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087224
2AA MUTUALLY
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9f*gilim,,ilfrffrrT TELANGANA
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Datc: l2:so PM2023. CO.OPERATIVf,
Porthucd ly: ,J SOCIETY
N. BAL KIRTHT RAM CENSED STAMP YENDOR
w/o N. RAIBABU Lic. No. 16-10410,2015
R/o I
HYD R€n.No. l6-1048,42021
For rvhom )ciety Counter, Metropolig,
.. SELE .. iminal Coult, Namprlly. Hyd

I Ph 9290150314

c
FORM 26 (See

CI T
lD
1,,7 4
I A
a *

IEL

AFFI dour- ,raa, By rHE .ANDTDATE AL.NGWITH N.MINATI.N pApER

BEFORE THE RETURNING OFFICER FOR ELECTION TO TELANGANA
AS SEIq BLY (NAME OF THE HOUSE) FROM LAL BAHDUR NAGAR
r.rdr ITUENCY No. 49 (NAME OF THE CONSTITUENCY)
g
PART.A

d/ KAT BALA KIRTHI RANI daughter of BALA KRISHNA Aged 47

resident of H.No.5-5-1128, PLOT NO 8./1, SRI SAINATH
I' Y, VANASTALIPURAM, R.R. DIST. -5OOO7O- T.S., a candidate at
a bo ve election, do hereby solemnly affirm and state on oath as under:-
E contd....2

q
l!
 (l) [ am a candidate set up by JAI MAIIA BIIARATII PARTY
(+*name of the political party)/++anr contesting as an Independent candidate.
(ttstrike out whichever is not applicable)
(2\ My name is enrolled in LAL BAHADUR NAGAR. TELANGANA (Name of the

constituency and the State). at Serial No 1072 in Part No 280

(-3) My contact telephone nurnber(s) is/are.. 9000250569 and my email id (if any) is
NIKITHANIKAITHA626@GMAIL.COM and my social media account(s) (if any)
is/are whatsapp & face book
(i) Whatsapp: 9000250569

1ii) facebook : NIL

(iii NrL
(l) Details of Permanent Account Number (PAN) and status of filing of Income Tax
retum:

SI Nanres PAN The finarrcial Total inconre shown in In-

yeal ft.rl which
Ntt come-Tax retuln (iu Rupees)
the last
Incorne-ta\ for the last five Financial
letunr lras been Years completed (as on 3 l''
filed
March)

Se lf I]DWP8423IJ NIL (i) NIL

ii)
( NIL
( iii) NIL
(iv) NIL
(v) NIL
2 pouse ( i) Not Applicable
N.RAJ BABU ( ii) Not Applicab le l
No PAN allotted Not ( iii)
Not Applicable
Applicable
o (iv) Not Applicable
(v) Not Applicable
o
,,. HUF(lf candidate is (i)
o_0 Not Applicable
Karta/Coparcener)
a-
Not Applicable Not Applicable ii) ( Not Applicable
( iii) Not Applicable
( iv) Not Applicable
(v) Not Applic,able
ndent- l Not A pplicable (i) Not Applicable
0 nA
( ii) No! 4!p!,. able
IKI No RAN a otted ( iii) Not Applicable
(iOBr
.!.t ( iv) tlSl{ppl,"eql"
D.
124--
(v) Not Applicable
o .,i,tB r'.9 11
AOVOCATE & TIOTARV
Appo inted by tha oovt- of T.
-5.1 7+
GOM$ ?; o. 280i12, (Ran. on.l
H.No: 23-S-776 Ch.ndu lal Bela
t ri q"oda l{r',l':- -rrd
 l Dependent-2 NIL Not Applicable (i) Not Applicable
( ii) Not Applicable
( iii) Not Applicable
( iv) Not Applicable
(v) Not Applicable
6 Dependenr3 (i) Not Applicable
NIL Not Applicable ( ii) Not Applicable
( iii) Not Applicable
(iv) Not Applicable
(v) Not Applicable
Noter lt is mandatory for PAN holder to rnention PAN and in Case of no PAN it
should be clearly stated : "No PAN allotted"
(s) Pending criminal cases

(i) I declare that there is no pcnding crinrinal c se against me. YES

(Tick lhis alternalive if there is no criminnl cuse pending against the
Candidute and h,rite N0'l' ngtinst ahernolive (ii) below)
^PI'LICAIII-Ii
OR
( ii) 'I'he follorving criminal casos are pending rgainst rne: NO'l' APPLICABI,E
(Il lhere ure peruling criminul cases ogoinsl the cuttlidole, then tick lhis
allennlive otttl score olf nllernative (i) above, and give details of all
pending coses in lhe Table below)

'I'able
(u) F-IR No. With
name and address of Not applicable Not applicable Not applicable
Police St:rtion
concerned

(t,) Case No. wilh Nanre

of the Court Not Not Not
applicable applicab le applicable
*
o o
c) Section(s) of
7)
concerned
Acts/Codcs iuvolved Not Not Not
(give no. of lhe applicable
o Section
applicable applicable

, e.g. Section
.,....,of 1PC, etc,).

,il a

,D.
7
2-=-\
_--<
/)
 (d) Brief description of
ofl'e nce Not Not Not
applicable applicable applicable

(e) Whether charges have

been framed (menlion Not Not Not
YES or applicable applicable applicable
NO)

(l) If ansrver against

(e) Not Not Not
above is YES, then applicable applicable applicable
give lhe dale on which
charges rvere
framed

(e) Whether any

Appeal/ Not Not Not
Application for applicable applicable applicable
revision has been liled
against the proceedings
(Mention YES or
No)

(6) Cases of conviction

(i) I declare that I have not been convicted for any criminal offence. YES
(Tick tltis alternative, if the contliddle has not been convicted
and write NOT API'LICABLII against alternative (ii) below)
OR
( ii) I have been convicted for the offences mentioned below: NOT APPLICABE
(If the NOT AI'PLICABI-E candidate has been convicted, then tick this alternative
* and score ofJ ulternative (i) trbove, and give rletoils in the Table below)
Table
=I
6',!
AE u
o (a) Case No. Not Not Not
fr applicable applicable applicable
l1 ?:

>, (b) n-anre of the Courl Not Not Not

+ applicable applicable applicable

T
un

J=:
t0vtj! t) llp Al rt\r.
:+
1)
cO!
:r;-: t
'/t 1
I
"r r-t-ri B.Con .,1.1.8
ADI,oc.{ '?'t E }'JCTA RY
A ,l the Govt of l'
i, iRen.m.1-
il,No: 33{.r76 Chandut;; 3
, flv rl
 (c) Sections oI
.A.cts/Codes
involved (give
no, of the
Not Not Not
Seclion,
applicable applicable applicable
e.g. Section .....,.of
IPC, etc.).

(d) Brief description of

offcnce
for rvhich convictcd
Not Not Not
applicable applicable applicable

(e) l)ates of orderc of Not Not

Not
conviction applicable
applicable applicable

(r) Punishmenl Not Not Not

applicable applicable
* iruposed applicable

o
n (g) Whelher any Appcal
has been filed against Not Not Not
conviclion onler applicable applicable applicable
(Mention YliS or
No)

lfanswer to (g)
above is YliS, give Not Not Not
detrils and prcsenl applicable applicable applicable
stalus
of appeal

(6A) r t'c given full:rnd up-to-dlle information to my political party about all
tn di ng criminal cases against me and about alt cases of conviction as given in
aragraphs (5) and (6). NOI'APPLICABI,E

,t
trfl, ules lo wlron, this ltcttr is not applicuble shoultl cleorly tu le NOT
/c, .) RLI, lN Vllilr Ol" ItNT'llIl S IN 5(i) and 6 (i), above I

CF TE
Dctuils shoukl bc enlered clcarly und legiblf itr I|OLD letters
2 Detoils to be given separately ior euch cose untler different colunrns against each ilenr,

4
 3, Detnits shoultl be given in reverse chronological order, i.e,, lhe latesl case to be
menlionedfirst otrd backwards in lhe order of dateslor the olher cases,
4. Adrlitional sheet may be added if rcquired.
5. Canclitlale is responsible for supptying ol! ittfornntion in compliance of Hon'ble
Supreme Court's jrulgment in ll.P (C) No. 536 of 201l.
6. Thot t give herein betow the ttetails of lhe ossets (movable dnd immovdble etc-) of
myself, my spouse and all dependents.

A. Dctails ol ntor altle asscls:

Note: I . Assets in joint name indicating the extent of joint ownership will also have to be given.
Note: 2. ln case of deposiVlnvestment, the details including Serial Number, Amount, date of
deposit, the scheme, Name ofthe Bank/lnstitution and Branch are to be given
Note: 3. Value of Bonds/Share Debentures as per 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 ofeach investment
Note: 6. Details should include the interest in or ownership of otfshore assets. Explanation - For
the purpose of this Form, the expression "oft'shore assets" includes, details of all deposits or
investments in foreign banks and any other body or instittrtion abroad, and details of all assets
and liabilities in loreign countries
Sl.No Description Se lf spft"_ ll UF Dcpclrdenl-l Depe!rdent-2 Dependent-3

(r) Cash in harrd 50,000 NIL NiL Nil Nil Nil

Details of deposit in
Bank accounts (FDRs,
Term Deposits and all Nil Nit Nil
7.000 NIL
other types of deposits N/A
( ii) including saving
accounts). Deposits
with Financial
Institutions, Non
Banking F inancial

Companies aud
Cooperative societies
and the anrount itr each
such deposit.

( iii) Details of investment

in Bonds-
t debentures/slrares aud
units in Nil Nit
Nit Nil Nil
companies/Mutual N/A
o
lr
funds and others and

q.
B
d
3 0."7
D sl\
$P AT
t
* o
= 5
\,
(/3
F I
 (iv) Details of investment
in NSS, Postal Saving,
Insurance policies and
illvestrnent in any Nit
Nit Nit Nit
NiI N/A
Financial instruments
in Post office or
Iusurance Cotnpany
and the amount.
(v) Personal loans/
advance given to ary
perso[ or entity
including firm,
Nil Nit N/A Nil Nil Nil
company. Trust etc.,
and other receivables
from debtors and the
antount.
(vi) Motor Vehicle NIL NIL NiA Nit Nil Nit
Aircrafts/YachtVShips
(Details of Make,
registration number
etc. year of purchase
and amount)
(vii) Jewitlery, butlion and 100 Cms Gold N/A
valuable thing(s) (give 500.000/- NIL Nit
Nil Nil
details of weight and 20 Tolas Silver
value) 10,000/-
(v iii) Any other assets such N/A
as value of Nil Nit Nit Nil Nit
clainrs/interest
(ix) Cross Total ValLre 5.67,000 NIL N/A Nit Nit Nit

B, Dct:rils ol Inrmovable Assets:

Note l. properties in joint ownership indicating the extent ofjoint ownership will also
have to be indicated

Note: 2. Each land or buitding or apartment should be mentioned separately in this format
Note: 3. Details should include the interest in or ownership of offshore assets.

Description Self Spouse Dependenr I Dependent-2 Dependent-3

S
HUI.
L\O_

(i) Agricultural Land

Location(s) NiI Nil N/A Nil Nit Nil
Survey number(s)
Area (total Nil N/A NiI Nil NiI
Nil
measurentenl in acres)
o Whether inherited
Nil Nit N/A Nir Nil Nil
property (Yes or No)
llr case
11y Nil Nil N/A Nil Nil Nil

0 t
.i .D. RATIGOP I
!
-1 t 6
tB )
FArro"^r,
'
*"ri3ililf
OF Appointed by the GovL ol LS
 Cost of Land (in case of
pulchase) at the tinlc of Nil Nil N/A Nil Nil Nil
pu rchase
Any investment on the
land by way of Nil Nil Nil
Nil Nil N/A
development.
construction etc.
Approximate cr,lr-r'ent
Nil N/A Nil Nil Nil
Nil
market value
( ii) Non-Agricultural Land
Location(s) Nit Nil
NIL Nil N/A Nil
Survey lunrber(s)

Area (total
NIL Nil N/A Nil Nil Nil
measurement in sq.ft.)
Whether inherited
NIL Nil N/A Nit Nil
property (Yes or No)
Date of pLrrchase in case
NIL Nit N/A Nil Nit
of self-acqu ired proPertY

Cost of Land (in case of

purchase) at the titne of NIL Nit NiA Nit Nil
purchase
Any investmetrt on the
land by way
Nil Nit N/A
of develoPtnent,
construction etc.
Approxinlate current
market value NIL Nil N/A

( iii) Conrmercial Buildings

(includinB apartlllents) N/A
Nit Nil
-Location(s)
-Survey nunrber(s)
Area (total
measuretrtent in sq.ft.) Nit Nil N/A Nil
Built-up Area (total
Nil Nil N/A Nil Nil
nreasurerleut in sq.ft .)
Whether inherited
Nil Nit N/A Nil Nit Nil
* property (Yes or No)
Date of pulclrase in case
Nil Nil N/A Nil Nil Nil
e of self-acquired ProPerty
o
Tl
Cost of property (in case
NiI Nil N/A Nit NiI Nil
c of purchase) at the time
of purclrase
investment on the
+ by way of Nil TESI
Nil Nil NiA
rt.
etc

*
7 the qo.,L of r_s .

(Ran.on.1 .5-1t)
Chalarilal Bela
OF
H.No: 23-o
qc-hrtir}.^r{J r, rh+d 3
 Approximate currettt
nrarket value Nit NiI N/A Nit Nit Nil
(iv) Residential Bu ildings
(including apartments):
-Location(s) Nit Nit N/A Nit Nit Nil
-Survey nurnber(s)

Area (Iotal
nreasurement in sq.ft.) Nil Nil N/A Nil Nit Nil
Built up area (Total
measurentent in sq.ft.) Nit Nil N/A Nil Nil NiI
Whether inherited
propeny (Yes or No) Nil Nil N/A Nit Nit NiI
Date of purchase in case
of self-acquired property Nit Nil N/A Nil Nil Nit

Cosl of property (in case

of purchase) at the time Nit Nil N/A Nit Nit Nit
of purchase
Any investment on the
laud by way of
development, Nil Nil N/A Nil Nil Nit
construction etc.
Approximate c u rrellt
nrarket value Nit Nil NiA Nil Nil Nil
(\ ) Others (sLrch as
interest in plopertl-) Nit Nit N/A Nit Nil Nil
(vi) Total of current tnarket
value of(i) to (v) above Nit Nit N/A Nit Nil Nit

8 I give herein below the derails of riabilities/dues to public financiar

institutions and
government:-

(Note: please give separate details of name of bank,

institution, entity or individual and
amount before each item)

S. Descliption Se lf Spous HUF Dependent- | Dependent-2 Dependen!3

No. c
* i) Loan or dues to
Bank/financial
o institution(s)
o
'n Narne of the Bank or NIL NIL N/A NiI Nil Nit
-,,i financial Institution,
ri tanding.
,
STED
a
'tr
8AM 00FAt
2 D. RAId
+'rl!
r r./0,.::: ; 0 B.Com. ,LL.F
Jt
^;";';:'w ADVG,]ATE & NOTARY ?Q
Appqirned bY the (}r')vL of
8 ?, {Ran.on.l'5-1?
OF ll.No: ?3-6-/7ir Ciraodtrlal Br'ia
 Loan or dues to any
other individuals/entity
other than mentioned
above
Nanre(s), Nit N/A Nit Nit
Antount Nit Nil
outstanding, nature of
loan

Any other liability Nil Nit N/A NiI Nit Nil

Grand total of NIL NIL Nit
N/A Nit Nil
liabilities
( ii) Gou"rnrl",rt d*rt (A) Has lhe Deponent been in YES,tlo
Dues to Departnlents occupalion of accommodalion providetl (Pl.
dealing with rick rhe
by the Governrnent at any time during
Covernment oppropriote
thc last ten years before the date ol
accomnrodation notificalion of the currenl election? ahernative)
(B)If answer to (A) above is yES, lhe
following dcclaralion may be
furnished nanrely: -
(i) 't'he address of the
Governmenl accommodation:
NIL __-NO____

(ii) 'l here is no dues payable in respect

ofabove Government N/A
accommodalion, towards-
(a) rent;
(b) electfi ciry charges;
(c) water charges; and
(d)telephone charges as on

ATTESTED NIL
(date)
I the date should be the last date of
D. GO
t
the third nronlh prior to lhe month
8.C 1.8 otified or
ADVOCATE & NOIA R)' date
A ppoir rted by the Govt ot T.S
GO M8 No. 28 0t12, (Ren.ori.,i -!-17) from lhe
H.Not ?3-6-775 C haDCui.il E,i: ia agencies concerned in respect of rent,
qhah Ali
Banda, Hydrrr,.,.,11 electricity charges, water charges and
lelephnne charges for the above
ntrnl accomntotlation shoultl be
Ggr c rn
su brrrified. |

( iii) Dues to departrneni Not

-
dealing with applicable
Governtnent transport
( inc lud in g aircratis and
licopters)
rne lax dues Not
applicable
Se lf Spouse HUF Depe"de"tl Dependent-2 Dependent-3
T Dues NIL NIL N/A NIL NIL NIL
l/Propefty tax NIL NIL N/A NIL NIL
,,E NII-
NIt- NIL N/A NIL
-r ai.
NIL NIL
O BA *
* 9
=
i)r
(v iii) Crand total of
all Govenrrlent NIT- NIL N/A NIL
N IL, NIL
dues
(ix) Whether any other
liabilities are in dispute,
if so, mentior't the
anrount involved and the NIL NIL N/A NIL NIL NIL
authority before which it
is pending.

(9) Details ofprofession or occupation:

(a) Self : ADVOCA'I'E

(b) Spouse: NIL

(9A) Details of sources of income:

(a) Self: Self l]mployed
(b) Spouse: NIL
(c) Source of income, ifany, of dependents, NIL
(9B) Contracts with appropriate Government and
any pubric company or companies
(a) details of contracts enteretr by the candidate ...Nor APPLICABLE
(b) details of contracts entered into by,spouse... NIL
(c) details of contracts entered into by dependents... NIL
(d) details of contracts entered into by Hindu undivided Famiry
or trust in which
the candidate or spouse or tlependents have interest.... NIL
(e) (e) details of contracts, entered into by partnership l,.irms
in which candidate
or spouse or dependents are partners.........NIL
(f) Details of contracts entered into by private companies
in which
candidate or spouse or dependents have share......NIL
l0 My educational qualification is as under:_
B.COM-I,LM-2o15- OU
(Give details of highest School/Unive rsity education
mentioning the full form ofthe
certi fi cate/diploma./degree course. name of the School/Collegefu
niversit y and the year in
which the course was completed.)

&l{ o 1a '+
,-E-l
t 9,
* D
on. 1.5"!
.D.
G p ,L
ADVOCATE & NOT
Appoi ntcd bY the Govt. ct L$
OF TEL GOIiE.$ !to 28Ci1:, (RGn.o n..'-5-r
7L
Cha ndt ( al tJilra
H.No: 23-5-iI€
ihah *,ii Eanda. Hydrr rabad
10
 PAR'I'.8
(I I) ABSTRACT OF THE DETAILS GIVEN IN (I) TO (IO)
OF PART.A:

Name of the candidate

N OVKA'I' BAT,A KIR'I'III RANI
Fu ll postal address
H.N o. 5-5-1128, PLOT NO.B/1 SRI
SAI NATH COLONY,
VANASTALIPURAM, R.R. DIST.-
500070- T.S
.) Nurnber and name of the constituency and 49- LAL BAIIAD UR NAGAR, T[LANGAN;
State
.l Nanre of the polit tcit lparty which set up the
,t AI MAIIA BIIARAT'II PARTY
candidate (otherw lse lvnte
'lndependent')
5 Total nutnber of pending crinrinal cases
Not applicable

6 Total number ofcases in rvhich convicted

Not applicable

1.
['AN of Year for which last Total income shorvn
income Tax return
ti led
(a) Candidate BDWPB423 IJ NIL NIL
(b) Spouse NII- NIL NIL
(c) HUF NIL NIL NIL
(c) Dependents NIL NIL NIL
8 Details of A ssets and Liabilities (inclLrding
offshore assets) ilr rupees

Description Se If Spouse HUF f)cpendcnt-l Depcndcnt- Dcpendent-lll

II

J .l 5 6 7 8
Moveable Assets Nit NIL N/A Nil Nit Nil
(Total value)
B Irrrntovable Assets NiI Nit N/A Nit Nil Nil
I. Purchase Price of
self-acqu ired
N/A
imrnovable pr.operty Nit Nit Nil Nit Nil

u. Developnrent/
constntction cost of
immovable
property after Nil N/A
Nit Nit NiI Nit
purclrase (if
applicable)
(!rir'0rl
rj o h
*
D.R D.D .+#l
G
st.
28'.tr,t2
* O BA
t)P l\
t .t'
s .on, 1-S-
* G.O $! * AoDvbck..Ethe oov
' Appointed b.v
.:1 l.S
GOi.-rS {c. iairl i2, (Ron.o n. l-5-17)
;.i klhtndul al Aela
.,{
OF ,l .
 l Approximate
Current
market
price-
(a) self-acquired N/A
Nit Nit Nit Nil Nit
assets (Total
Value)
(b) inherited
assets (Total
Value)
I L iab il it ies
(i) Covernnrent dues Nit Nit N/A Nil Nit NiI
(Total)
( ii) Loans ll'orn Bank.
Financial N/A
Institutions Nit r.Nil Nil Ni1 Nit
and
others ('Iolal)
I0. Liabilities that are under dispute
(i) Government dues Nil NiI Nit Nil NiI
(Total) N/A
( ii) Loans frorn Bank. Nil Nil N/A Nit Nit Nil
Financial
Institutions and
others (Tofal)
ll. Highest educatiorral qualifi cation:
B.COM-I,I,M.2OI5. OU.
(Give details of highest School/University education nrentioning the full form of the
certifi cate/diplonla/degree course, narne of the School/College/University
and the year iu
which the coursc was cour pleted.)

Ar'll'iJ:i'JLy
A
ti
.D. ?
tu
A
.la t I tt .B
1r * I NOTARY
G .o
i) i Appc by the Gort. of lS
1
GO['i S No. 2t c/-r?, (Ran.or.1-s-l 7l
H.No: ?3-6- 778 Chanduia! Hr,!a
OF Shah Ali Banda, Hyde?'

12
 VIJItII.'ICA'I'ION

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 there f'rom. 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, or my dependents do not have any asset or liability, other than those
mentioned in iterns 7 and 8 ofPart A and items g, 9 and 10 ofpart B above.

Verified at HYDERABAD this the l0 day of November,2}23.

D NENl'

Note: l. Affidavit should be filed latest by 3.00 pM on the last day of filing nominations.
Note: 2' Affidavit should be sworn betbre an Oath Commissioner or Iriagistrate
of the First
Class or before a Notary public.
Note: 3. Al[ column should be filred up and no column to be left brank.
If there 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 Atlidavit should be either typed or wrirten legibly and neatly.
Note:5. Each page ol the Affidavit shourd 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 swom_

IlSttl.rr
rE
D. GO o )
3.Corn.,L.L.
i ' lovocltE a NotaRY-
-
'rl = 3fi B"'1Y'ELtiff*.:i! :'l I
" H.No: 23'6'776 Chsrdulel Hela
.q|.:h A!i Ba!rda, HYderabad
0t gy;r)rrP d

13