9lf~~~;1 fi~-cp=r~ln\1 WES·r Bt:~IGAL 40AA 550b88 Defore Sri Lalmohan Mahanty Notary Public, puru~ia. ~ FORM-26 ~ •A.•..•.F• F-...::I~D..•.A:•..:.....;V;...... ,;;:I;...... ;;.T..:-. &.\...~~ A \ ~ (see rule 4A)

~ ~ a. Affidavit to be furnished be the candidate before the a w~;) t--~-<.~J . . i Returning Officer for election tQ ~".lieglslative

~ Assembly Constituency (Name of the llouse) from 241 Joypur

, Legislative flssembly eonstitu4;ency (Name of tho Constitueoc' ...... C.'' \ IfH;- ,..'. ' J".'\ .\. (!;.~~,::':\.U';I'..:;F)f.'_'\ ~hrlpl.l L~\nllilto :.;on of Late GhnnJram MiJhJto. Jged about \,) . Dl'3'\ I.)..,:, ·'.,>.,,1 ~ ~ ( '!~~i'I'" jJ? years, resident of Village- Chayadih. P.O. - Jiudaru, '(91": ~~~~~.s.-t/~Kotshila, District- purulia (menticed full postal ~s.;-'J address) candidate at the above election, do hereby solemnl ~ affirm/state on oath as under :-

~ . ,1. 1 ' I ami "mnot "eeu sed of any off enee( s) puni shabl e with

1 ;\tll)h(UI1\,'jlJ .•;:1.~rlsonment for two yenrs or more in a pending case( s) I.(.1 Nnl:"!"'IJ I in which a chQrge( s) has/have been framed by the court( s)

18?41~: of competent jurisdiction. , If the deponent is accused of any such furnish the following information:_ Contd ~/ ~ ····.J,.·2. <;:3 ~ 'C~ \' - \.. l.( '\\)\ ~ ~ ,'~ ~ st.ate(s) :- N.A. (iii) Section(s) of the concerned Act(s) and short description

he shall furnished the following informatiQn l- ease/First informat.ion report No./Nos. :- N.A. Court(,s) which punished :- N.A.

of the offence(s) for which the candidate has baen 1\ /:} ~ ",~il\ I charged:- N.A. .\ ~.. ~•.•...

~ ,(o.~ I' -"NOLJ{\1 (v) Date (s) on which the sentence( s) was/were pronounced:- N.A. 1 nlt;1 3

(vi) Whether the sentcence(s) has/have been stayed by any

\ court(s) of competent jurisdiction :- N.A.

1i11'\:1.~:~~·'" -,\r. the above named deponent do hereby verify and declarQ .~·.~. ~,.;'I~ '.;.':.J ... ,".'" - 'i' '.,"!.; !that the contents of this affidavit are true and correct " ,'" ~·j,'';l-.''·-i:;·/ >..::..~~>.,~to~/ the best of my knowledge and belief. no part of it is \< ".,~ ,., . \_:...- '

,'>')L 1w·.-l.l ".SI, I Advocate. J1J'~ J)_ 9j~~4''lf Uif~-:cr1=f~R1 WEST BENGAL 40AA 550687 Before Sri Lal Mohan Mahanty , Notary PUblic, Purulia.

..;}.:~ ~ A F F I D A V I T. &.~~\ ,A ~ '('fiI!I' ~ i Affidavi t to be Furni shed by the candidate alon gwi"th Nomination Paper Before the Returning Officer

-'-~-~ ~ F El i 1 • ( ) /~\:;;l~/f~\or ect on to v'.;'At~:;t~;pL-j at~ve Assembl y name of house 0'(~f',;·=~'~~;'tfrom) .ia¥Jll1l\x 241 JOYPu"\ cOnt ti tu en cy (Name of th e Constituen cy

\:-,:..),:~_"'::,::.'::;~)~~I,~J/hripaW\ahato Son of Late Ghanc:JramMahato, agod about "'( ,'-~-'- -y ,& ····-:~L_~~-_0\:.;'5~1 years, resident of 'Jillage- Chayadih, P.O.- Jiudaru, ~ P.S._ Kotshila, District- purulia (mentioned full postal I I ~ 1) I am a candidate set up by Bharatiya Janata Party

Con to P¢2. '2) Details of PAN and stlltus of filinl?:oflncome Tax Return: The financial year Total income Permanent SJ. for which the last shown in Income Names Account Number No. Income Tax Return Tax Returh (PAN) has been filed (in Rupees) I. Self Nil l'~il Nil Nil Spouse 2. Nil 1'. il Nil Nil 3. Dependent-! N.A. ;',il Nil Nil 4. Dependent-II N.A. Nil .'Hl ._------_ ...__ . .__ ~ .i.l._ ..__...... Dependent- III N.A. 5. Nil Nil I Nil

3 The followin uinllt mc in which co lIizllnco bllll hCQIl ~1.1!~!!..~~_~'(~~!r~~:1.~~ S1, Offence Description No. (a) The details of cases where the court has taken cognizance, Sections of the Act and description of the offence for which Cl) 'niZlmco taken: (b) Name of the court, Case No. and Date

Ill' order [LIking C(lL~llizltlH':(l;

(c) Details of Appeal(s) / Application(s) for revision (if any) filed against the above order(s):

4 Cases in which I have been convicted b a court of law other those referred to in Form 26 : SI. Offence Description No. (a) The details of cases, Sections of the Act IUlddescription of the offence for which convicted: . Name of the Court(s), Case No. and Date s of order s) Punishment imposed: fhat I give herein below the details of the assets (movable and immovable etc.) of myself, my sopuse and all dependents: ( , \ ' /, '. ' I ~~~:eta~ls of movable :~ /~.<." '":'", ..",<.'.".\ i I, 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; ;NaIrie of Bank/Institution and Branch are to be given \.: ....r u;, ~,.'.',:., , . 3, Value of Bonds/SharP/Debentures as pel' the current market value in Stock Excharige hi"respeci of listed companies and IlS per books in oese of non-listed companies should be given' ' 4. Dependent, here means a person, substantially dependent on the income of the candidate S. Details including amount is to be.given separately in respect of each investment

Sl. De.~crjptjon Self Spouse Dependent - I Dependent - 2 Depcndcnt ~ 3, No. (i) NJ..L N~.L I Cash in harid 19000 Nil Nil (ii) Details of Deposits in Bank accounts (FDRs, Term Depo$its Nil N.A. N.A. N.A. l\i. A. and all other types of Deposits induding saving accounts), I Deposits with Financial Insti~tion, Non Banking Financial Companies and Co- operative societies and the amount in each such deposit (i i i) Details of investment in Bonds, I Debentures/shares and lmits in compunic:JMutuuJ Funds mid ''vii i'J. A. N.A. N.A. l~.·A. others and the amount -- (iv) Details of investment in NSS, ,I Postal Saving, Insunmce Policies and investment in any Nil N.A. N.A. N.A. N.A. Finmlcial Instrwnent in r'ost Oftice or Insprance Company and the amount (v) Personallo

of Clllim:JintereSI 0· ••••••• ••••· •• __ w • , ...... 1•. .... - --_.~._--. - ~.~. ...~~.w_._·,___..__.,._...... _..".~._. _~, .--.""----~---~-._....__. ,._----.~_..•.."._._ _ ~ (h) Gross Totnl Vllluc 6'1000 N.A. i~.A • N.A. '{ A B. Det!!ili..Q.fImmovablt: assets: ~I.,;A YcJH\~",--h:l Note: L Properties in jaiLl ownership indicating the eXlent ofjoinl.owncrship willnlso !II1VO III he illdil~:Iil'd 2, Each land or bllJ Jing or apartment should be mentioned separately in this forlllat

~.~_,¥a ~t\~~ D~~~ tw,.1· "' ...... _;.i ~t- •.. - r·.l"·· \~{'\I l·~' --~O,((/4111 ._, -_. ~- ., _· ..·_ ... ·~ ..__ n~._ •..•... ,---,-,-_.,~ ..-- -.-...... -- -~-..~.~.... _..'.-'.. .-.- ....~-...- ..----_.-..--- - .. ,. Description .\0. Self Spollse Dependent - I Depcndcnt - 2 Dependent - 3 f',1) ,AgricultuTlll Land tWt. Location(s) N.A. N.A. N.A. N.A. Survey numher(s) 21 v 1'2.\\ ...... ~-- ._---_ _- ._~ _. .' . Area (TotnllllC'lIsIIIOClHC'l\t In IO'~;}W acres) ~ N.A. N.A. N.A. N.A. I Whether inlwrited property , ~S (Yes or No) N •j\. I-i.A. N.A. N.A. Date of purc:'ase in case of self acquired pro. :erty N.A. N.A. N.A. N.A. N.l\. ------Cost of Land (in case of '~~JJ-!> 'b;:;:A~ N. A. ' N./\. purchase) at ,,\e timeof purchase N.A. N.A. ;\ny Investm.'lll on the land by way of deve!· prnent, N.A. l·,. A. ;'~. A. N.i\ • N.A. construction, tc. Approximate ::un'ent market 3~ value ~. N.A. N.A. N.A. NTA. (ii) Non-Agricul ~mllLand ' Location(s) N.A. N. A. N.A. N. t\ • N.". ..~\lI'Vey numh, I~) Area (Total n,'nsurement in sq. n.) N.J\. 1"1. 1\ • , ".A. ill • /\ • N.A. "._--,------_ ... -- Whcthcr inhc; ,(l'd property t....•A. N.A. N.A. (Yes or No N.A. N.A. , . Date of purch :e incase of self acquired prop:_ ty 1'-1. A. 1-J• A . L~.1\ • N.A. ,N.A. Cost of Land ( 1 case of I r\ I purchase) at tl. time of purchase N.A. N.A. !\l.A. N. . N.A. Any lnvestme on the' land by way of develo. ,nent, N.A. N.A. N.A. N.A. N.A. constructionel '. Approximate ( urrent market value N.A. N.A. N.A. N.A. N.A. (iii) Commercbl) qildings (including apru ;nents) N.A •. i'-J.A. Location(s) l·~.A. N.A. N.A. Survey nwnbe; ::;) Built up Area ( 'otal N.A. N.A. N.A. N.A. N. A . measurement i: sq. ft.) Whether inheri d property N.A. N.A. N.A. N.A. N.A. (Yes or No) Date of pw-cha: in case of self' rJ. A •. N.A. acquired pro eJ N.A. N",A. N.A. Cost of propert: 'incase of N.A. N.A. N.A. N.A. N.A. purchase) at th<.. me of purchase Any Investmenl ,n the property . by way of deve: ,)ment, , N.A. N.A. 1". A . N.A. N.A. constmction de Approximate C\ rent market , -- -N1·A..,. N.A. N.A. N.A. N.A •. /- value . ''C'' f I' ,"" .'" .' ... _~ , . , I ...... - _~_..-.~ I ' :~sidentilll Buildings (including apartments) Nil Locati1m(s) N.A. N.A. N./\. N.A. Survey number(s) Area (Total measurement in sq. 1'1. ) N.A. N.A. i\i. A. N.A. N.A. Built up Area (Total I-J.A. N.i"-. measurement in Sq. ft.) N.A. N.A. N.A. Whether inherited propelty N.A. l\j.A. (Yes or No) N.A. l\!. A., N.A. Date of purchase in case of self N.A. N.A. N.A. acquired property N.A. N.A. Cost of property (in case of purchase) at the time of purchase ,N.A. N.A. N.A. N.A. N.A. Any Investment on the land by N.A. N.A. way of development, N.A. N.A. N.A. construction etc. Approximate Current market N.A. N.A. ~'-J.A • N.A. value N~A. (v) Others (such as interest in I H.A. N.A. ;'J. ;\ • N.i\. N.A. I property) (vi) Total of Current Mad{et \Talue N.A. N.A. N.A. of (i) to (v) above N.A. N.A.

(6) I give herein below the details of liabilities/dues to public financial institutions an gOVCl"IllllCllt:- (Note: Place give separate details of name of Bank, institution"entity or individual and amount for each -item)

! Si. t ' No. Description Self Spouse(s) Dependent - I Dependent - 2 [).pend •• , - 31 (i) Loan or due to BllnklFinancial Institution(s) Nil Name of Bank orFI N.A. N.A. N.A. N.A. .' Amount outstanding Nature of loan Loan or dues to allY individuals/entity other than N.i 1 mentioned III (I) uhove N.A. N.A. N. /\ • N. ;\. Name(s) AmoUnt outstanding Nature of loan Any other liability , Nil N.A. N A. N A.' i\T Grand total of liabilities Nil N.A. N.A. N.A N A. (ii) Government Dues: Dues to departments dealing Nil N.A. N.A. N.A. N.A. with government acconunodation . I Dues to departments dealing Nil N.A. N.A. N.A. N.A. L_-J with supply of water -- ._------I I Dues to depmtments dealing ' ...N. A. ..' N.A. N.A. with supply of electricity /. ·\~J'~li~':;.. N.A • l , . . :" '( Dues to departments G ealing I with supply of Nil N.A. N.A. N.A. tek hones/mobiles N.A. . - Dues to departments dealing with govenunent trans port Nil N.A. N.A. N.A. N.A. (including nircrafts ml, I helico ters Income Tax Dues Nil N.A. N.A. N.A. N.A.~-- Wealth Tax Dues Nil N.A. N.A. N A N A Service Tax Dues Nil N.A. N.A. N A N A Municipal/Property T: .-.Dues: Nil N.A. N.A. N A . N A Sales Tax Dues Nil N.A. N.A. N.A. N A Any other dues Nil N.A. N.AT N.A. N.A Grand total of all Go "f. dues Nil N.A. bJ.A. N.A. .- N.A.

(7) Details of profession Of occupation: a. Self \1.I).~.!f1J?+'9.Y.~.c;l, b. SpoUSe 7.9.: '.7 . (8) My educational qual lication is as under:

(Give details of highest Scho,;\/University education with full fonn <;lfthecertificnte/diplomn/dogl'oo COlll'sc) .(Name of the SchooI/Collcg<.::University and the year in which the course was completed)

~ of the Candidate Sri/~t13. Shrip ati Mahato I _ ------..-..,,..~..- I 2. Full postal address Vil- Chayad~.O.- Jiudaru p s.- 3. Number and Name oft!. . constituency ane state D~str~ct- Purulia 241 Jaypur A.C l,'JestBenqal •. 4. Name of the Political po, ty which set up the candidate otherwise wri 'e'Independent') Bharatiya Janata Party 5. (a) Number of cases in ,\'hich conviction order N.A. assed other than those "ferred to in Fonn 26) (b) Total number of Pen, !lng cases where the N.A. court s 'have taken co 1 .....ance ---~ 6. PAN of Yellr for whloh IIIMI 111001110 Totul 1110011\(1ShllWIl Tax Return flied - (n) Candidnte N.A. N A 1,1; 1 (b) Spouse N.A. NA 1\1-1 l-.-- (c) Dependents N.A. N A N-I 1 Details of Assets and Liabilities in rupees . i>escription' Self Depende:;~ - II D~pcndellt - III Spouse PelJendent - I - A. Moveable Asst (Total value N.A. N.AT N.A. N.A. N A D. Immovable Asset _ ..._------(i)Purchllse Price and Development Cost of Immovable Property (To \.1 N. A •_._ ~!,. N•.A. N.A. N.A. I: ". Value) .<. :'~-\I ,.- ., "~, / ..' -,-, ..,.. ~"':-."" (ii) App~ximate Cwnmt Market Price of Asset Ni 1 Total Value 8. Liabilities Nil Nil (i) Government l1ues Nil N.'I.J. _jl_i~l_ (ii) Loanll fl'om Bank. Financial Institutions and Nil Nil others (Total 9. Highest education qualification:

I..... " '.~ •. I,· . l 1,. ...., .,.l-o' .. \.\ ';'. \

(Give details of SchooVUniversity education with full form of the certificate/diploma/degree coutse) I •. . . : ~ " i ame of the SchooUColle elUnlversi and the "" in which the con," was com leted ' ,,',:,< 'f,:~(i3:C';:/'~/

\~/ ~ ... _-----::~~/ '-.":) I' \..,{:~ /" '~ :.;.../ ..

I, the deponent, above named. do hereby verify and declare that the contents of this affidavit are true and corree·t to the best of my knowledge and belief, no part of it is false and nothing material h!IS been concealed there ii'0I11. Ifurther declare that: (u) There is no case 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 i~.items 5 and 6 above.

Verified at ..~:1~ tllis the 1.~ day of ~~.' 201 I

Note: I. Aftiduvil should bl~tiled latest by 3.00 p.m. on lhe lust dale of filing nominutions. 2. Afiidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before u Notary Public. . .' 3. All columns should be filled up and no colurrm to be left bllmk. If there is 110 inforrnntiol\ to fUl'l\isll ill respect of any item, either "Nil" or "Not applicable", as thccase Illay be, should be mentioned. 4. The affidavit should be either typed or written legibly and neatly.