Bishnupar»At>Ali3j M Low

Home , Chandrakona, Ghatal, Ramjibanpur

Affidavit to be Furnished by the candidate alongwith Nomination Paper u Before the Returning Officer " For election to West Bengal Assembly (name of the House) A From 232 Chandrakona (S.C.) Assembly Constituency (Name of the Constituency)

I Sibaram Das, son of Late Anil Kumar Das, Aged about 34 years, resident of VU1.+ PO.-Ramjibanpur, P.S.-Chandrakona, Dist.-Paschim Medinipur (mention \ full postal address) a candidate at the above Election, do hereby solemnly af• firm and state on oath as under :- (Strike out whichever is not applicable)

B (1) I am a candidate set up by All India Trinamul Congress (AITC) (Name of 1 the political party) / am contesting as an Independent candidate.

BishnuPar»at>ali3j M low/ Notary ( Govt of jcdii ) ' l) Details of PAN and Status of filling of Income tax return :

SI. No. Names Permanent The financial year for Total income shown Account which the last income-tax in income Tax Number (PAN) return has been filed Return (in Rupees) 1. Self BBCPD5161M 2009-2010 Rs. 1,61,014/- 2. Spouse N.A. N.A. N.A. 3. , Dependent 1 N.A. N.A. N.A. 4. Dependent 2 N.A. N.A. N.A. 5. Dependent 3 N.A. N.A. N.A.

(3) The following case(s) is / are pending against me in which cognizance has been taken by the court.

SI. Offence Description No. (a) The details of cases where the court has taken cogni• N.A. zance, Sections of the Act and description of the offence for which cognizance taken : (b) Name of the court, case No. and date of order taking N.A. cognizance:

(4) Cases in which I have been convicted by a court of law (other those referred to in Form 26 ) :

(a) The details of cases, Sections of the Act and description of the offence for which convicted: N.A.

(b) Name of the Court(s), Case No. and Date(s) N.A. of order(s)

1 [ 3 ] J) 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. 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. 3. Value of Bonds / Share / Debentures as per the current market value in Sotck Exchange in respect of listed companies and as per books in case of non-listed companies should be given. 4. Dependent, here means a person, substantially dependent on the income of the candidate. 5. Details including amount is to be given seperately in respecto f each investment.)

SI. Description Self Spouse Dependent Dependent Dependent No. No.l No.2 No.3 i) Cash in hand Rs. 16,5007- Rs. 19,500/- N.A. N.A. N.A.

'0 Details of Deposits in Bank UCO. Bank UCO. Bank accounts (FDRs, Term Deposits Ramjibanpur Ramjibanpur A/c. No. A/c. No. and all other types of Deposits 043401100O79J2 04340110008485 including saving accounts), Depos• Rs. 400O00/. Rs. 73,270/. N.A. N.A. N.A. Post Office Post Office its with Financial Institution, Non A/C. No. 136756 A/C. No. 0496 Banking Financial Companies and Rs. 40,000/- Rs. 1,768/- 136753 Cooperative societies and the Rs. 40,000/-1442181 amount in each such deposit. Rs. 42,845/. Hi) Details of investment in Bonds, Debentures / shares and units in N.A. N.A. N.A. N.A. N.A. companies / Mutual Funds and others and the amount. iv) Details of investment in NSS, L.I.C. Policy L.I.C. Postal Savings, Insurance Policies No. Policy No. N.A. N.A. N.A. and investment in any Financial 436428611 498795903 Instrument in Post Office or Rs. 12,500/- Rs. 6000/- Insurance Company and the 439417129 499038725 amount. Rs. 30,882/- Rs, 8000/- v) Personal loans / advance given to any person or entity including firm, Company, Trust etc. and otehr N.A. N.A. N.A. N.A. N.A. receivables from debtors and the amount. vi) Motor Vehicles / Aircrafts / Yachts / Ships (details or Make, Registra• N.A. N.A. N.A. N.A. N.A. tion No. etc, Year of Purchase and amount) Jewelry, bullion and valuable thing vii) N.A. 30gm N.A. N.A. (give details of weight andvalue) Rs.60,000/- N.A. viii) Any other assets such as value of N.A. N.A. N.A. N.A. N.A. Claims / interest ix) Gross Total value Rs. 5,66,227/- Rs. 1,49,038/- N.A. N.A. N.A. B. Details of Immovable assets : Note : 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated. 1. Each land or building or apartment should be mentioned separately in this format. 1

ft 9 V Aoown to me & Sig&ao I * J ascription Self Spouse Dependent Dependent Dependent No.l No.2 No.3 7 Agricultural Land N.A. Location (s) N.A. N.A. N.A. N.A. Survey number (s) Area (Total measurement in acres) N.A. N.A. N.A. N.A. N.A.

Whether inherited property N.A. N.A. N.A. N.A. N.A. (Yes or No)

Date of purchase in case of self N.A. N.A. N.A. N.A. N.A. acquired properly

Cost of Land (in case of purchase) N.A. N.A. N.A. N.A. N.A. at the time of purchase

Any Investment on the land by way N.A. N.A. N.A. N.A. of development, construction etc. N.A. Approximate Courrent market value N.A. N.A. N.A. N.A. N.A. Non-Aericultural Land Ramjibanpur Location(s) J.L.No. 16 N.A. N.A. N.A. N.A. Survey number(s) Area (Total measurement in sq.ft.) 3500sq.ft. N.A. N.A. N.A. N.A. Whether inherited property N.A. N.A. N.A. (Yes or No) Yes N.A.

Date of purchase in case of self N.A. N.A. N.A. N.A. acquired property N.A. Cost of Land (in case of purchase) N.A. N.A. N.A. N.A. at the time of purchase N.A. Any Investment on the land by way N.A. N.A. N.A. N.A. N.A. of development, construction etc. Approximate Courrent market value N.A. N.A. N.A. N.A. N.A. Commercial Buildings (including apartments Ramjibanpur Ramjibanpur N.A. N.A. N.A. Location(s) J.L.No. 16 J.L.No. 16 Survey numbers)

Built up Area (Total measurement in 2Rooms(10xl2) 1 Room N.A. N.A. N.A. sq.ft. = 240 sq.ft. 120 Sq.ft.

Whether inherited property No No N.A. N.A. N.A. (Yes or No) Date of purchase in case of self Rental Rental N.A. N.A. N.A. acquired property Cost of Land (in case of purchase) N.A. N.A. N.A. N.A. at the time of purchase N.A. Any Investment on the land by way N.A. N.A. N.A. N.A. N.A. of development, construction etc.

Approximate Courrent market value Rs. 40,000/- Rs. 30,000/- N.A. N.A. N.A.

Inown to m« & Sign** Residential Building (including Ramjibanpur JUL No. 16 apartments) N.A. N.A. N.A. N.A. 1 -Location (s) -Survey number(s) Area (Total measurement in sq.ft.) 1200 sq.ft. N.A. N.A. N.A. N.A.

Built up Area (Total measurement 600 sq.ft. in sq.ft. N.A. N.A. N.A. N.A. Whether inherited property Yes N.A. N.A. N.A. N.A. (Yes or No)

Date of purchase in case of self N.A. N.A. N.A. N.A. N.A. acquired property

Cost of property (in case of pur• N.A. N.A. N.A. N.A. N.A. chase) at the time of purchase Any Investment on the land by way N.A. N.A. N.A. N.A. N.A. of development, construction etc. Approximate Courrent market Rs. 50,000/- N.A. value N.A. N.A. N.A. (v) Others (such as interest in property) N.A. N.A. N.A. N.A. N.A.

(vi) Total of Current Market Rs.12,56,227/- Rs. 1,79,038/- N.A. N.A. N.A. Value of (i) to (v) above (6) I give herein below the details of liabilities / dues to upblic financial institutions and government :- (Note : Please give separate details of name of Bank, institution, entity or individual and amount for each item) SI. Description Self Spouse(s) Dependent Dependent Dependent No. No.l No.2 No.3 i) Loan or dues to Bank / Finan• UCO Bank cial Institution(s) Ramjibanpur Name of Bank of FI Rs. 5000/- N.A. N.A. N.A. N.A. Amount outstanding Nature of loan Loan or dues to any inviduals / Entity other than mentioned in (i) N.A. above. N.A. N.A. N.A. N.A. Name (s) Amounting outstanding Nature of loan Any other liability N.A. N.A. N.A. N.A. N.A. Grand total of liabilities Rs. 5,000/- ii) Government Dues : Dues to departments dealing with NIL NIL NIL NIL NIL government accommodation.

Dues to departments dealing with NIL NIL NIL NIL NIL supply of water

Dues to departments dealing with NIL NIL NIL NIL NIL supply of electricity

inown to me & Signed inI 1 Await3> [ 6 ] ;s to departments dealing with supply NIL NIL NIL NIL NIL i electricity of phones / mobiles Dues to departments dealing with with government transport (including aircrafts NIL NIL NIL NIL NIL and helicopters. Income Tax Dues NIL NIL NIL NIL NIL Wealth Tax Dues NIL NIL NIL NIL NIL Service Tax Dues NIL NIL NIL NIL NIL Municipal / Property Tax Dues NIL NIL NIL NIL NIL Sales Tax Dues NIL NIL NIL NIL NIL Any other dues NIL NIL NIL NIL NIL Grand total of all Govt, dues NIL NIL NIL NIL NIL

Details of profession of occupation: a. Self - Business & Social Worker b. Spouse - Para Teacher by educational qualification is as under: Passed B.Com from A.K.P.C. Mahavidyalay under Burdwan University -1996. details of highest School / University education with full form of the degree course) of the College / University and the year in which the course was completed.

(9) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (8) ABOVE : 1. Name of the candidate Sh./ Smt,/ Kum. Sibaram Das 2. Full postal address VU1.+ P.O.-Ramjibanpur, P.S.-Chandrakona, Dist. Paschim Medinipur. 3. Number and Name of the constituency and 232-Chandrakona (SC)-West Bengal state Name of the Political party which set up the candi• 4. All India Trinamul Congress date (otherwise write 'Independent') (a) Number of cases in which conviction order passed 5. N.A. (otherthan those referred to in Form 26) (b) Total number of Pending cases where the court(s) N.A. have taken cognizance 6. PAN of Year for which last In• Total Income Shown come Tax Return filed (a) Candidate 2009-2010 Rs. 1,61,014/- (b) Spouse: NIL NIL (c) Dependents NIL NIL 7. Details of Assets and Liabilities in rupees Description Self Spouse Dependent-I Dependent-II Dependent-Ill A. Moveable Rs. Rs. NIL NIL NIL Asset (Total Value) 5,66,227/- 1,49,038/- B. In movable Rs. Rs. Asset 6,90,000/- 30,000/- NIL NIL NIL 0) Purchase Price and Development NIL NIL Cost of Immovable Property (To• NIL NIL NIL tal Value) [ 7 ]

/ & Approximate Current Market NIL NIL NIL NIL NIL Price of Asset (Total Value) 8. Liabilities (i) (jovernment NIL NIL NIL NIL NIL dues (Total) (ii) Loans from Bank, Rs. Financial Institutions and others 5,000/- NIL NIL NIL NIL (Total) 9. Highest educational qualification : Passed B.Com from A.K.P.C. Mahavidyalay under Burdwan University - 1996.

(Give details Schools / University education with full form of the degree course) (Name of College / University and the year in which the course was completed)

VEFIFICATION 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 part of it is false and nothing material has been concealed there from. I further declare that: (a) there is no cawe of conviction or pending case against me other than those mentioned in items 3 and 4 above; (b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 5 and 6 above.

Ghata! this the 11 th day of April, 2011

known to and Identified by me and signed in my presence r ^— 0 ' C\ 4* £>f W^k ^TQ-^W^ V-Kk-

7'f Advoca* f^rJJ; Memnly afTlrmed & Declared before me on Identification* J) BWmuPadiPalui [ifrkftf Notary ( Govt, of India ) j I BfetfiKbimMednveaj TEN _ f-M^-m '-..yZZiTZS RUPEE C

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fl J? IJ > Affidavit to be furnished by the candidate before the Returning Officer for election to Assembly Constituency (name of the House) from 232 Chandrakona (S.C.) Assembly Constituency (name of the constituency)

I, Sibaram Das Son / Daughter / wife of Late Anil Kumar Das, aged about 34 years, | resident of VIII. + RO.-Ramjibanpur, RS.-Chandrakona, Dist.-Paschim Medinipur candidate at the above election do hereby solemnly affirm / state on oath as under. 9 1. I am / am not accused of any offence(s) punishable with imprisonment for two years or more in a pending case (s) in which a charge (s) has / have been framed by | the court(s) of competent jurisdiction. If the deponent is accused of any such offence(s) he shall furnish the following | information: (i) Case / First information reports No. / Nos (a) N.A. (b) N.A.

Bishn i Tada Palui Notary ( Govt, of India ) (ii) Police Station(s) Ghatal District (s) Paschim Medinipur State (s) West Bengal (iii) Section (s) of the concerned Act (s) and short description of the offence(s) for which the candidate has been charged (a) N.A. (b) N.A. (iv) Court (s) which framed the charge (s) N.A. (v) Date (s) on which the charge (s) N.A. (vi) Whether all or any of the proceeding (s) have stayed by any court (s) of competent jurisdiction. : N.A. 2. I have been / have not been convicted of an offence (s) [other than any offences) referred to in sub-section (1) or sub-section (2) or covered in sub-section (3), of section 8 the Representation of the People Act. 1951 (43 of 1951)] and sentenced to imprison• ment for one year or more. If the deponent is convicted and punished as aforesaid, he shall furnish the following rmation. Case / First information reports No. / No.s N.A. Court (s) which punished : N.A. Police station (s): N.A. Disrict (s) : N.A. State (s) : N.A. (iv) Section (s) of the concerned Act (s) and short description of the offence (s) for which the candidate has been charged : N.A. (v) Date (s) on which the sentence (s) was / were pronounced N.A. (vi) Whether the sentence (s) has / have been stayed by any court(s) of competent jurisdiction: N.A.

Place : Ghatal Date: 11.04.2011 3)

Signature of Deponent

Known to me & Signs* in my Presenon.

BishnuPadaPalu* \\{9i\U( Notary ( Govt, of India ) ( ' Din^Paachim Modioip*, [ 3 ]

VERIFICATION

I, the above-named deponent, do hereby verify and declare that the contents of this Affidavit are true and correct to the best of my knowledge and belief, no part of it is false and nothing material has heen concealed therein.

Verified at Ghatal this lith day of April, 2011.

Solemnly affirmed & Declafed before me on Identification*