FFTY

RUPEES

F.50 Rs.50
INDIA
INDIA NON UDICIAL
Gdb00 AKERALA Form 26 CX 902676
(See ryBe 44) TAR
ANANTHARAMA.
KasaragodDIst.
Kerala
Regn. No:21781
Erpiry Date
12.03-2025

SOvTO
AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONGITH NOMINATION PAPER
BEFORE THE RETURNING.OFFICER FOR ELECTION TO HOUSE OF THE PEOPLE (LOK
SABHA), (NAME OF THE HOUSE) FROM KASARAGOD CONSTITUENCY (NAME OF THE
CONSTITUENCY)
PARTA
I, ASHWMINI ML, *sen/daughterWife of Shashidhara P, Aged 38 years, resident
of Ashiwad house, Kodlamogaru Post & Village, Vorkady Panchayat,
Manjeshwara Via & Taluk, Kasaragod District-671323(mention full postal
address), acandidate at the above election, do hereby solemnly affirm and state
on oath as under:
OTAR
ANANTHARAMA.P
KasaragodDist
Kerala
Regn.No:21781 2 L

ExpiryDate H A R
ARAGOD

Mo.t.SVALUE 12-03-2025
2
2

sOLD TO..Shui.....nL KASAR

KASARAGOD SHRIDHARA.C
RAt4.cOURT STAMP VENDOP Voraty
 FIFTY
RUPEES

F50 Rs.50
O
INDIA
INDIA NONJUDICIAL
G00 KERALA CX 902677

the political
(1) | am a candidate set up by Bharatiya Janata Party (**name of
party)
Constituency of Kerala
(2) My name is enrolled in 001, Manjeshwara Assembly
State at Serial No. 696 in Part No. 43.
my e-mail id is
(3) My contact telephone number(s) is 9061871899 and is
Shashiashwini4@Gmail.com and my social media account
)Face Book Account Ashwini ML
(i) Instagram : ML Ashwini
(ii) XAccOunt: M L Ashwini -3-202

ANANTHARAMIA.P
KasaragodDBst.
Kerala
Regn.No:21781
ExpiryDate
12-03-2025
OT Of INC

ASURY

9 A2
R 024

Ho.sOLDa+h.TO..ShwÂ..NL
3vALUE R%.AAD:A.ly
KASARAGOD SHRTOHARA.C
KACA

n.RaRRRd).tTURT STAMP VENDOP

 (4) Details of Permanent Account Number (PAN) and status of flingof Income
Tax return:

SI. No. Names PAN The financial year for Total income shown
which the last Income-tax in Income Tax
retum has been filed Return (in Rupees)
1 Self Nil NA
BAGPA2087L NA (ü)
NA (iii)
NA (iv)
NA (v)
2 Spouse CKCPS0264G Nil NA ()
NA
NA (ii)
NA (iv)
NA (V)
HUF(If the NIL NIL NA
Candidate is NA (i)
Karta or NA (i)
Coparcener) NA (iv)
NA (V)
Dependent-1 NO PAN Nil NA
Allotted NA
NA (ii)
NA (iv)
NA ()
5 Dependent-2 NO PAN Nil NA ()
Allotted NA (ü)
NA (ii)
NA (iv)
NA (v)
6 Dependent-3 NO PAN Nil NA (0)
Allotted NA (i)
NA (iü)
NA (iv)
NA (V)

ANANTHARAMA. P
KYsaragod Dist.
Kerala
Regn. No:21781
Expiry Date
12-03-2025
 Note: It is mandatory for PAN holder to mention PAN and in
should be clearly stated "No PAN allotted". case of no PAN, it

(5) Pending criminal cases

() Ideclare that there is no pending criminal
case against me. (Tick this
alternative if there is no criminal case pending against the Candidate and write
NOT APPLICABLE against alternative (ii) below)
OR
(i) The following criminalcases are pending against me:
(If there are pending criminal cases against the
candidate, then tick this
alternative and score off alternative (i) above, and give details of all pending
cases in the Table below)
Nil
(6) Cases of conviction

) Ideclare that | have not been convicted for any

criminal offence. (Tick this
alternative, if the candidate has not been convicted and write NOT APPLICABLE
against alternative (ii) below)
OR
(0) Thave been convicted for the offences mentioned below. t NOTAPPLICABLE
(If the candidate has been convicted, then tick this
alternative
alternative and score off

() above, and give details in the Table below)

Table
La) Case No. Nil NA NA
Lb) Name of the Court NA NA NA
(c) Sections of Acts/Codes NA NA |NA
involved (give no. of the
Section, e.g.
Section..... of IPC,
etc.).
(d) Brief description of NA NA NA
offence for which
convicted
(e) Dates of orders of NA NA NA
conviction
() Punishment imposed NA NA NA

ANANTHARAMA. P R2o24
Kasaragod Dist.
Kerala
Regn. No:21781
Explry Date
12-03-2025
 (g) Whether any Appeal No NA NA
has been filed against
conviction order
(Mention YESor No)
(h) If answer to (g) above is NA NA NA
YES, give details and
present status of appeal
(6A) Ihave given full and up-to-date information to my political party about all pending
criminal cases against me and about all cases of conviction as given in
paragraphs (5) and (6).
[candidates to whom this Item is not applicable should clearly write NOT
APPLICABLE IN VIEW OF ENTRIES IN 5) and 6(0), above]
Note:
1. Details should be entered clearly and legibly in BOLD letters.
2. Details to be given separately for each case under different columns
against each item.
3. Details should be given in reverse chronological order, ie., the latest
case to be mentioned first and backwards in the order of dates for the
other cases.
4. Additional sheet may be added if required.
5. Candidate is responsible for supplying all information in compliance of
Hon'ble Supreme Court's judgment in W. P (C) No. 536 of 2011.
(7) That igive herein beiow the detaiis of the assets (movabie and immovabie
etc.)of myself, my spouse and all dependents:
A, Details of movable assets:
Note. 1.Assets in joint name indicating the extent of joini ownership wii aiso
have to be given.

Note: 2. In case of deposit/lnvestment, the details including Serial Number,

Amount, date of deposit, the scheme, Name of Bank/nstitution
and Branch are to be given.
Note: 3. Value of Bonds/Share Debentures as per the current market value
in Stock Exchange in respect of listed companies and as per
books in case of non-listed companies should be given.

B3-2024

ANANTHARAMA. P
Kasaragod Dist.
Kerala
Regn. No:21781
Epiry Date
12-03-2025
 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 of
each investment.
Note: 6. Details should include the interest in or ownership of offshore
assets.

Explanation- For the purpOse of this Form, the expression "offshore assets"
includes, details of all deposits or investments in Foreign
banks and any other body or institution abroad, and details of
all assets and liabilities in foreign Countries.
S. Description Self Spouse HUF Dependent- Dependent- Dependent
No. 1 2 3
Cash in hand Rs. 25,000 00 Rs. 10,000.00 NA Rs Nil Nil
1,000.00
(ü) Details of deposit in SB. ACcount 1. S.B. Account
Nil Nil Nil
No No
Bank accounts Nil
42282200117408 41825001021301
(FDRS, Tem Canara Bank, 01. Karnataka
Deposits and all Vorkadi Branch Bank, Kurnud
other types of Rs. 4,710.00 Mudipu Branch
deposits induding 2.S.B.
No
Account Rs. 1518 00

saving accounts). 40606101028298 2. Bank of Baroda,

Deposits with KGB Bank, Pavvoor Sukkadakatte
Financial Branch Branch SB A/c
Institutions, Non Rs. 29,804.00 No
3.SB Account 686101000101
Banking Financial No. 003001001150 84
Companies and The Vorkady Co Rs. 5,000/
Cooperative operative Bank
SOCieties and the Vorkady Branch
Rs. 4,700.00
amount in each
such deposit 4. SBI Kasaragod
Branch
Account No.
42826747350
Rs. 5,000.00

(i) Details of NIL Nil Nil Nil Nil Nil

investment in
Bonds,
Debentures/Shares
and units in
companies/Mutual
Funds and others
and the amount.

ANANTHARAMA. P B32o2
KasaragodDist
Keraia
Regn.No:2178!
Expiry Date
12-03-2025
 (iv) Details of Nil Ni Nil NIL
investment in Nil Nil
NSS, Postal
Saving.
Insurance
Policies and
investment in any
Financial
instruments in
Post office
Insurance
Compay and the
amount

(v) Personal Nil Nil Nil Ni Nil Nil

loans/advance
given to any
person or entity
including fim,
company, Trust
etc. and other
receivables from
debtors and the
amount.
(vi) Motor 1. Maruthi Omni Maruthi Alto Nil Nil Nil Nil
Vehicles/Aircrafts/ Van Reg. No. Car
Yachts/Ships KL 14 P 8468, Reg. No. KL 14
(Details of Make, year of M 8498,
Purchase Purchased in
registration 2014, Rs 2013
number. etc. year 1,00,000.00 Amount Rs.
of purchase and 1,50,000.00
amount
(vii) Jewellery, bullion Gold-66 Grams Gold-36 Gram Nil Gold-20 Gold-23
and valuable Value-Rs. Value-Rs. Gram Gram
thing(s) (give4,12,500.00 2,25,000.00 Value Value
details of weight Rs Rs
and value) 1,25,,000 1,43,750.
00 00
(vili) Any other assets Nil Nil Nil Ni Nil Nil
such as value of
claims/interest
(x) Gross Total| Rs. 5,81,714.00 Rs. Nil Rs Rs. NA
value 3,91,518.00 1,26,000. 1,43,750.
00 00

B. Details of Immovable assets:

Note: 1. Properties in joint ownership indicating the extent of joint ownership
willalso have to be indicated.

IAR
ANANTHARAMA. P
Kasaragod Dist.
Kerala
Regn. No:21781
Expiry Date
12-03-2025

SOVT.OE
 Note: 2. Each land or building or apartment should be mentioned separately
in this format.

Note: 3. Details should include the interest in or ownership of offshore

assets.

S Description Self Spouse HUF Dependent. Dependent-2 Dependent-3

No
Agricultural Ni Nil Nil Nil Nil Nil
Land
Location(s)
Survey
number(s)
Area (total NA NA NA NA NA NA
measurement in
acres)
Whether NA
Nil Nil NA NA NA
inherited
property (Yes or
No)
Date of NA NA NA NA NA NA
purchase in
case of self
acquired
property
Cost of Land (in NA NA NA NA NA NA
case of
purchase) at the
time of purchase
Any Investment NA NA NA NA NA NA
on the land by
way of
development,
construction etc.
Approximate NA NA NA NA NA NA
Current market
value
Non- Agricultural Property situated in Property situated in NA NA
in NA NA
land: Location Kodlamogaru Village Kodlamogaru Village
Manjeshwar Taluk in Manjeshwar Taluk
(S)
Survey Survey Extents( Survey Exte
number(S) No. No. Acres) No nts(A
0. cres)
1 143/4pt1 0.71 1 143/4pt 0.27

Area (total 3440 1093 NA Nil NA NA

measurement in
sq.ft.
Whether No No NA NA NA NA
inherited
property (Yes or
No)

gTAR
ANANTHARAMA. P
Kasaragod Dist. /63-203
Xerala
Regn. No:21781
Suiry Date
12-03-2025

GOV
 Date 15/12/2016 20/01/2005 NA NA NA
NIL
Purchase in
case of self
acquired
property
Cost of Land (in Rs. 6,00,000.00 Rs. 10,000/ NA NA NA NA
case
purchase) at the
time of purchase
Any investment Nil Nil NA NA NA NA
on the land by
way of
development,
construction etc.

Approximate Rupees ten lakhs for Rupees Four NA NA NA NA

cument marketRS no. 143/4pt1 Lakhs only
value

Commeriai 0Nii Nii N Nii Ni

building
(including
apartments)
Location(S).
Survey
numbers)

Area Total NA NA NA NA NA NA
Measurement in
sq.ft.)
Area NA NA NA NA
Built-up NA NA
(total
measurement in
sq. ft.)
|Whether NA NA NA NA NA NA
inherited
property (Yes or
No)
Date of NA NA NA NA NA NA
purchase in
case of self
acquired
property
Cost of property NA NA NA NA NA NA
(in case of
purchase)at the
time of purchase
Any investment | NA NA NA NA NA NA
on the property
by way of
development
NA NA NA NA NA
Approximate NIL
current market
value

oTAR
ANANTHARAMA.P
KasaragoDIst.
Kerala
Regn. No:21781
Expiry Date
12-03-2025
)

IV Residential Property situated ir Ni

NIL NIL Nil Nil
Building Kodlamogaru Village in
Manjeshwar Taluk
(including
apartment SI
No
Survey No Extent
Location(s). (Acres
Survey 1 143/4pt4 014
number(s)
Area (Total 1800 Sq ft NA NA NA NA NA
measurement in
Sq. ft)
Built up area 1650 SFT NA NA NA NA NA
(total
measurement in
sq. Ft.)
Whether No NA NA NA NA NA
inherited
property (Yes or
No)
Date 12/11/2020 NA NA NA NA NA
purchase in
case of self

acquired
property
Cost of PropertyNo (Gifted) NA NA NA NA NA
(in case of
purchase) at the
time of purchase
Any investment Rupees twenty five NA NA NA NA NA
on the land by lakhs
way of
development,
construction etc,
Approximate Rupees twenty eight NA NA NA NA NA
cument marketlakhs
value

Others (Such as NIL NIL NIL

interest in NIL NIL NIL

property)
Total of current|Rupees thirty eight| Rupees four NA NA NA NA
market value of lakhs lakhs
(0) to
(V)
abo
Ve
(ii

8). Igive herein below the details of liabilities/dues to public financial institutions and
govermment:

(Note : Please give separate details of name of bank, institution, entity of individual and
amount before each item)

OTAA
ANANTHARAMA.H
KasaragodDlst.
Kerala
Regn.No:21731
Epiry Date
12-03-2025
 S Description Self Spouse HUF Dependen Depende Dependent
No. t-1 nt-2 3
Loan or dues 1. Housing Loan from NIL
NIL NIL NIL NIL
to KGB Bank. Pavoor
Bank/financial Branch Total
institution(s) Balance is Rs.
Name of the 9,34.841.00
Bank or
financial 2 Agricultural Loan
institution, from Canara Bank,
Amount Varkady Branch Rs.
outstanding. 1,63,856.00
'Nature of
Loan"

Loan on dues Nil

NIL NIL NIL NIL
to any other Nil
individuals/
entity other

mentioned
above
Name(s)
amount
outstanding.
nature of loan

Any other NIL NIL

NIL NIL NIL NIL
liability
Grand total of Rs. 10,98,697 Nil NA NA NA NA
Liabilities

(i Government (A)Has the Deponent been in occupation of accommodation

NO
dues
to
: Dues provided by the Govemment at any time during the last ten years
before the date of notification of the current election?
departments
dealing with (B) If answer to (A) above is YES. the following declaration may be
govermment fumished namely:
accommodati (() The addresS the Government accommodation:
on
ABL
(i) There is no dues payable in respect of above Govermment
accommodation, towards
(a) rent;
(b) electricity charges; (c) water charges; and (d) telephone charges
as onaasaldate) [the date should be the last date of the third
month prior to the month in which the election is notified or any date
thereafter]. Note- No Dues Certificate" from the agencies
concemed in respect of rent, electricity charges, water charges and
telephone charges for the above Government accommodation
should be submitted

OTARP
ANAATHARAMA.P
KasaragodDist
Kerala ae3-202
Regn.No:21781
ErpiryDate
12-03-2025

GOV!
(ii) Dues to
department NIL NIL NIL NIL NIL NIL
dealing with
govemment
transport
(including
aircrafts and
helicopters)
(iv) Income tax Nil Ni Nil Nil Ni Nil
dues

Self Spouse HUF Dependent Dependent-2 Dependent-3

1

(v) GST dues Nil Nil Nil Nil Nil Nil

(vi) Municipal Nil Nil Nil Nil Nil
property Tax
Dues
(vii) Any other Nil Nil Nil Nil Ni Nil
dues
(viii Grand total of NIL NA NA NA NA
all
Government
dues
(ix) Whether any
other NIL NIL NIL NIL NIL NIL
Iiabilites are
in dispute, if
So, mention
the amount
involved and
the authority
before which
it is pending

(9) Details of profession of occupation:

(a) Self :Housewife
(u) Spouse Assistant FaciityMaiager, NitMC Hospiiai, Trivänúram

(9A) Details of source(s) of income

(a) Self :Nil

(b) Spouse :3,00,000.00 PA

(c) Source of income, if any, of dependents, Nil.

(9B) Contracts with appropriate Govenment and any public Company or Companies
(a) detais of contracts entered by tie Candidatë : Ni
(b) details of contracts entered into by spouse: Nil
3z02y
(c) details of contracts entered into by dependents: Nil

ANANTHARAMA. P
KasaragodDist.
Kerala
Regn.No:21781
Explry Date
12-03-2025
 (d) details of contracts entered into by Hindu Undivided Family or trusts in which the
candidate or spouse of dependents have interest: Nil
(e) details of contracts Partnership Firms in which candidate or spouse or dependents
are partners : Nil.
() details of contracts entered into by private companies in which candidate or spouse
or dependents have share; Nil.
(10) My educational qualification is as under:
Diploma in Montessord Training from Bharath Uppala in 2012-13 affiliated to Bharat
Sevek Samaj, Trivandrum.
(Give details of highest school University education mentioning the full form of the certificate/
diploma/ degree course, name of the schoo/ college/ university and the year in which the
course was completed.
PART -B
(11) Abstract of the details given in (1) To (10) of Part -A
1 Name of Candidate ASHWINIML
2 Full Postal Address W/o Shashidhara P, Aged 38 years,
resident of Ashirwad house, Kodlamagaru
Post & Village, Vorkady Panchayat,
Manjeshwara Via & Taluk, Kasaragod
District-671323
3 Number and name of the Constituency (01) KASARAGOD
and State KERALA
4 Name of the political party which set up BHARATIYA JANATA PARTY
the candidate (otherwise write
Independent')
5 Total number of pending criminal cases Nil
6 Total number of case in which convicted NIL

7 PAN of Year for which last Total Income

Income Tax Return filed
BAGPA2087L Nil Ni
(a) Candidate
(b) Spouse CKCPS0264G Nil Rs. 3,00,000.00
(c) HUF NIL NA NA
(d) Dependent-1 Nil Nil Ni
(e) Dependent-2 Nil Nil N
8 Details of Assets and Liability (including offshore assets) in Rupees
Description Self Spouse HUF Dependent Dependents Dependents
-
A Movable Assets Rs. Rs. Nil 1,26,0000. 1,43,750.00 Nil
(total Value) 5,81,7 3,91,51 00
14.00 8.00

ANANTHARAMA. P
KasaragodDist Rs32624
Kerala
Rega. No:21781
ExpiryDate
12-03-2025
 Immovable Assets
Purchase Price of setf 6,00,000
Rs Rs NI Nil Nil
acquired immovatble 10,000
property
Developmentvconstruci Rs. Nil Nil Nil Nil Nil
on cost of immovable 25,00,0
00/
property after
purchasef applicable)
Approximate Current Rs 38,00 4,00.00
0004 0.00
Market Pice
(a) Self-acquining
assets
(b) Inheited assets
Liabilities 10,97, Nil Nil Nil Nil Nil
697.
00
)Govemment dues Nil Nil Nil Nil Nil
(Total)
Loans from bank. 10,97, Nil Nil Nil Nil Nil
Financial Institutions 697.
and others (Total) 00
1
Liabilities that are under dispute
Govermment dues Nil Nil Nil Nil Nil Nil
(Total)
Loans from Bank, Nil Nil Nil Nil Nil Nil
Financial Institutions
and others(Total)
11
Highest education qualificaion: Diploma in Montessori Education Training Bharath Collage, Uppala
2012-13, Affiliated to Bharat Sevak Samaj Trivandrum.
(Give details of highest schooWUniversity education mentioning the full fom of the
certificatediploma/degree course, name of the SchooVCollege University and the years in which the
cOurse was completed)

VERIFICATION
, 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 from. 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 Aand Babove;

(c) I, my spouse, or my dependents do not have any asset or liability, other than those
mentioned in items 7 and 8 of Part Aand items 8, 9 and 10 of Part Babove.
Kasataged o24
Verified this the... ..day of..Mat eh

DEPONENT

ks3202
ANANTHARAMA.P
KasaragodDist.
Kerala
Regn.No:21781
ExpiryDate
12-03-2025
 Note: 1. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations.

Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class
or before a Notary Public.

Note: 3. Allcolumns should be filled up and no column to be left blank. If there is no intormation
to furnish in respect of any item, either "Nil" or "Not applicable" as the case may be,
should be mentioned.

Note:4. The affidavit should be either typed or written legibly and neatly.
Note: 5. Each page of the Affidavit should 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 sworn.

Solemy aftimed any eheunt ague m ay

uneetniy an
eponert aftet True
the
Corte hove ore ae
admtHng t e match Ro2 4 t
Y tis
2g7h
Kasatagod.
R93-2014

ANANTHARAMA.
P
ANAHARAMA,3
ADVOCATE
& NOTARY Kaßa
KASARAGOD(KERALA) INDIA
o:~1781
5piryDate I N D

17-63-2025
28-3-ROR4
SL. NO.RO.pat. o82 GiRUPEES ONEH 2
O1..Page No.... SPECIAL
ADHESIVE
Volume No...
Of NOTORIAL REGISTEF