FORM2A (See rule 4)
NOMINATION PAPER Election to the House of the People
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,'i 1:1 ,:1 . STlUKE OFF PA:. T I OR PART II BELOW WHICHEVER IS NOT APPLICABLE I i 1 PART I :'1 (To be use by candidate set up by recoganised Political Party) ;:i· I nominate ~s election to the house of the people from the
...... ii·f...... Candid1 ate's name . . ,I Fathen's/mother's/husband's name His postal address ...... ~ P.O P.S...... : , Dist. , Pin No , West Bengal. His name is entered at S. No in Part No of the electoral roll for '...... (Assembly Constituency comprised within)
My name is •..' and it is e ered at S. No...... •. in Part No of the electoral roll for (Assembly Constituency comprised within) ...... ~.>~ -;- .
Date. Signature of the proposer
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PART II i .r(To be used by candidate NOT set up by recoganised political party) We hereby nominated. as candidate for election to the House of the people from the 15 - BARRACKPOREiiParlia'mentary Constituency. ,ii Candidate's nameiGANESH DAS father's Imothel'sfhttsbMid's name Late. PREMCHANDRA DAS • I II His postal address f'40, ruSHI BANKIM CHANDRA ROAD, P.O: GARIFA, P.S. NAIHATI, DIST. NORTH 24 PARGANAS, PIN NO. 743166,WEST BENGAL. His name is entered at S. No. 648 in Part / no. 118 of the electoral roll for 104 - NAIHATI (Assembly Constituency comprised within) 15 - BARRACKPORE". Parli$1entary Constituency. I't Wfi(declareli1,1'that we are electors of the parliamentary constituency and our names are entered in the electoral r6ll for th~t Parliamentary Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:- ;1, Particulars of the proposers and their signatures
S1. Name of ~ Elector Roll No. of Component i proposer No. Full Name Signature Date Assembly \' Part No. of S. No. Con~tituency Electoral in that i part Roll 7 3 4 5 6 1 2 :1 , 16/04/19 Rarljeet Kumar Singh 106~lDL. 99 t> 153 Ro-.~~~~"-V- - 1 ,. ,- '" ~6/04/19 106 99 DipakKewat Kett)q} 2 'I II ./ '" 199 ~ttk ! 16/04/19 99 Nagman Mallah y17") R-I r:rI V1crm IE- 3 106 ..-v 201 " 16/04/19 , Om Prakash Sahani 4 106 .J, 99 .~ 217 G
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PART III I, the Candidate mentioned in Part I / Part II (Strike out which is not applicable) assent to this nomination and hereby declare• (a) that I, am citizen of India and have not acquired the citizenship of any foreign state / country. I ',p; (b) that I have eompleted 57 years of age.
[STRIKE OUT c (i) G>R! c (ii), BELOW WHICHEVER IS NOT APPLICABLE] (c) (i) that I am:~et up at this election by the NOT APPLICABLE, which is recoganised National Party / State Party in this State and,that the symbol reserved for the above party be allotted to me.
,j OR (c) (ii)' that lam '~~tup at this election by the INDEPENDANT party, which is a resiitered HIlre~oSl1iiedpoliti~al party / that Iam contesting this election as an independent candidate. (Strike out which is not applicable) and that the symbols I have chosen, ~ order bf preference, are:- ! it! , (i) CC'J1V (ii) COMPUTER (iii) TV, REMOTE (d) that;my name and my father's/mother's/husband's name have been correctly spelt out above in ENGLISH (name,of the lan~'Iage);
'(e)' That to the b~Ist of my knowledge and'belief, I am qualified and not also disqualified for being chosen' to fill the seat in the H~use of'the People. *I'further de~~arethat I am a member of the NOT APPLICABLE ** Caste/tribe which is a Scheduled ** Caste/tribe of
I the state of $OT A~PLICABLE in relation to NOT APPLICABLE (area) in that state. I also declareithat I have not been, and shall not be nominated as a candidate at the present general election/bye _ I I" ~s beirtg held simultaneously, to the House of the People from more than two Parliamentary Constituencies.
Date 16/04/2019 'ji: H
, I Signature of candidate ! Score out t~e words "assembly constituency comprised within" in the case of the Jammu and Kashmir, Andaman Nicobar Isla~6s, Chandigarh, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep I "score out this paragraph, if not applicable. I **Score out ~hewords not applicable. N.B. -A "reqoganised political party" means a political party recoganised by the Election Commission under the I Election symbols (Reservation and Allotment) order, 1968 in the state concerned. ,I d:'
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I, I:! 3 'I' I 'i ;il [PART IlIA] (To be filled by the Candidate) , 1. Whether the icandidate - ./ (i) has be c'6nvicted- " (a) ofan~ offence (s) under sub-section (1); or !: (b) for c6ntravention of any law specified in sub-section (2) , of section 8 of the Representation of the People Act,1951 (43 of 1951);or
" (ii) has been'convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. , I I If the answer is "Yes", the candidate shall furnish the following information: ~I I (i) qase/Fir~t information report No. / Nos. NOT APPLICABLE (ii) ~~lice st~tion (s) NOT APPLICABLE District(s) NOT APPLICABLE State(s) NOT APPLICABLE. Siection(s) of the concerned Act(s) and brief description of the offence(s) 'for which he has been convicted , ,OT A~PLICABLE. , (iii) "Qate(s)Jr conviction(s) NOT APPLICABLE :II (iv) Courus) which convicted the candidate NOT APPLICABLE I (v) eunishment(s) imposed [indicate period of imprisonment (s) and! or quantum of fine (s) NOT APPLICABLE ~(vi) ~ate(s) of release from prison NOT APPLICABLE (vii) ras/were any appeal(s) revision(s) filled against above conviction(s) rs/No (viii) pate and particulars ofappeal(s) / application (s) for revision filed NOT APPLICABLE " (ix) Name of the court(s) before which the appeal(s)/application(s) for revision filed NOT APPLICABLE , , (x) Whetherthe saidappeaJs(s)appJication(s)for revisionhas/havebeendisposedof or is / are pendingNOT APPLICABLE (xi) If the said appeahs) appJication(s)for revision has/have been disposed of- (~) Daters) of disposal NOT APPLICABLE. (~) Natvre of order (s) passed NOT APPLICABLE. (2) Whether the c~didate is holding any office of profit under the Government ofIndia or State Government? cytsINO) -If Yes, .details of the office held NOT APPLICABLE (3) Whether the c~didate ~as been declared insolvent by any court? (yisINO) -If'Yes.ihas he been discharge from insolvency Not Applicable (4) Whether the candidate is under allegiance or adherence to any foreign country? etlNo) , -If Yes,' give details Not Applicable (5) Whether the c~didate has been disqualified under section 8A of the said Act by the order of the president? ...... _CjsINO)
-If Yes,,the period-.for which disqualified Not Applicable (6) Whether the carididate was dismissed for corruption or for this loyalty while holding office under the Government ofIndia or Governmenl of any:State? (Y/slNo) I', TO -If Yes, the date of.such dismissal Not Applicable (7) Whether the candidate has any subsisting contract(s) with the Government either in individual capacity or by trust or partnership in Jhich the candidate has a share for supply of any goods to that Government or for execution of works und~rtaken by t~at Government? Cl'sINO) -If Yes, with which Government and details of subsisting contract(s) Not Applicable I I 9 4 'i' , (8) Whether the c~didate is a managing agent, or manager or Secretary of any company or corporation (other than a
cooperative society) i4 the ca;Zit Iof which the central Government or State Government has not less than twenty five percent share~r ; ( es!No) . :: -If Yes, with whlchGovernment and the details thereof Not Applicable (9) Whether the ca*didate ras been disqualified by the commission under section lOA of the said Act. 7eS!NO) -If Yes, the date of:~hisdisqualification Not Applicable
~i. Place: Barasat] c., Date: ,16:~04/2019 Signature of Candidate
I I}i PARTV Iii' Deeision of Returning officer Accepting or Rejecting the Nomination Paper ! I have examined this nomination paper in accordance with section36 of Representation of the People Act, 1951 (43 of I 1951) and decide as follows:- ....•.••...... • ',:;:Ir ~••...... ••...... •...•...... •.•...... •..•.•...... •...... •......
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5 - BEFORE THE N01AR"
TEN RUPEES
Rs.10
rl-. • qp~:qB~TTR WEST BENGAL
AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG WITH NOMINATION PAPER J BEFORE THE RETURN,:NG OFFICER FOR ELECTION TO 15 - BARRACKPORE PARLIAMENTARY CONSTITUENCY (NAME OF THE HOUSE) FROM 104- NAIRA TIASSEMBLY CONSTITUENCY (NAME OF THE CONSTITUENCy)
PART-A
I, GlXNESH DAS , Sonof Late PREMCHANDRA DAS Aged 57 years, resident of 440, Rishi Bankim Ch~~ra Road, P.O: Garifa,. P.S Naihati, Dist. 24 Pgs. (N) Pin. 743166 (W.B) (mention full Postal address), a candidate at the above election, do hereby solemnly affirm and state orroath as under:-
(ll J am a can~idate set up by NOT APPL!CABLE (~*aame~cal ~a~!) / amContestmg as an Independent candtdate.(**stnke out whichever is not applicable)
(2) M~ name is enrolled in 104, Naihati Assembly Constituency, (West Bengal) (Name of the ConstItuency and the state), at serial No. 648, in part No. 118.
1,1 2 APR 20'9 1 i_ ""_
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,. (4)Details of Permanent Account Number (PAN) and status of filing ofIncome Tax return:
Sl. Names PAN The financial year Total income shown No. for which the last in Income -Tax Income- tax return Return (in Rupees) has been filed for the last five financial years completed (as on 31st March) FY-2013-2014 (i) NIL 1. Self - GANESHDAS ALTPD6337R FY-2014-2015 (ii) NIL FY-2015-2016 (iii) Rs. 2,67,860.00 FY-2016-2017 (iv) Its. 2,98,970.00 FY-2017-2018 (v) Rs. 2,10,000.00 2. FY-2013-2014 (i) Nil (ii) Spouse - MANJUSREE DAS AMBPD0465D FY-2014-2015 Nil FY-2015-2016 (iii) 2,15,000.00 (iv) FY-2016-2017 2,67,300.00 (v) FY-2017-2018 1,56,000.00
3. (i) Nil HUF (If Candidate is Karta / (ii) Nil Coparcener Nil Nil (iii) Nil (iv) Nil (v) Nil 4. (i) Nil (ii) Nil Dependent-l Nil Nil (iii) Nil (iv) Nil (v) Nil 5. (i) Nil (ii) Nil Dependent-2 Nil Nil (iii) Nil
, (iv) Nil (v) Nil 6. (i) Nil (ii) Nil Dependent-3 Nil Nil (iii) Nil (iv) Nli (v) Nil
Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly stated "No PAN allotted".
II2 APR 201
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\ \ (5) Pending criminal Cases (i) I declare that there is no pending criminal case against me(Tick this alternative if there is no criminal case pending against the candidate and write NOT APPLICABLEagainst alternative (ii) below)
OR (ii) The following criminal Cases are pending against me: (If there are pending criminal cases against the candidate, then tick this alternative and score off alternative (i) above, and give details of all pending cases in the Table below)
Table
(a) FIR No. with name and address Case No.1. of the police station concerned Naihati P.S. Case No.829/2018, dated 10/12/2018, State vis Ganesh Das & others. U/s-341/325/326/307/34 & 25/27 Arms Act of I.P.C. GR Case- 7267/2018
Case No.2. Naihati P.S. Case No.527/2017, dated 27/07/2017 U/s-341/323/506 of I.P.C. GRCase - 5048/2017
Case No.3. Naihati P~S.GR Case No.715/2010 State v/ s Ganesh Das U/s- 120B IPe & U/s- 25/27/35 Arms Act. (b) Case No. with name of the court Case No.1. Name of the court: LdACJM Barrackpore, Naihati P.S. Case No. 829/2018, dated 10/12/2018.
Case No.2. Name of the court: Ld ACJM Barrackpore, Naihati P.S. Case No. 527/2017, dated 27/07/2017.
Case No.3. Name of the court: Ld ACJMBarrackpore, Naihati P.S. Case/GR No. 715/2010. (c) Section(s) of concerned acts / Case No.1. Naihati P.S. Case No.829/2018, dated codes involved (give no. of the 10/12/2018, State vis Oanesh Das & others. section, e.g, section ...... OfIPC, U/s- 341/325/326/307/34 & 25/27 Arms Act etc.). ofI.P.C. ORCase- 7267/2018.
Case No.2. Naihati P.S. Case No.527/2017, dated 27/07/2017 U/s- 341/323/506 ofI.P.C. ORCase - 5048/2017.
Case No.3. Naihati P.S. ORCase No.715/2010 State vis Ganesh Das ist«. 1208 IPC & U/s- 25/27/35ArmsAct. (d) Brief description of offence Case no 1. Sections stated on wrongful Restrain, Voluntarily Causing Grievous Hurt, Voluntarily causing grievous hurt by dangerous weapon or means, attempt to murder with common intention and Arms Acts. Case no 2. Sections stated on wrongful restrain, Voluntarily causing hurt and threatening. Case no 3. Sections stated on conspiracy with Arms. (e) Whether charges have been NOT APPLICABLE framed (mention YES or NO) (f) If answer against (e) above is NOT APPLICABLE YES, then give the date on which charges were framed ~g) Whether any Appeal/Application for revision has been filed against NOT APPLICABLE the proceeding (Mention YES or NO)
(6) Cases of Conviction (i) I declare that I have not been convicted for any criminal offence. (Tick this alternative, if the candidate has not been convicted and write NOT APPLICABLEagainst alternative (ii) below)
[[ OR (ii) I have been convicted for the offences mentioned below: (Ifthe candidate has been convicted, then tick this alternative and score off alternative (i) above, and give details in the Table below) Table
(a) Case No. NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (b) Name of the Court NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (c) Sections of acts/Codes involved NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (give no. of the section, e.g. section ... IPC, etc. (d) Brief description of offence for NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE which convicted (e) Dates of orders of conviction NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (:0 Punishment imposed NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE (g) Whether any Appeal has been NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE filed against conviction order (Mention YES or No) (h) If answer to (g) above is YES, NOT APPLICABLE NOT APPLICABLE NOT APPLICABLE give details and 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 & 6. [Candidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i) above]
!1 2 APR 2019
4 Note: 1. Details should be entered clearly and legibly in BOLD letters. 2. Details to be given separately for each case under different columns against each item. 3. Details should be given in reverse chronological order, i.e., the latest case to be mention first and backward in the order of dates for the other cases. 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court's judgment in W.P. (C) No. 536 of2011.
(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 ofjoint 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 Bank / Institution and Branch are to be given. Note: 3. Value of Bond / share / Debentures as per the 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), daughter(s) of the candidate or spouse and any other person 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, deta:ils 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. Description Self Spouse HUF Depend Depen Depen No. ent dent dent
1 2 3
(i) Cash in hand 35,468.00 9,567.00 Nil Nil Nil Nil
(ii) Details of deposit in State BankOfIndia Nil Nil Nil Nil Nil Bank accounts (FDRs, SavingAccountNo- Term Deposit and all 34800106186: other types of Deposits Rs.3137.50 including saving accounts), deposits with Financial Institutions, Non-Banking, Financial Companies and Cooperative societies and the amount in each such deposit
(iii) Details of investment in Nil Nil Nil Nil Nil Nil Bonds, Debentures / shares and units in companies /Mutual Funds and others and the amount.
II2 APR 2019 (iv) Details of investment in Nil Nil Nll Nil Nil Nil NSS, Postal Saving, Insurance Policies and Investment in any financial instruments in Post office or Insurance company and the amount. (v) Personal Loans / Nil Nil Nil Nil Nil Nil advance given to any person or entity including firm, company , Trust etc. and other receivables from debtors and the amount. (vi) Motor Vehicles / Nil Nil Nil Nil Nil Aircrafts / Yachts / Ships Nil (Details of Make, registration number etc. year of purchase and amount).
(vii) Jwellery, bullion and 50 Gms.. 70 Gms. Nil Nil Nil Nil valuable thing(s) (given details of weight and Rs.1,75,000.00 Rs.2,35,000.00 value)
(viii) Any other assets such as Nil Nil Nil Nil Nil Nil value of claims / interest
(ix) Gross Total Value Rs.2,13,605.50 Rs.2,44,567.00 Nil Nil Nil Nil
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.
S. Description Self Spouse HUF Depende Depende Depende No. nt nt nt3 1 2 (i) Agricultural Land Nil Nil Nil Nil Nil Nil Location( s) Survey number(s) Area (total measurement in acres) Nil Nil Nil Nil Nil Nil Whether inherited Nil Nil Nil Nil Nil Nil Property (Yes or No) Date of purchase in case of self- Nil Nil Nil Nil Nil Nil acquired property
Cost of Land(in case of purchase) at Nil Nil Nil Nil Nil Nil the time of purchase Any investment on the land by way Nil Nil Nil Nil Nil Nil of development, construction etc. Approximate current market value Nil Nil Nil Nil Nil Nil
II 2 APR 2019 Nil Nil (ii) Non-Agricultural land Nil Nil Nil Nil Location(s) Survey numbers(s) Area (total measurement in sq. ft.) Nil Nil Nil Nil Nil Nil Whether inherited property (Yes or Nil Nil Nil Nil Nil Nil No) Date of purchase in case of se1f- Nil Nil Nil Nil Nil Nil acquired property Cost of Land (in case of purchase) Nil Nil Nil Nil Nil Nil at thetime of purchase Any Investment on the land by way Nil Nil Nil Nil Nil Nil of development, construction etc. Approximate current market value Nil Nil Nil Nil Nil Nil Nil (iii) Commercial Buildings Nil Nil Nil Nil (including apartments)- Nil -Location(s) -Survey(s) Area (total measurement in sq. ft) Nil Nil Nil Nil Nil Nil Built-up Area (total measurement in Nil Nil Nil Nil Nil Nil SQ. ft) Whether inherited property (YES or Nil Nil Nil Nil Nil Nil NO) Date of purchase in case of self- Nil Nil Nil Nil Nil Nil acquired property Cost of property (in case of Nil Nil Nil Nil Nil Nil purchase) at the time of purchase Any Investment on the property by Nil Nil Nil Nil Nil Nil way of development, construction etc. Approximate current market value Nil Nil Nil Nil Nil Nil (iv) Residential Buildings 440, Rishi Nil Nil Nil Nil Nil (including apartments): Bankim Chandra -Location(s) Road, Post office -Survey number(s) and Police Station: - Naihati, Dist.:- North 24 Parganas, Pin- 743166. West Bengal. Area(total measurement in sq. ft) Nil Nil Nil Nil Nil Nil Builtup Area (Total measurement in Nil Nil Nil Nil Nil Nil sq. ft) Whether inherited property (Yes or Nil Nil Nil Nil Nil Nil No) Date of purchase in case of self- Nil Nil Nil Nil Nil Nil acquired property Cost of property (in case of Nil Nil Nil Nil Nil Nil purchase) at the time of purchase Any Investment on the land by way Nil Nil Nil Nil Nil Nil of development, construction etc.
Approximate current market value Nil Nil Nil Nil Nil Nil (v) Other (such as interest in property) Nil Nil Nil Nil Nil Nil (vi) Total of current market value of (i) Nil Nil Nil Nil Nil Nil to (v) above
~12 APR 201S
7 (8) I give herein below the details of liabilities/dues to public financial institutions andgovernment:• (Note: please give separate details of name of bank, institution, entity or individual and amount before each item)
S. Description Self Spouse HUF Dependen Dependent- Dependen No. t-l 2 t-3 (i) Loan or dues to Bank / Nil Nil Nil Nil Nil Nil Financial Institution(s) Name of Bank or financial Institution, Amount outstanding, Nature of Loan Loan or dues to any other Nil Nil Nil Nil Nil Nil individuals/entity other than mentioned above Name(s), Amount outstanding, nature of loan Any other liability Nil Nil Nil Nil Nil Nil Grand total of liabilities Nil Nil Nil Nil Nil Nil (ii) Government Dues: (A) Has the Deponent been in occupation of YES/ accommodation provided by the Government at NO Dues to departments dealing any time during the last ten years before the date of (PI. tick the appropriate with Government notification of the current election? alternative) accommodation (B) If answer to (A) above is YES, the following Nil declaration may be furnished namely:-
(i) The address of the Government Nil accommodation: Not applicable
(ii) There is no dues payable in respect of above Government accommodation, Nil towards- (a) rent; (b) electricity charges;NIL (c) water Charges; and ""L (d) telephone charges as on..... (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 inrespect of rent, electricity charges, water charges and telephone charges for the above Government accommodation should be submitted.
(iii) Dues to department dealing with Nil Nil Nil Nil Nil Nil Government transport(including Aircrafts and helicopters)
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Self Spouse HUF Dependent Dependent Dependent -1 -2 -3 (iv) Income Tax dues Nil Nil Nil Nil Nil Nil (v). GST dues NlI Nil Nil Nil Nil Nii (vi) Municipal/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 Nil Nil Nil Nil Nii Nil dues (ix) Whether any other liabilities are Nil Nil Nil Nil Nil Nil in dispute, if so, mention the amount involved and the authority before which it is pending.
(9) Details of profession or occupation:
(a) Self Business qb) Spouse Housewife
('ill)Details bfsource(s) of income: (a) Self ' Business (b). Spouse Housewife (c) Source of income, if any,of dependents, NOT APPLICABLE
(913)Contracts with appropriate Government and any public company or companies (a) Detailsof contracts entered by the candidateN.A. (b) Details of contracts entered into by spouseN .A. (c) r?etails of contracts entered into by dependents N.A. (d) Details of contracts entered into by Hindu Undivided Family or trust in which the candidate dr spouse or dependents have interest N.A. (e) Details of contracts,entered into by Partnership Firms in which candidate or spouse or dependents are partnersN.A. (f) Details of contracts, entered into by Private companies in which candidate or spouse or dependents have shareN.A. (10) My educational qualification is as under: - Matriculation Passed from Adarsha Hindi High School, Hazinagar, in the year 1977
(Give details of highest SchoollUniversity 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.)
PART-B (11) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART -A:
1. Name of the candidate GANESHDAS 2. Full postal address 440, Rishi Bankim Chandra Road, Post office - Garifa, Police Station: - Naihati, Dist.:- North 24 Parganas, Pin.:.743166.West Bengal. 3. Number and name of the constituency and 104 - Naihati Assembly Constituency and West State Bengal 4. Name of the political party which set up the Independent candidate (otherwise write' Independent') 5. Total number of pending criminal cases 03 (three) Cases
6. Total Number of cases in which convicted Not Applicable ,
112 APR 201t 7. PAN of Year for which last Total Income shown Income Tax Return filed i (a) Candidate ALTPD6337R FY-2017-2018 Rs.2,10,000.00
(b) Spouse AMBPD0465D FY-2017-2018 Rs. 1,56,000.00 (c) HUF Nil Nil Nil
(c) Dependent Nil Nil Nil
8. Details of Assets and Liabilities (including offshore assets) in rupees 'Description Self Spouse HUF Dependent Dependent Dependent 1 2 3 A. Movable Nil Nil Nil Nil Nil Nil Assets(Total value) B. Immovable NIL Nil Nil Nil Nil Nil ~ssets I. Purchase Price Nil Nil Nil Nil Nil Nil of self-acquired immovable property II. Development/c Nil , Nil Nil Nil Nil Nil onstruction cost of immovable property after purchase (if applicable) III. Approximate Nil Nil Nil Nil Nil Nil Current market I price- (al) Self- acquired assets (Total Value) (b) Inherited
I assets (Total Value) ,
9. Liabilities (i) Government Nil Nil Nil Nil Nil dues (Total) . (ii) Loans from Nil Nil Nil Nil Nil Bank, Financial Institutions and others (Total) 10 Liabilities that ~re under dispute (i) Government Nil Nil Nil Nil Nil dues (Total) (ii) Loans from Nil Nil Nil Nil Nil Bank, Financial Institutions and others (Total)
2 APR 2019 1 0 ,
Highest education qualification:Matriculation Passed from Adarsha Hindi High School, 11 Hazinagar, in the year 1977
(Give 'details of highest SchoollUniversity 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 and no part of it is false and nothing material has been concealed therefrom. I further declare that:-
(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, ormy dependents do not have any assets or liability, other than those mentioned in, items 7 and 8 of Part A and items 8, 9 and 10 of Part B above.
Verified atBarrackpore thisthe 12th dayof April 2019.
DEPONENT
Note: l.Affidavit should be filed latest by 3.00PM on the last day filing nominations. Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or Before a Notary Public. Note: 3. All columns should be filled up and no Column to be left blank. Ifthere is no information to furnish in respect of any item, either "Nil" or "Not applicable", as the case may be, should be mentioned. Note: 4. The iAffidavit should be either typed or written legibly and neatly. Note: 5. Each page of the affidavit should be signed by the deponent and the affidavit should bear on each page the stamp of the Notary or Oath Commissioner or Magistrate before whom the Affidavit is sworn.
SOLEMNLY AfFIRMEt. & DECLARED BE -ORE ML: ON l·t···A.p ·~8W·"·
I2 APR 20~