfion by the ArlazlaZi'--/ Ll* f,anah Panl party, which is a recognised National Party/Stat€ Party in this State and that the symbol reserved for the above party be allotted to me. OR (c) (ii) that I am set up at this election by the NIL party, which is a registered-un recognized political party/that I am contesting this election as an independent candidate. (Strike out which is not applicable) and that the symbols I have chosen, in order of preference, are:- (,)ML (,,) NrL (,r,)ML (d) that my name and my father's/mother'sftrusband's name have been correctly spelt out above in English (name of the language); (e) that to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in ttre House of the people. *I further declare that I am a member of the Rajbanshi **Caste/tibe which is a scheduled **caste/tibe of the State of WEST BENGAL .in relation to COOCHBEHAR.(area) in that State. I also declare that T have not been, and shall not be nominated as a candidate at the present general election/the bye+lections being held simultaneously, to the House of the People from more than two Parliamentary Constituencies. ,,r/,U1a f,^r**,rtll oate.l.{:.Q?.../.7 Signature of Candidate * anrl Kashmir, Andaman and Nicobar Islands, Chandigarh, JuO.u and Nagar Haveli, Daman and Diu and Lakshadweep. *Score out this paragraph, if not applicable. **Score out the words not applicable. N.B.-A "recognised political part5r" means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order- 1968 in the State concerned. PART IIIA (To be filled by the candidate) fl) whether the candidate- (i) has been convicted- (a) ofany offence(s) under sub-section (l); or ) O) for contravention of any law specified in sub-section (2), I of section 8 of the Representation of the People Act, l95l (43 of l95l); or I V.VNO (il) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. If ihc answci is "Ycs", thc candidatc shall furnish thc following information: (i) Case/first information report No./I.Ios-NIL. (ii) Police station(s) ML Disfict(s)-Ml State(s) NIL (iii) Section(s) of the concerned Ac(s) and brief description of the offence(s) for which he has been convicted ML (iv)Date(s) of conviction(s) NIL (u) Court(s) which convicted the candidate NIL (r'l)Punishmort(s) impcsed [indicate pericd of impiscnnnent(s) snC/or quantum of fine(s)1...NIL.. (uz) Date(s) of release from prison...NIL (vfil)wavwere any appea(s/revision(s) filed against above conviction(s) No YeMl.Io (ix) Date and particulars of appeat(s/application(s) for revision filed.........NIL.. (*) Name of the court(s) before which the appeal(s)/application(s) for revision filed... ... ...NIL (xi) Whether the said appea(s)/application(s) for revision has/have been disposed of or is/are pendlng...NIL (xii) If the said appeal(s/application(s) for revision has/have been disposed of- (a) Date(s) of disposal...NIL (ii) i.iatiiie of oide(s) passe,i. NiL (2) whether the candidate is holding any office of profit under the Govemment of India or state Government?.,....... (ye#No) NO -If Yes, details of the oflice held.. (3) ..NO. whether the candidate has been decrared insolvent by any court?.,........ (yevNo) No -If Yes, has he been discharged from insolvency. (4) Whether the oandidate is under allegiance or adherence to any foreign country?.........(yes/No) NO -If Yes, give details (5) whether the candidate has been disqualified under section gA ofthe said Act by an order of the President?.................. (yeVNo) NO -If Yes, the feriod which disqualified (6) for .........NO whether the candidate was dismissed for comrption * r"r disloyalty while holding under office the Govecnuneot of Inrria or the Governmen! of an;, state? ---_-_ .-.(yes1No,\ -If 11gr Yes, the date of such dismissal. ......NO.... (7) whether the candidate has any subsisting contrac(s) with individual the Government either in caoac\ or by trust or partnership in which the candidate has a share for supply of any goods to that Government or for execution of works undertaken by that Government?.............. (yes/No) NO -If Yes, with which Government and details of subsisting confract(s)......NO. (8) whether the candidate is a managing agent, or manager or secretary of any company or ccrycraticn (cther thcn a oocperati'.e secieg,) i-* tt e caprtal of whrch Government or state Government the cenfal has not less than twenty-five percent (YeVno) NO share?............ -If Yes, with which Government and the details thereof ...NO....... (9) whether the candidate has been disqualified by the commission under section I0A of the said Act. (yesNo) NO -Ifyes, the date of disqualification...NO J /-ilLl,^. Place: CocrehBe-har ?<r.h,ul^llt- Sigralre of Date:25l0312019 Ca-ndirtate PART IV bv the Returning officer) sl" No. of nomination our.r...rrpl)ffid Serial This nomination- OO,,6r w.s derivered 'orrlt or proposer (name of Returnirlg Qfcer, I Coochbehar (SC) Parl ixgffi flu 8ff.,31r. " ", PART v Decision of Rehlrning officer Acce4fing or Rejecting the Nomination paner I have examined this norirrutio, pup"i ii accoroanc" with section Representation of the people Act, l95l(43 36 or tn" of r95l) and decide as follows:_ Date... Returning Officer ion) q airnr;r WEST BENGAL 21 AA 639993 ',!(;6rffim Foru 26 \:A (Sce ruh4A) Bh.%# E LI= - ATIIIDAVTT TO BE tr'ILED BY TTIE CAIIDIDATE ALONGWITII NOIVINATION r&pnn BEToRE THtr RETURNING oFucER FoR f,,LECTIoN To rHa Housn OII THE PEOPTE (NAME OFTHE HOUSE)TROM THE I ,COOCH BEHAR lccy TaT,TAMENTARV coNsrrrurNcy (NAME oF THE coNsrITuENCy) fi! 9. pABr.+ dd*w*[-sRlMSITHPMlv{AMKi.son/@ghter/yi6of sRTBTDHUB}TUSHAN */^d!ffinuemK Aged 33 Yeors, resident of Vill.-Kharija Batadangq Bhetaguri, td-"gl*,lrfO. Bhetaguri, P.S. Dinhata, Dist. Cnoch Behar ,Pin-?36l341nrurticn i.$i,O y, postal address), a cmdidatc at thc above ehtion, do hercby solemnly affirm and '"'.VX * oath as under:- *4Pt It O) I am a cmdidae $ot up by BHARATIYA JAI.IATA pARTy U Contd ... .pt2 I '-/AJ'L f,.4,^t'JK ' .:i WW >u1"l4Y A1m0-"- FEB 2O1q ::2 i: (**name of the noriticar party) /'r*u* contesting (*tstrike as an Independent candidate. out whichever ii noi uppfi."if.) My name @ is enrolled i, N;-7finfrata AC,West constituency Bengal (Name of the and.the state), at seriar No.2gr part (3) Mv in No.234. contact tell1h3ne (i)96350-btios [email protected]"lni",*'u.ririi'rr*. liilzozr s-ss227 and my e- ,ociar media fl}},'$#:*'is 'nv account(s) (if (i) Facebook-Nisith pramanik (ii) Whatsapp.96350-02 I 08 (iii) Not applicable of permanenr Aceount Numher (pAN) nnd [f,l*:lr,- srat*s of fiting of Income rax Names rAN flhe Finan6 flTotal income- fear for shown in Income Tax %, trrtI Return(in ["trict for the I lIt(:(lIIla- lRupo.) Iast five lt' last Financial Years t completed (as !, lor return has .I on 3l"March) I been W filed i [grutusrunrEnrx tsESPPI P0t7 ffi V*/ luzr ho (i) 2ots W 2.68.694=00(20 I 4-20 I 5) Fts. 6 I R.s.5,97,688=00(201 5-l 6) (rii] I 8.s.8,06,586=00(201 6-t ?\ (iv)l Rs.
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