AFFIDAVIT FORM 26 (Seer 4A) Afidavit to he filed by the candidate alongwith nomination paper before ihe returning clticer for election tothe Legislative Asseubly of Gua {Nune ofthe House) from 08 ~ Porvorim Constituency | (Name of the eonstitueney) g 4 Shri Ashok Khaunte, aged 42 yeats, resident oF 13 a AOSS2L (mention till postal siliress) a ‘atthe above election, dé hereby solemnly altirm and state on oath as under'=(1) Lama-candidate set up by Not-Appiieable ("name of the political party)!"*am contesting us an ingependent candidate (% Strike out whichewer is not applicable) (2) My name is enrolled in 09. Porvorim Constituency Goa State ( Name of the Constituency und the State) st rial No.$30 ia Part No.8 (3) My contact telephone number(s) isiare 9822121515, my e-mail Id (if any) is rahuuaesbivsswuet social media ageoun’s- are ok contoliankhaus (lyr insdorarn convshinunterchuan;(ivjvouw rohan Ehaunte.corn{v) se Facebook cumiarovortnrsina isin. 21.60 nuparv (vidwww instagiam comiparvorinrisiug and ¢vihtps:! ‘www, youtube.coméchannel ICG YnF- XerPiN (4) Dewils of Permanent Account Number (PAN) and status of ling of Inconse Te return rs | Rass T FAN] “Wie inanctal year forvehick | “Toul hermes No ihetast nomestas reuen | Incomes oun Gi has bee fed Rupa Soll: Shei ROMAN KHAUNTES AnTPKASWL | 2015.15 Reg 21 019% 2 Spouse : Smt. NEFIAM KHAUNTE ADLISS0Q | 2015-10 R192 619 3 | Depentent-ty Mast: NEEHAN KUALNTE | Micon Not appl eae Net applies | pendent -2 Miss. NUPUR KLIAUN Minor Nov applicable ‘et soph [| Depend 3 Not arplisable | Not applicable Not applicable (3) 1am / not accused of any ofTence(s) punishable with imprisonment for two years or more in a pencling ease(s) in which a charge(s) has’ have been framed by the courts) ci competent jurisdiction Ifthe deponent is accused of any such offenee(s), he shall Furnish the Following information: i) The following case(s) isare pending ayains! me in which chaiges have been framed by the court foran ‘offence punishable with imprisonment for two years or mare:+ a) | CaseFest Information Report No/Nos. togothor with complete dota oP conemed—Pice Stabe ie | Sowton(s) of the voncerned Aet(s) and short eseription | Not applicable title offence lor which charged to | Name orrtie Const, Case Nov and date of onter taking | fo spplicable sonia | coy | ours sich amen he charges) Notapotivate Z | (e)_| areca on whiet tne wets) waster Not applica (| Whatterattorany arte procectingts) have bes by any euur(s) of compeent uit ured | Not wpalsable Gi) The following case(s) ie'are pending against ae in which cognizance has been taken by the court [Lotter than the eases mencioned is iter () abovel: (ay) Name ti Cour, Case No-one wor ‘Not applies | lahing cognizanc TET] The detelis of eases STS WE court Tas [ROH euNizZaNee, Revapplicalic seatins) of the Acts) and ceseription ute cflneet) tor ‘which enprizanes taken{e)_| Denil of Appeals AppTsatouts] For evision av aprlicale (il any filed azaint the above ond(8) L WH Hiave been not been convieted of an offencels) [olher than any offence(s) referred to: subsection {1 or sub sestion (2) or eavered in sub-section (3) of sectivn 8 of dhe Representation af the People Act, 1951 (43 af 1951 J] an soatenced to imprisonment for one year ar more. IF the deponent is convicted and punished a8 aforesaid, he shall fumish the following information’ In the following eases, | have been convicted and sentenced to imprisonment by a court of law ‘@)_] The detailsof eaves, section(s) ul the concernad Acts} and | Not apicable | csssrntion ofthe aftence(s) forwlich comvisted TH) Nansol the Counts). Case Nowand diets) of aden) —_| Natapplieable ie)_| Punishment inpscd Not applicbis Tay] Wieder any appest waslas Goon led again! de [ Not applicabie sonviction ordet Ir deals nnd the prsent stu of he apyeai (7) That | give herein below the detils of the asses (movable and immovable ete.) oF myself, my spouse and al dependents A. Details of movable assets: Note: 2 Assets in joint name indicating the extent of joint 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 the Bank/institution and Branch are to be given, Note:3, Value of Bonds/share Debentures 5 per current market value in Stook Exchany prose and agper book n ‘case of non listed companies should be given in respect of listed _ot]ia, Dependent here has the same meaning & asigned in Explanation (v) under section 788 of the Ropresentation cf the People Act, 1951 Note:s. Details including amount is to be given separately in respect of cach investment sr.vo.] Deseition sau ] spase | eentart | Pepundont | Open 0 | carminame Ressie | MENG xi Nin | [tie Ww Details of deposit ia Bank secounts FPORs, Team Deposis and all net Iypet of depose inching ving ecowis), deposis wih Final Institutions, Nev-anking Financia | Companies ant Co-operative Soci aid the Gimme im otc Sc eepot | ens Ks ws dot sae tanorinda | suse pian — | von tas | BeSinem | ragitean stat Brae otinie | atin ae rag Staiaoh aie ho Panes KISS Sitinaans | Ses vit a bsRe 6.000 Aiea Hroapoas speae Rs1O.LS62- ie Old Goa rsa Ge peraive Cre Sosy Lio Old Gina Alene 120 Rst6,6t.a00 TBPE Boats Ln tamajs Cow Branch aero omponaa USRW9R 2 ers OgoTIE Awko Sesenen issu 37 Rs, LS8775 ie Nv SUS Reasons DFE Basie ad Pani Goo Iii Avene, sous re 5.665.498" AeNe. (NSP ToR7ES00 e170 esneichaa Fas 1 Poon Gos rine veo 1105 s.87 001 Sta Bank of | nwtia. Pana ie 60,000 AeNO SHIM jointly with spouse) RstO, Ale No S113 886 so9.4080. HEC thante Tal Parni ‘0 trai Ae a Susqunyss es. 138380 RA 1SS.ID6 svinss Hanke ‘econ Here tank 1a Bana ‘Gos eeosh fos8 00006 281 Ks.2.7 910% NENA 2vnteaea2 5000 S131 360 HFC Dank Pasa Branch ArNo ‘503000013306 RAAST II Savings Bak, AccoMnts HDTE Pan R238 DEL sone Li Pane, Goo Brn AeND. seen 2.20950). Kil vil Ni Now applicableTre We No Lo3ts909 Rs sT.6TBi. Ale. S221 760088 Bs. 1107 THC Bom} Gina t Ase No eong0rmot0? Rs 38.138" | Gd Tetaits of Invesuinenis. im Bonds, Debenturesshares nd unis in ‘Conpanies/Mutual Funds and others and the amount Mutuit Mutual ‘Mutual Funds unds Fundls Funds | NOt Fant | applicable (Bia Sen Lite nee Nil nee Sevings Pon= balance fund Ralance slay dividend Dividend Growth Fund 5 RS 184,075; LX RsSALLe Rs. 1 68.806 + ON ‘Birla Sun lt Advantage Pd Dividand unt Y aL 08.222 DEE pala Tasd Dividend pave Rs. 110,16 HFC Cosh ‘Magen Fd eat. HILO Cash ‘Management Fn is. a.29n KCICT Prudent Value ecnver Tost Re, w.9n 360% \e1C1 Pradial esis Income Reuter Plan Rita 1s te rs Pai [Lect shor ° axTea Fant RONG Reliance Moves Manaer Weekly siv Rein Rod 266 Reliisca ity Dpsernssinse Fund RAIOIT.S2L shares Debentures oat Inia Cinta eons2ae Power Gest Coeporacien at Ry 1.14000! solace a net Rs97,t0b eats Faerie ait RSI Mepiawsit Hiling Limited Rass iste Sait ios Reta St Pavechemicals inital Re. 900 iteenne Inirastrncranes| di) Prive ited Re2b.78.000- Saat Fstatoe Prvate Lemiice 50.70.00: Soh ies Mospitalgy Hvisate Limited Re 25000 Nil Nave fn sasticiies Private Linstod Re 80,0000 Nil Ni Ni sor apglieibis Mat mtsNaivedya t fladiaiPavate Tite Rs. 18,75.000 Shiv Saat Marketirg (Unis Peat 0 shiv saath Moors Luncis Prive Lanited Rs 600,000 Shissemarts MooidarsPrvite Tinie | 29.11.8004 Majo Hees rivine Litinad ssa: Firms Nil Nil Nil Not snplivable She dae Bsnekrs 800,000. Sv Sus Mex KSAT 343 Tadouth Builders Ang Des Rs. 10.000% Shiv Sans Fngevering Re2ith MOF ‘Shiv Seiuih Dewcoger | gs tno: