f;
a
FORM 2A (See rule 4)
NOMINATION PAPER I Election to the house of the people
I
STRIKD OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE. PART I
(To be used by candidate set up by recognized political party)
I nominate as a for election to the from the amentar5z Con stitu ency. Candidate's n Father's Name: _1, His Address D.No.-- andal
His name is part at Serial No. -- in No of the Electoral roll for No. -(ASSEMBLY CO comprised within) ----Parliamentar5z Constituency.
My 1S and it is entered Sl.No._in part No._-- of the electoral roll for the 43 MUMMIDIVARAM Assembly Constituency.
Date: .03.2019. Signature of proposer PART-II We hereby nominate - as candidate for election to the house of the people from the No. 7 oF AMALAPURAM (sc) PARLIAMENTARY CONSTITUENCY Candidate's name EBNTHAGAnA VIJAYA CHAKnallAETHy Father,s narne NARAYANA MURTHY his Postal address D.N of of AIN RAM village, MUMMID IVARAM Mandal, tr G.Dist. His name is entered at Sl.No.338 in part No.59 of the electoral roll for 43 MUMMI IVARAM (Assembly Constituency comprised within) AMALAPURAM Parliamentary Con stitu ency.
We declare that we are electors of the above Parliamentar5r constituency ancl our neunes are entered in the electoral roll for this Parliamentary constituency as indicated below and we append our signatures below in token of subscribing to this nomination. Particulars of the proposers and their signatures
Elector roll No. of proposer sl. Part No. No. of Full name Signature Date electoral Sl.No. in that part Roll 1 2 3 4 5 6 1 sq j+q 3blroq5,rS {"ffi"{$"t- ?s 3 tq 2 sq 3sg s6t,$ s** k.,t"^ F,4 -- zsls\r q J q36 s9 ,GadtSfuo r.t. L{4h-dl6li\r zrl: I rq 4 sq \o\ *3&"r,[no..u o ,4 zsle,l,q 5 sq rtzo "6r{orsro 5Q., K0o$hp.Wb^ zslslrq 6 sq t-tLtu. of( t{^f,illsa*r, u. #(Leunr n&!)- ln 7 (t*.)J 'sls sg 3qs }:.n # 0 n* PART-III I, the candidate mentioned in Part llPart II (strike out which is not applicable) assent to this nomination and hereby declare that - a) I am a citizen of India and have not acquired the citizenship of any foreign State/Country b) That I have completed 65 years of age; (strike out c(i) or c(ii) below whichever is not applicable) c) i) I am set up at {ris election by the ---- , which i" ...og,fua National Party/State party i\his state and the symbol reserved fo\he above party be allotted to m\ or ii) I am set up at this election by the REPUBLICAN PARTY OF INDIA (RPl. K) party, which is a registered unrecognized 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:- GAS CYLTNDER (ii) GAS STOVE (iii) ELECTRICAL POLtr d) My name and my father's/mother's/husband's name have been correctly spelt out above in ENGLISH (Name of the language); and 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 the legislative Assembly of this state. a I further declare that I arn a member of the SCHEDULED CASTE ** Caste which is a Scheduled**caste of the state of NIL in relation to NOT APPLICABLE (area) 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 Legislative Assembly NIL of (state) from more than two Assembly Con stituency. Date: L{ March, 2019 S of candidate *Score out this par graph, if not applicable **score out the words not applicable N.B. - A "recognized political party" means a political party recognized by the Election Commission under the Election symbols (Reservation and Allotment) order, i968 in the State concerned. PART III A (To be filed by the candidate) (1) Whether the candidate * i) Has been convicted:- ND" a) Of any offence(s) under sub-section (l); or b) For contravention of any law specified in sub-section of section 8 of the Representation of the People Act, 1951 (43 of 1951); or No.T NpeLtCnBLA ii) Has been convicted for any other offence(s) for which he has been Sentenced to imprisonment for two years or more NU-f RppLt(ABL€- If the answer is "yes" the candidate shall furnish the following information i) Case/first information report No./Nos. .. NIL. ii) Police station(s) .. NIL .. District(s) .. NIL.. (state(s) .. NIL iii)Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted .. NIL iv)Date(s) conviction(s) .. NIL I v) Court(s) which convicted the candidate .. NIL vi)punishment(s) imposed (indicate period of imprisonment(s) and/or quantam of fine(s) .. NIL.. vii)Date(s) of release from prison .. NIL viii) Was/were ay appeal(s) revision(s) filed against above conviction(s) .. NIL ix) Date and particulars of appeal(s)/application(s) for revision filed NIL x) Name of the court(s) before which the appeal(s)/application(s) for revision filed .. NIL xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending .. NIL xii) If the said appeal(s)/application(s) for revision has/have been disposed of a) Date(s) of disPosal .. NIL b) Nature of order(s) Passed ..NIL 2l Whether the candidate is holding any office of profit under the Government of Indi or State Government? .. NO. If yes, details of the office held ....'. NIL 3) whether the candid ate has been declared insolvent by any court? ..No . If yes, has he been discharged from insolvency.. NIL 4l Whether the candidate is under allegiance or adherence to any foreign country.. NO .. If yes, give details .. NIL s) Whether the candidate has been disqualified under Section B A of the said Act by an order of the President .. No If yes, the period for which disqualified .. NIL while 6) Whether the candidate rvas dismissed for corruption or for disloyalty holding office under the Government of India or the Government of any State .. NO. If Yes, the date of such dismissal .. NIL 7l Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in which the candidate has a share fbr supply of any goods to that Government or for execution of works undertaken by that Government"NO" If yes, with which Government and details of subsisting contract(s) ... NIL 8) Whether the candidate is 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 Government has not less than twenty-five percent share .. NIL lf yes, with which Government and the details thereof .. NIL- e) Whether the candidate has been disqualified by the Commission under Section 1O A of the said Act .. NO If yes, the date of disqualification .. NIL Place: Mummidivararn oate:4dMarch, 2Ol9 the Candidate (To be tirr"a or#rrning officer) Serial No. of nomination Paper -- -- -ry OE:S' PF1 This nomination was delivered to me at my office at ...... (hour) on ..ZSl.Oflf 1. (date) by the f,candidate/ o.,.....#ao.h ir.r,'rttrifnq a Score out the word not applicable 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 of the People Act, 1951 and decide as follows:- Date ...... Returning Officer (perforation) PART VI Receipt for Nomination paper and Notice of Scrutiny (To be handed over to the person presenting the Nomination paper) Serial No. of nomination PaPer The nomination paper of ...... a candidate for election from the ...... Assembly constituency was delivered to me at my office at ...... (hour) on ...... (date) by the *Candidate/proposer. A11 nomination papers will be taken up for scrutiny at '...... '..'.(hour) on ...... (date) at ...... '...' (Place) Date. Returning Officer *Score out the word not aPPlicable PART - VI Receipt for Nomination Paper and Notice of Scrutiny (To be handed over to the person presenting the nomination paper) Serial No. of Nomination paper | . 91 The nomination paper of a candidate for election from the 7-Amalapuram (SC) Parliamentary Constituency was delivered to me at my Office at Czlss p{ (hour) on (date) by the Candidate / Proposer. All nomination papers will be taken up for scrutiny at 11.O0 A.M on 26.O3.2O19 at 1't Floor, Revenue Divisional Office, Amalaouram. Place :Amalapuram 1 7 Date : 2,.5 .03.2019. Returnino Officer turisur't ReFurnino 0tfrcer, iloT.lnataouram (50 Partianfuruy furutitnq &'iluniciPat Commisioncr W Airahguram a I E w Ifi ru I I s s I I I I D RUPE E= *{ Ni.-\:Ns-,"r -rDt ()C $Pro -rc, oo1 00 1 001 0 ()c)'f -l 1 0()(-)''t 1 C)O O<>nn ool oo 001 J i)1 c)o (_)(-)r oo'l:\ o o( )1 ( 1 frk 1 r o o( ).t 1 o( )-| 1 o( , l C eeo6f df err*r stvr ANDHRA rRADEsH cE 87 6565 S.No. 1443, Dt. 22.O3.2019, Rs. r00-00 ,r*9'r*!}ffi* * Sold to: $odr{d ea:o6 $15SQ, s/o rood5:ta$r"Q Licensed Stomp Vendor E' L.No.O4-25-029 /2012 Rl/o : esorp66o R.L.No.04-25-011/2018 Mummrdivorom 533 216. For whom: self I &llt A17926A963 FORM 26 I (See Rule 44) ! t I fi Affidavit to be filed by the candidate along with nomination paper before the returning officer for election to the house of people from MEMBER OF PARLIAMENT (Name of the house) from No. 7 OF AMALAPURAIvI (SC) I PARLIAMENTARY CONSTITUENCY (Name of the Constituency) PART-A H t, PANTHAGADA VIJAYA GHAKRAVARTHY son of Narayana Murthy, aged 65 years, resident of D.N0.8.136. DUDALA VARI PETA OF AINAPURAM village. MUMMIDIVARAM lvlandal, East Godavari District ! (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under. fli I am a candidate set up by REPUBLICAN PARTY OF INDIA (RPl. K) (**name of the political party. My name is enrolled in 43 MUMMIDIVARAM ASSEMBLY SEGMENT ANDHRA PRADESH (name of the constituency lrl and the state) at Serial N0.338 in Part N0.59 . My contact telephone numbe(s) is/are 9848379643 and my e-mail id (if any) is No and my social medial account(s) (if any) is /are r^rn Aep(fcAtsL& i) 9848379643 - whatsapp P.V.CHAKRAVARTHY ii) 9848379643 - facebook P.V.CHAKRAVARTHy iii) 9848379643 - NtL AT/TES ',--t.A^4^ ^,-[ffiIffiH.,.T!"" iij0 F[ nm ]uis $t=ed';*6'a 2 income tax return 4) Details of permanent Account Number (PAN) and status of filing of The financial year for Total income shown in lncome tax st. PAN which the last income return (in Rupees) for the last five Name financial years (as on 31s March No. tax return has been filed 2017-2018 Nil 2016-2017 Nil 201 5-201 6 Nil 1 Self AHMPPlSO9M 2014-2015 Nil 2013-2014 Nit NIL 2 SE t..to e^r,ff*L(o[<& NIL HUF (lf the candidate 3 Nil Nir Nil is Karta/ Nil ltA Dependent-1 Nil Nil Nil 6 2 Nir Nil Nil Nit 6 Dependent-3 Nit pAN PAN it should be clearly stated Note it is mandatory for holder to mention PAN and in case of No. "No Pan allotted" 5) Pending Criminal cases i)|declarethattherelnopendingcriminalcasesagainstme; Or ii) The following cases (s) is/are pending against me the alternative and I if there are-pending iriminal'cases igainst the candidate then tick in the table below) score off alteinativeli) above and give details of all pending cases TABLE and address of police NOT NOT a FIR No. with name NOT APPLICABLE APPLICABLE APPLICABLE station concerned NOT NOT b Case No. with name of the court NOT APPLICABLE APPLICABLE APPLICABLE involved c Section(s) of conce rned acts/codes NOT NOT NOT APPLICABLE (give No. of the section, e.g. station.'. of IPC APPLICABLE APPLICABLE etc NOT NOT Brief description of offence APPLICABLE d NOT APPLICABLE APPLICABLE framed mention NOT NOT e Whether charges have been APPLICABLE NOT APPLICABLE APPLICABLE sorNo NOT NOT (e IS YE S t then f tf answer aga nst ) above NOT APPLICABLE APPLICABLE APPLICABLE the d ate 0n wh ich cha WE re framed for revision g Whether any appeal/apPlication NOT NOT APPLICABLE has been filed against the proceedings NOT APPLICABLE APPLICABLE YES or No ATT' l- STE PUBLIC IT AMAIAPURAM.SSS 201 E;G.Dl", {A.P.) lNDtr' J 6) Cases of conviction (Tick this alternative, if the i)l declare that I have not been convicted for any criminal offence. against alternative (ii) below. candidate has not been convicted and write NOT APPLICABLE Or candidate has been convicted, ii) I have been convicted for the offences mentioned below(if the give details in the table below. then tick this alternative and score off alternative(i) above, and NOT APPLICABLE NOT APPLICABLE A Case No NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE B Name of the court C Section of Acts/codes involved (give No. of the section e.g. NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE section .. of IPC etc. of offences for D Brief description NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE which convicted NOT APPLICABLE NOT APPLICABLE E Dates of orders of conviction NOT APPLICABLE APPLICABLE NOT APPLICABLE NOT APPLICABLE F Punishment i NOT G Whether anY appeal has been APPLICABLE filed against conviction order NOT APPLICABLE NOT APPLICABLE NOT mention Yes or No H lf answer to (g) above is YES, APPLICABLE NOT APPLICABLE give details and Present status NOT APPLICABLE NOT of political party about all pending criminal 6A) I have given full and up-to-date information to my paragraphs (5) & cases against me and about all cases of conviction as given in not applicable should clearly write not applicable in view of fOllcanOiiates to whom this item is entries in 5(i) and 6(i), above) Note: letters 1) Details should be entered clearly and legibly in BoLD columns against each item Zi Details to be given separately oieach case under different the latest case to be mentioned first 3i Details shoud be given in reverse chronological order, i.e., and backwards in the order of dates for the other cases 4) Additional sheet may be added if required in compliance of Hon'ble Supreme 5i Candidate is responsible for suppiying all information Court's Judgement in WP@ N0. 536 of 2011 (movable and immovable etc.,) of myself, my 7) That I give herein below the details of the assets spouse and all dePendants of joint ownership will also have to be given. Note: 1) assets in joint name indicating the extent including serial number, amount, date of Note : 2) in case of deposiUinvestmeit, the details Branch are to be gtven' deposit, the scheme, name of the bank/institution and W A TESTE UBLI' i. RY AMAI.APUfrA M-533 ?01 p.) E:G.Dt., i,,1. !ij:!A 4 Note:3) value of bonds/shares 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 Note.4) dependent means parents, son(s), daughte(s) of the candidate or spouse and any other persons related to the candidate whether by blood or marriage, who have no separate means of income and who are dependent on the candidate for their livelihood. Note:5) details including amount is to be given separately in respect of each investment Note.6) details should be 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 countries: S. Depen Depen Depen Self Spouse HUF Description dant-1 Dant 2 Dant 3 No Nit No No No Nil i Cash in hand Rs.50,000-00 ii Details of Deposit in Bank Accounts (FDRs, Term Deposits and all other tYPes of deposits including saving with accounts) deposits Nit Nir Nil Nit Nit financial institutions, Non- Rs Banking financial companies and cooperative societies and the amount in each such deposit tii Details of investment in Bonds/debentu res/shares Nil units in companies/ Nir Nit Nit Nil and Nil mutual funds and other and the amount iv Details of investment in NSS, Postal Saving, lnsurance Policies and Nil Nrl investment in any Nit Nit Nil Financial lnstruments in NiI post office or insurance company and the amount Personal loan/advances given to any person or including firm, entity Nit Nil Nir Nil Nit and company, trust etc., Nil other receivables from debtors and the amount vi Motor vehicles/ Aircrafts/ Yachts/Ships (Details of Nil Nit make, registration Nil Nit Nit Nir number etc., year of and amou vii Jewellery, bullion and valuable thing(s) give Nit Nit Nil Nit Nil Nir details of weight and ,\- value AT ESTE D ( I o ) 5, I + , PU BLIC : ay {L A AMALAP . ,- L/ t:_r 5 viii Any other assets such as value of claims/ Nit Nil Nit Nir Nil Nil lnterest No Rs. Rs Nir ix Gross Total value Rs.50,0001 Nit B. Details of lmmovable assets joint will also have to be Note. 1 properties in joint ownership indicating the extent of ownership indicated in this format Note:2. Each land or building or apartment should be mentioned separately Note:3 details should include the interest in or ownership of offshore assets Depen Depen- Depen- S HUF Description Self Spouse dant-1 Dant 2 Dant 3 No. Agriculture land Nil Nil Nit Location(s) Nit Nil Nir Survey Number (s) Area (total Nit Nit Nil measurement in Nil Nir Nit acres Whether inherited Nil Nit NII Nil Nil Nir es or No Date of purchase in Nir Nil Nil case of self-acquired Nit Nit Nil Cost of land (in case Nil Nil Nil of purchase) at the Nil Nit Nil time of rchase Any investment on land by way of the Nit Nil Nit Nit Nit Nit development, construction etc., Approximate current Nil Nil Nit Nit Nit Nit market value Non-Aqriculture Nil Nil Nil land Location(s) Nit Nil Nit Su Number e Area (total Nit Nir Nit Nit Nit Nit measurement in acres Whether inherited Nit Nir Nit Nil Nit Nil propery ffes or No) Date of purchase in Nil Nil Nit Nil case of self-acquired Nil Nil property Cost of land (in case No Nil of purchase) at the Nit Nit Nir No time of purchase Any investment on by waY of No Nil the land Nit Nit Nit No development, construction etc., current No Nil .Approximate Nit Nit Nit No s l)narket value u€' !} ,iE ) (a I + , rLA t -\ '1' i ..; .:- -,: : 6 iii Commercial Buildinq (including Nil apartments) Nil Nit Nit No No Location(s) Survey No.(s) Area (total No Nit measurement in Nit Nil Nit No sq.ft) Built-up area (Total Nir measurements in Nit Nil Nil No No sq.ft) Whether inherited Nit Nil Nit No No Nil property (yes or No) Date of purchase in No No Nil case of self acquired Nit Nil Nit property Cost of property (in No No Nit case of purchase at Nit Nir Nit the time of purchase) Any investment on the property by way Nit Nil Nil No No Nit of development, construction etc. Approximate current No No Nit market value Nit Nir Nil iv Residential Buildins R.C.C. Building (including apartments) D.Patta Land Nit Nil Nit Nir Nil Location(s)SurveY R.S.No.4B4/1 of No.(s) Ainapuram Area (total 0-03 cts Nil Nir Nil Nit Nit measurement in sq.!) Built-up area (Total Nit Nit measurements in 0-02 cts Nit Nil Nir sq.ft) inherited Whether Yes NiI Nit Nit Nit Nit property (yes or No) Date of purchase in Nil Nit Nit case of self acquired Nil Nil Nil property Cost of propertY (in Nlr Nil case of purchase at Nir Nit Nir Nit the time of purchqgeL Any investment on the property bY waY Nir Nit Nit Nil Rs.3,00,000 Nit of development, construction etc. current Nit Approximate Rs.5,00,000 Nit Nil Nil Nil market value Others (such AS Nil Nil Nil Nil Nil Nit interest in of current market Nit Nil Total Rs.5,00,000 Nil Nil Nil \ value of to above ( A TESTE \ , .r,L f, AMALAP{J |?AIVI.533 201 H.C.Dr., {A.P.) !NDIA 7 and Government (Note: g) I give here below the details of liabilities/dues to public financial institution amount before each pi.ri. give separate details of names of bank, institution, entity or individual and item) Depen Depen- Depen- S. Spouse HUF Description Self dant-'1 Dant 2 Dant 3 No Loan or dues to bank/financial 1 institution(s) Name of the bank or financial institution, amount Nit outstanding, nature of Nil Nit Nit Nit Nil loan Loan or dues to anY other individuals /entitY Nit Nit Nit Nil NJI other than mentioned ^d 2 above Name(s) dr"{ Nru( amount outstanding, Tvrl LL;,1 rrul ffil nature of loan Nit Nit Nil Nil 3 any other liabilitY Nit Nit Nil Nit Nil Nit 4 Grand total of liabilities Nit Nil A Has the deponent been tn 0ccu pation of accommodation provided by the Government at any time during the last ten years before the date of notification of the CU rrent election No Government dues: B) lf answer to (A) above is YES, the following declaration may Due to departments be furnished namelY (pl. tick the dealing with The address of the Government accommodation i) appropriate Government ii1 mere is no dues payable in respect of the above alternative accommodation Government accommodation, towards a) Rent b) ElectricitY charges c) Water charges; and di Telephone iharges as on Nil date (the date should be the last date of the third month prior to the month in which the election is notified or any date thereafter) Note: No Dues certificate from the agencies concerned in respect of rent, electricity charges, water charges and telephone charges for the above government accommodation should be submitted Dep.3 Self Spouse HUF 1 Dep.2 rii Dues to dePartment government Nil dealing with Nil Nit Nir Nir Nir transport (including aircrafts and Nil Nit Nil Nil iv lncome tax dues Nit Nil Nil Nil Nit Nil GS T dues Nil Nil tax Nit Municipal/proPertY Nil Nil Nil Nit Nil ffi dues ,\. ( ( m L-\ 4 \ ) (} + '.t , rr fLA B Nil vii Any other dues Nit Nil Nit Nit Nil viii all Grand total of Nir Nil Nil Nit Nit Nir Government dues ix) whether any other liabilities are in disPute, if mention the amount so, Nil Nit Nil Nil Nit Nir involved, and the authority before which it is pendinq 9) Details of profession or occupation a)Self : Advocate b) Spouse House Wife 9A) details of source(s) of income a) Self Advocate b) Spouse House Wife c) Source of income, if any of dependant NIL 9b) contract with appropriate Government and any public company or companies a)Detailscontractenteredbythecandidatenr,1z by b) Details contracts entered into spouse *,U . ,l c) Details of contracts entered into by dependants '*'ji4 candidate or spouse di Details of contract entered into by Hindu Undivided family or trust in which the or dependants have interest lU{ - or dependants e) Detaiis of contracts, entered into by partnership Firms in which candidgte or spouse are partners $M or dependants f) Details of contracts entered into by private companies in. which candldate or spouse have share ,{I1 10)My Educationalqualification is as under M.A., from Andhra University' June, 2003 8.L., from Andhra University' July, 2001 (Give details of highest school/University education mentioning the full form of the certificate/diploma/degree was completed) course, name of the school/co]lege/University and the year in which the course PART- B 11) ABSTRACT OF THE DETAILS GIVEN lN (1) TO (10) 0F PART - A VIJ A A C HAKRA VART H Y 1 Name of the candidates Sri PANT H AGADA MurthY 2 Full postal address S/o Narayana D.No.8-136, Dudala vari Peta of Ainapuram Mummidivaram Ma E.G Dist AMALAPURAM (SC) PARLIAMENTARY 3 Number and name of the No. 7 c0 and state CONSTITUENCY PARTY oF rND|A (RPl.K) 4 Name of the Political PartY which set up the REPUBLICAN \ candidate other than write 'lnd ent' ATTEST I )5 I + t ,ui I,LA AM[ffir',jB$'$s1"0' BG.DI., (4.P.) INDIA 9 5 i) Total number of pending cases where charges have been framed by the court for Nil offences punishable with imprisonment for two 0r more ii) Total number of pending ca SCS where th e nizance (other than Nit c0u rt( S) have taken c0g the CASCS mentioned n item (i) arbover) t-l Total number of cases in which convicted and sentenced to imprisonment for one year Nil or more (except for offences referred to in sub-sections (1) (2) or (3e) of section 8 of Representation of the people Act, 1951) Year for which last totalincome PAN of 7 income tax return filed shown Nit Candidate AHMPPlB09M 2017-18 Nil Nil b NIL Nit Nir HUF Nit Nil Nit ndants 1 Nil Nil Nil e)Dependants 2 Nit o Details of assets and liabilities (including offshore assets) in Rupees Depen Depen- Depen- Spouse HUF Description Self dant-1 Dant 2 Dant 3 No. A Moveable Assets Nil Nit Nil Nil Nil Nil otal value Nil Nil Nil Nil B lmmovable Asset Purchase price of self Nit Nil Nir Nil acquired immovable Nil Nil DevelopmenUconstruction cost Nir Nil Nil Nil Nit of immovable ProPertY after Rs.3,00,000 Current lil Approximate Rs.5,00,000 Nit Nil Nit Nit Nit market of self acquired assets Nil Nil a) Nit Nil Nil Nil otal value inherited assets Nir Nit b) Rs.5,00,000 Nil Nil Nit otal value Nit Nil Nit Nit 9 Liabilities Nit Nil Nit Nil Nil Nil Nil Nit I Government dues ll Loans from Bank, Nil Nil Nil Nir Financial institutions and Nit Nit others 10 that are under NiI NiI Liabilities Nit Nil Nit Nil dues (Total) Nil Ntl Government Nil Nil Nir Nil ( to I o ) q , t + l0 Loans from Bank, Financial lnstitutions and Nil Nit Nil Nil Nil Nil others (Total) 11 Highest educational Qualiflcations: M.A., from Andhra University' June,2003 8.L., from Andhra University' July, 2001 mentioning the full from of the (Give details of highest school/University education . and the year in which iertificate/diploma/degiee courses, name of ihe school/college/ University the course was com VERIF TION of this affidavit are true l, the deponent, above named, do hereby verify and declare thatihe contents part false and nothing material has been and correct to the best of my knowledge and betief and no of it is concealed there from, I further declare that:- mentioned in items 5 and 6 a) There is no case of conviction or pending case against me other than those of part A and B above mentioned in items b) l, my spouse, or my dependents do not have any assets or liability, other than those 7 and B of part A and items B, 9 and 10 of Part B above Verified at Mummidivaram this lhe 25 Day of March, 2019' nomination Note: 1) Affidavit should be filed lasted by 3-00 p.m. on the last day of filing the First Class or Note: 2) Affidavit should be sworn before an oath Commissioner or Magistrate of Before a Notary Public no information to furnish Note: 3) All column should be filed up and no column to be left blank. lf there is in respect of any item, either "nil" or "Not applicable", as the case may be should be mentioned. Note:4) The affidavit should be either typed or written legibly and neatly" bear on Note 5) Each page of the affidavit should be signed by the deponent and the affidavit should each page the stamp of the Notary or oath commissioner or Magistrate before whom the affidavit is sworn) (Ministry of law & Justice notification No. H 11019 (4)/2018-Leg.ll, dated 1Oth October, 2018 No. H 11019/13/2016-Leg.ll, dated 26h February, 2019) E; and notification 5 + , At A TESTED t -n BLIC { l \- b, AMATAPURAM.SSS 201. t {r \l .\ E;c.st., {4.P.) lNDi { r,f,rtif,l HiolBBzr