5 L A 22 0 a

FORM 2 B
(See Rule4)
NOMINATION PAPER
Election to the Legislative Assembly of..s$AM... (State)

STRIKE QFF PARTI OR PARTII BELow WHICHEVER IS NOT APPLICABLE

a 1 2 . 4P
PART 1
(To be used by candidate set up by recognised political party)

ominate as a candidate for election to the Legislative Assembly from the L.A-2

ATHARKANDI
Candidate's
Assembly constituency
name
kRISHNENDU PAUL
Fathers/mgther's / husband's name LATE KRIPESH RaNJAN FAUL
His Postal address V1LL: KALACHERRA, P.o & PS BAZARIcHERRA

DIST- KARIMG ANJ , ASSAM-7887255

His name is entered at SI. No. 6 0 6 in Part No.173
of the electoral roll forL.A-2. PATHARKANDI Assembly constituency.
My name is SANTI DEBNATH_ and it is entered at Sl. No. 05
in Part No. S _ofthe electoral roll for_LA-2, PATHAKKANDI
Assembly Constituency.

Date 3/202
ybeboab
Signature of Proposer

PART I NA
(To be used by Candidate NOT set-up bý recognised political party)

We hereby nominate as candidate for election to the Legislative Assembly from the_

Assembly Constituency.
Candidate's name,
Father's/mother's / husband's name

His postal address

His name is entered at SI. No. in Part No. of the electoral roll for
Assembly Constituency.
 we declare that we are electors of this Assembly Constituency and our names are
entered in tha
toral roll for this Assembly Constituency as indicated below and we append our signatures belowin
TOken of
subscribing tó this nomination N. A
Particulars of the proposers and their signatures.
Elector Roll No. of proposer
No. Part No. of S. No. in
Electoral Roll Full Name Signature
that art Date

10

N.B. There should be ten electors of the

constituency as proposers.
 PART 1

, the candidate mentioned in Part /Part ll (Strike out which is not applicable) assent to this nomination and

herebydeclare
(a)that lam a citizen of india and have not acquired the citizenshipofanyforeign State/Country

(b) that Ihave completed 47 (FORT SEVEN) years of age;

[STRIKE OUT c(i) or c(i) BELOW WHICHEVER IS NOTAPPLICABLE]

) 0 that lam set up at this election by the HARATIYA JANATA party,

which is a recognised National Party/State Party in this State and that the symbol reserved for the

above party be allotted to me.

OR
(Gi) that I am set up at this election by the N.A. party,
(c)
which is a registered-unrecognised political party/that I am contesting this election as an independent
in order of
candidate. (Strike out which is not applicable) and that the symbols I have chosen,
preference, are
NA (i) N.A. (i) NA
have been correctly spelt out above in
(d) that my name and my Father's/Mother's/Husband's name

FNGLIS4 (name of the language); and

chosen
(e) that to the best of my knowledge and belief, I am qualified and not also disqualified for being
to fill the seat in the Legislative Assembly of the State.

*I further declare that l am a member of the_OTHERBACKWARD_ *Caste/tbe

which is a scheduled * caste/tribe of the State of AssAM in relation to

ALL (area) in that State.

shall not be nominated as a candidate at

the present general
l also declare that I have not been, and
the Legislative Assembly_
AssAM of
election/the bye-elections being held simultaneously, to
Constituencies.
(State) from more than two Assembly

Date.3/202
Signature of the Candidate
Score out this paragraph, if not applicable.
** Score out the words not applicable.

means a political party recognised

by the Election Commission under
N.B.-A "recognised political party" the State concerned.
and Allotment) Order, 1968 in
the Election Symbols (Reservation
 PART II A
(To be filled by the candidate)
(1) Whether the candidate
() has been convicted-
(a) of any offence(s) under sub-section (1); or
(b) for contravention of any law specified in sub-section (2), of section 8 YesINo
of the Representation of the People Act, 1951 (43 of 1951); or
(i) has been convicted for any other offence(s) for which he has been
sentenced to imprisonment for two years or more.
If the answer is "Yes", the candidate shall furnish the
following information:
Case/first information report No./Nos NA:
(i) Police station(s) N.A District(s) N.A. State(s) NA,
(ii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been
convicted N,A
(iv) Date(s) of conviction(s) A. A
(Courtfs) which convicted the candidate NA
(vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum
of fine(s)_
N.A
(vil) Date(s) of release from prison
A
(vii) Waswere any appeal(_)/revision(s) filed against above conviction(s)
(ix) Date and particulars
NO_Yes/No
of appeal(s)/application(s) for revision fled N.A
)Name of the court(sJbefore which the appeal(s) /application(s) for revision
filedN, A.
xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or is/are pending
N.A
(xii) If the said appeal(s)/application(s) for revision has/have been disposed of
(a) Date(s) of disposal N.A
(b) Nature of order(s) passed NA
(2) Whether the candidate is holding any office of profit under the Govemnment of India or State Govemment?
YésINó)
If Yes, details of the office held N.A.
(3) Whether the candidate has been declared insolvent by any Court? NO
Ve[/No)
-fYes, has he been discharged from insolvency
N.A
(4) Whether the candidate is under allegiance or adherence to any foreign country? O_(yes!
Nb
FYes, give details NA.
(5) Whether the candidate has been disqualified under section 8A of the said Act by an order of the
President? NO Ye[/No)
If Yes, the period forwhich disqualified NA.
(6) Whether the candidate was dismissed for corruption or for disloyalty while holding office under the
Government of India or the Government of any State? NO YeSINo)
If Yes, the date of such dismissal_ N.A
(7) Whether the candidate has any subsisting contract(s) with the Government either in individual
capacity
or by trust or parnership in which the candidate has a share for supply of any goods to that Govemment
or for execution pf works undertaken by thatGovemment? NO YesNo)
f Yes, with which Government and details of subsisting contract(s)_ N.A
(8) Whether the candidate is a 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? N yes/no)
If Yes, with which Government and the details thereof N,A
(9) Whether the candidate has been disqualified by the Commission under section 10A of the said

Act NO_(Yas/No)
-Ifyes, the date of disqualification_ N. A

Place. UTngaa

Date./03/2021 Signature of Candidate

PART-IV
(To be filled by the Returning Officer)

Serial No. of nomination paper 05

This nomination was delivered to me at my office at 240 Pm (hour) on
(date) by the Candidate/proposer (Name of proposer SupbDebmalh

Returnihg Officer
Date 03/202( LA2 ANdPTnsstuency
"Strike out the word not applicable.

PART- V
or Rejecting the Nomination Paper
Decision of Returning Officer Accepting of the
in accordance with section 36 of the Representation
Thave examined this nomination paper
1951 of 1951) and decide as follows:
(43
People Act,

Returning Officer
Data
 FORM OF OATH ORAFFIRMATIOON
Article 173 (A) of the Constitution of India]

(to be made by a candidate for election to the Legislative of a State)

candidate to fill
RISHNENOr.PAUL ****
.
having been nominated as a
a seat in the Legislative Assembly ("or Legislative Council) do swear in the name of the God/S

emnly affirm that I will bear true faith and allegiance to the consjitution of
India as by la establishgd
and thatl will uphold the sovereignty and integrity of India.

CRRISHNENDU PAUL
Siganture and name in block letters of the candidate

Shri/Shimati.RiSHNEDU PAUL
Swon in the name of God/Solemnly affirmed by ****************

atARIMEANO..(Place) at..202. (hour) this the...l!.dhy.. day of Marh 2021...

before me.

Signature of authorized person

Returiny Officer