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Sl.No. in Part No. -- of the Electoral Roll for the 43 MUMMIDIVARAM Assembly Constituency

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Sl.No. in Part No. -- of the Electoral Roll for the 43 MUMMIDIVARAM Assembly Constituency 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*<lrt rg rsls lrq q B sq aj+ ds&a,[ffu;r { --, rsl rlrt 9 sg \6fr ? 6il."f $oL b,E4zt rslr lrq 10 rg trTo eSood S furJ k*s-h4f z-slr 1 ,q N.B. there should ten electors of the constituency as proposers. 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.
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