Certificate No. Cortiticate Issued Date Account Reference A Unique Doc. Reference 2 SUBIN-PYPYSHIMP1725682563214264W_ Purchased by > NIRMALA © Description of Document 2 Article 4 Affidavit © Properly Description : AFFIDAVIT Consideration Price (Rs.) ao (Zero) First Party 2 NIRMALA Second Party : ELECTION COMMISSION OF INDIA ‘Stamp Duty Paid By 2 NIRMALA Ste ‘Stamp Duty Amount(Rs.) ei ity only) < Plows Wit or pe Belo WeisAFFIDAVIT TO BE FILED BY THE CANDIDATE ALONG WITH NOMINATION PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO PUDUCHERRY LOK SABHA (NAME OF THE HOUSE) FROM PUDUCHERRY CONSTITUENCY (NAME OF THE CONSTITUENCY) PART-A I Mrs. NIRMALA wife of Mr. Gopi Aged 36 years, resident of No.24, 14" Cross Street, Krishna Nagar, Puducherry ~ 605 008 (mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under:~ 1. 1am contesting as an Independent candidate. 2. My name is enrolled in (10) Kamaraj Nagar, Puducherry (Name of the constituency and the State), at Serial No.339 in Part No.23. 3. My contact telephone number (s) is /are 8122991999 and my e-mail id (if any) is srisairam2510@gmail.com and my social media account(s) (if any) is / are @NIL Gi) NIL iii) NIL4. Details of Permanent Account Number (PAN) and status of filing of Income Tax return: Total income shown in ‘The financial year | Income Tax return sl. for which the last | (in Rs. ) for the last No. ed aN income Tax retum | five Financial Years | hhas been filed | completed (as on 31° March) Rs.4, 98,460 sett Rs.5.90,040/- ea BGLPNS037Q 2023-24 Rs3.55.020 Nil Rs.4,99,450/- Spouse Rs.5,07, 160/- 2. | Gorr AQDPG69206 2022-23 Rs.4,97,930/- Rs.3,49,850/- Nil | HUF (If Candidate is Nil | Karta/Coparcener) . Nil__| 3 Nil i Nil___| Nil Nil Dependent 1 Nil 4. | Srisairam (Minor) gerbe Nil Nil Son aged 09 yrs Nil Nil__| Dependent -2 Shavethini (Minor) No Pan , 5. | Daughter aged 05 yrs | allotted pal nl 6. | Dependent -3 Nil Nil Nil Note : It is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly stated “No PAN allotted”. Qe eske5. Pending Criminal Cases (1 declare that there is no pending criminal Case against me. (Tick this alternativ: there is no Criminal Case pending against the Candidate and Write NOT APPLICABLE against alternative ( OR If the following Criminal Cases are pending against me: NOT APPLICABLE (if there are pending Criminal Case against the Candidate then tick this alternative and score of alternative (i) above, and give details of all pending case in the Table Below) TABLE @ | FIR No, with name and address of | Not Applicable | Not Applicable ] Not Applicable Police Station concerned @®) | Case No. with Name of the Court | Not Applicable | Not Applicable | Not Applicable (] | Section(s) of concerned acts/Codes | Not Applicable | Not Applicable | Not Applicable involved (give no. of the Section eg. Section.....of IPC, etc @ | Brief description of offence Not Applicable | Not Applicable | Not Applicable © | Whether charges have been Not Applicable | Not Applicable | Not Applicable framed (mention YES or NO) @ | If answer against (e) above is ‘Not Applicable | Not Applicable | Not Applicable YES, then give the date on which charges were framed ® | Whether any Appeal/Application | Not Applicable | Not Applicable | Not Applicable for revision has been filed against the proceedings (Mention YES or No) it = S. KRISHNARAD a PULUCHERRY No, : 1656572000(6) Case of Conviction (i) 1 declare that I have not been convicted for any criminal offence. (Tick this alternative is the candidate has not been convicted and Write NOT APPLICABLE against alternative (ii) below OR (ii) have been convicted for the offences mentioned below : NOT APPLICABLE. (if the candidate has been convicted, then tick this alternative and score off alternative (i) above and give details in the Table below) @ [Case No. ‘NOT APPLICABLE © | Name of the Court NOT APPLICABLE © _ [Section of Acts/Codes involved (give no. of | NOT APPLICABLE the section, e.g., section ...of IPC, etc.) @ | Brief description of offence for which NOT APPLICABLE convicted © _ | Dates of Orders of Convicted NOT APPLICABLE |@ | Punishment imposed ‘NOT APPLICABLE (® | Whether any Appeal has been filed against | NOT APPLICABLE, conviction order (mention YES or No) | Tfany to (@) above is VES, give details and | NOT APPLICABLE present status of appeal | (6A) I have 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). NOT APPLICABLE [Candidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6 (i), above] 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. ils should be given in reverse chronological order, i.c., the latest case to be tioned first and backwards in the order of dates for the other cases. ial sheet may be added if required idate is responsible for supplying all information in compliance of Hon'ble }e Count’s judgment in W.P-(C) No. 536 of 2011 Q. News7) That give herein below the details ofthe assets (movable and immovable etc.) of myself, my spouse and all dependents: A. Details of movable assets: Note: Assets in joint name indi the extent of joint ownership will also have to be given. . In case of deposit/Investment, the details including Serial Number. Amount, date of deposit; the scheme, Name of the Bank/Insttution and Branch are to be given. 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 nortlisted companies should be given. |. “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. cluding amount is to be given separately in respect of each investment 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” x Description Seif Spouse TUF] Dvr Den Dee @ | Cash in hand Bs.50,000- Rasoo00- | Ni] na | Ni (ii) Details of deposit in 1. State Bank of | 1. Puduvai Bank accounts(FDRs, | India, ADB Bharathiar Grama Term Deposits and all | Pondicherry | Bank, Current other types of Savings Ale. No, | Account Ale deposits including 20202955442, No.60009374561 saving accounts), | R8.1,779/- Rs.5,604/- Deposits with Nil ’ Financial Institutions, | 2. Puduvai 2, State Bank of NaN Non-Banking. Bharathiar Grama | India, ADB Financial Companies | Bank, Current | Pondicherry and Cooperative | Account A/e__| Savings A/c. societies and the ‘No.60009612293 | No. 41125237149, amount in each such | Rs.5,000/- Rs.1,400/- deposit Details of investment in Bonds, debentures/shares and units in Nil Nil ni] ni | Ni | Nil companies/Mutual funds and others and the amountGv) _| Details of investment in NSS, Postal Saving, Insurance policies and investment in any Nil Nil Nil} Nil | Nil | Nil inancial instruments in Post office or Insurance Company and the amount ©) _ [Personal Joans/advance given to any person or entity including firm, , , 3 5 aisanyl Tastete, | °8250,000/ Nil wa | Nil [Nil Nil and other receivables from debtors and the amount (i)_| Motor Vehicles/ 1. Pulsar 150 ES Aircrafis/Yachts/ DTS, Reg. Ships(Details of ‘No.PYO1X8138, Make, registration | son Magnite | Year 2008, number etc. year of | NSM Rs.42,000/- . Reg. ; Purchase and amount) | No PYOICY2156 F Nil) wa | Nil | Nil 2. Susuki Access Year 2021, ia aay, Rs.6,00,000- | No PYOICV8833, Year 2019, Rs.65,000/- (ii) | Jewellery, Bullion and - valuable thing(s) 120 Grams Gold Nil (give details of weight | Jewels, Value Nil Nil | Nil | Nil SL Rs.7,44,000/- (il | Any other assets such Nil Sverre Nil Nil Nil | Nil Nil claims/interest (iy | Gress Total Value | R5.16,50,779/- a Nil | Nil PUDUCHERRY ON reno: 165652020 ZAG ps n0128B, Details of Immovable Assets: Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated 2, Each land or building or apartment should be mentioned separately inthis format 3. Details should include the interest in or ownership of offshore assets a Self ‘Spouse | HUF] Depen] Depe] Dep No Descriy dent-1} ndent| ende -2_ | mt3 @ | Agricultural Land: - ea] Ni aes i Location(s) Survey number(s) a it Re Ne ‘Area (total measurement in acres) Nil Nil Nil Nil Nil Nil Whether inherited property (YES : NTT na : or NO) Nil Nil Nil Nil | Nil Date of purchase in case of sel || Nl i Sancl eaey Nil Nil | Nil | Nil Cost of Land (in case of purchase) ‘i ” ‘Nil 7 " " prereset ay Nil Nil Nil | Nil | Nil ‘Any investment on the land by Nil way of development, construction Nil Nil Nil Nil | Nil etc. "Approximate current market value Nil Ni_[ Ni Ni Gb | Non-Agricultural Land: SaramRV. RS. | _Nil Nil_| Nil Nil Location(s) Survey number(s) No.164 Nil Nil Nil Nil ‘Area (total measurement in St.ft) 450 sq. fect Nil Nil Nil Nil Whether inherited property - - F : (YES or NO) No Nil Nil Nil | Nil Date of purchase in case of sel rel Nal seers) Aaa acquired property 18.04.2018 Nil Nil Nil Nil Cost of Land (in ease of purchase) = - ciihe dase areas Rs.5,86,000- | Nil Nil Nil ‘Any investment on the Tand by way of development, construction Nil wil |-Nil | Nil | Nil | Nil etc. ‘Approximate current market value | Rs.10,00,000-. | Nil_| Nil Nil ‘Non-Agricultural Land: Saram R.V., R.S. Nil Nil Location(s) Survey number(s) No.288 Nil Nil ‘Area (total measurement in St.ft) 1050 sq. feet Nil Nil ‘Whether inherited property : aa (YES or NO) No Nil Nil | Nil Date of purchase in case of self | 1g 9) 2922 wi | N# | ni | na | Nit acquired property Cost of Land (in ease of purchase) F Seer tal at the time of purchase Rs.20,06,000/- Nil Nil Nil Nil | Nil ‘Any investment on the Tand by way of development, construction Nil Nil Nil Nil Nil | Nil etc. Approximate current market value Ni_| Nit [Nil [Nil BA. UB.MBA PUDUCHERRY‘Commercial buildings Nil Ni_[ NI] Ni Nil (including apartments): Location(s) Nil nil | it | Nit | Nit | Nit “Survey number(s) ‘Area (total measurement in acres) Nil MiNi NNT | Battup Area Total measurement a pores peers ae et } [msg ft) in ‘i | | Whether inherited propery (Ves ra tea ante ene le | forty : Date of purchase in ease of self Hi oat a. lane au | | acquired property Cost “of 5 property © (In\jcase|/of Nil nit | wa | na | nit | Nit purchase) at the time of purchase ‘Any investment on the land by ‘way of development, construction Nit nil | nit} wat | Nit | Nit etc “Approximate current market value = aaa sie melee la Gv) | Residential buildings (including apartments): Serer eaiae wi | na} ona | Na | No Location(s) Survey number(s) ‘Area (total measurement in acrés) | _430sq.feet__| Nil_| Nil | Nil_| Nil | Nil seg ee Cota measurement | 150059 feet | Nil | Nil | Nil | Nil | Nil sWhethersinberffediiproperty. (es No wit | na} ona | na | Ni or No) este [On ante see ncaa Ores a7 Nil | Nil | Nil | Nil | Nil acquired property Cost of property (in ease of 7 a eae gS purchase) athe time of purchase | _R8585,000- | Nil | Nil | Nil | Nil | Nil ‘Any investment on the property by way of development, construction | Rs.12,00,000- | Nil | Nil | Nil | Nil | Nil etc. Approximate current market value | ps >s.99,990/- | Nil | Nil | Nil | Nil | Nil (vy) ae i as interest in Nil Nil wit | Nit | Nit [Gi | Total of current market value of (| @ 0 @) above Rs.60,00,000/- | Nil | Nit | Nit | Nit | Nit (8) I give herein below the details of tiabi government:- (Not ‘amount before each item) ‘dues to public financial institutions and lease give separate details of name of bank, institution, entity or individual and[OF] Depend a Description Self ‘Spouse PTS] Opt] Det (i) | Loan or dues to | 1. Punjab National Bank/financial Bank, Business institution(s) Name of | Loan, the Bank of financial | Rs.30,00,000/- | National Bank, institution Business Loan, | Nil] Nil | Nil | Nil Amount outstanding, | 2. Shriram Finance | Rs.15,00,000/- Nature of Loan Ltd, Business Loan, Rs.15,00,000/- Loan or dues to any | ose Jain Pawn individuals/entity Sate Pawn Broker, | “prajcer other than mentioned Jewel Loan, |. 9°90, 000/- Nil | Nil | Nil above Name(s), Rs.2,50,000/- Se Nil Amount outstanding, nature of loan Nil Nil Nil} Nil | Nil Rs.47,50,000/- | Rs.17,00,000/- |.) Nil | Nil ‘A. Has the deponent been in occupation of ‘accommodation provided by the Government Vy any time during the last ten years before the | YES / NO date of notification of the current election? B. If answer to (A) above is YES, the following | (Please tick declaration may be furnished namely: the Government dues: |) The address of the Government appropriate accommodation - Nil - alternative) Dues to departments dealing with Government accommodation ‘There is no dues payable in respect of above ‘government accommodation towards (a) Rent: not applicable (b) Electricity Charges : Not applicable (©) Water Charges; and (@) Telephone charges as on Not applicable (date) (the date should be the last day 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 shouldbe submited. Dues to department | Nil dealing with Government transport (including aircrafts and helicopter)Self | Spouse | HUF] Depen] Depen| Depen dent-1) dent-2} dent-3 Income tax Dues Nil Nil Nil Nil Nil GST dues Nil Nil Nil Nil Nil “Municipal/Property Tax Dues | _Nil Nil_|_Nil_[_Nil_|_Nil Any other dues Nil Nil Nil Nil Nil Grand Total of all Government Nil | Nil | Nil | Nil | Nil | Nil dues | (is) | Whether any other ies are in dispute, if so mention lea the amount involved and the | Nil Nil | Nil | Nil authority before which it is Nil pending | 9. Details of profession or occupation: (a) Self -: Business - Proprietor — Sri Sairam Industries (b) Spouse : Business - Proprietor ~Sri Sairam Agency (9A)Details of sources of Income (a) Self : Business - Proprietor ~ Sri Sairam Industries (b) Spouse: Business - Proprietor ~ Sri Sairam Agency (©) Source of Income, if any, of the dependents...Nil (9B) Contracts which appropriate Government and any public company or companies (a) details of contracts entered by the candidate...Nil (b) details of contracts entered into by spouse... Nil (©) details of contracts entered into by dependent il (@) details of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest... Nil (©) Details of contracts entered into by 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:- ‘A. Higher Secondary (+2) Completed in Girls Christian Hr. Sec. School, Melpattambakkam — 607 104, in the year 2005, B, The Diploma in Computer Hardware Technology, completed in Tiruchirappalli Regional Engineering College Science and Technology Entrepreneurs Park, ‘Tiruchirappalli ~ 620 015, in the year 2008. (Give details of highest Schoo/University education mentioning the full form of the certificate/diploma/degree course, name of thi jllege/University and the year in which the course was completed.) ZOTAR ~ xPART-B (11) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A: T__ | Name of the Candidate Mrs. Nirmala iz Full postal address No.24, 14" Cross Street, Krishna Nagar, Puducherry — 605 008 3. | Number and name of the constituency and State Puducherry, Puducherry % [Name of the political party which set up the | Independent candidate (otherwise write ‘Independent") '3__| Total number of pending Criminal cases NIL 6. | Total number of cases in which convicted NIL 7. PANof | Year for which last | Total income shown income tax return filed mez (@) Candidate BGLPNS037Q___| 2023-24 Rs.4,98,460/- (b) Spouse AQDPG6920G 2022-23 Rs.4,99,450/- (HUF NIL NIL (@) Dependents No PAN allotted | NIL NIL B. | Details of Assets and Liabilities (including offshore asseis) in Rs. Description ‘Self Spouse HUF] Depe | Dep ] Dep ndent | end | end =1 Jent | ent-| Eze | 3 (i) (2) 3) (4) (3) (6) _| (7) | (8) A Movable assets Rs.16,50,7797- | Rs.1,64,008/- | Nil Nil [Nil | Nil (Total Value) B |__| Immovable Assets : T | Purchase price of self | Rs.31,77,000/- | Nil Nil Nil [Nil | Nil acquired immovable property ii | Development/constructio | Rs.12,00,000- | Nil Nil Nit [Nit_| Nit ‘cost of immovable property after purchase (if applicable) iii | Approximate Current | Rs.60,00,000- | Nil Nil Nil [Nil_| Nit Market Price (a) Self — acquired assets (Total Value) (b) Inherited assets (Total Value)9 Liabilities (@ | Government dues (Total) [Ni Nil Nil_| Nil (i) | Loans From Bank, Nil Nil | Nil_| Nid Financial Institutions and other (Total) Rs.47,50,000/- | Rs.17,00,000/- 10 Liabitities that are under | Nil [Ni Nil Ni | Nil_| Nil dispute | @__| Government dues (Total) | Nil Nil Nil Ni [Nl [Nil Gi)_| Loans from Bank, Nil Nil Nil Ni [Nil | Nit Financial Institutions and others (Total) 17 ‘A. Higher Secondary (+2) Completed in Girls Christian Hr. Sec. School, Melpattambakkam — 607 104, in the year 2005, B. The Diploma in Computer Hardware Technology, completed in Tiruchirapalli Regional Engineering College Science and Technology Entrepreneurs Park, ‘Tiruchirappalli — 620 015, in the year 2008. (Give details of highest School/University education mentioning the full form of the certficate/ diploma’ degree course, name of the School/College/ University and the year in which the course ‘was completed.) VERFICATION 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 from. | further declare that:- @ there is no case of conviction or pending case against me other than those ‘mentioned in items 5 and 6 Part A and B above; 0) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in item 7 and 8 of Part A and items 8,9 and 10 of Part B above. © Verified at Puducherry this the 26" Day of March 2024. SIGNED BEFORE ME Gane a: Daa <3) 2" ppponeNt ge s. INARAJ, BA, LLB, MBA, «a ADVOCATE ( Enrol. No 2583/2005) NOTARY ( Govt of india) sa Regd No: 16585/2020 [Ph tat rome Seect, Sih Nagar, Odd Sara, Pusu 605 013 1B. Mobile : 99454 17825 Email: rshna7iaw@gmail.com ne >Note: 2: ‘Affidavit should be filed latest by 3.00 PM on the last day of filing Nominations. ‘Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public. ‘All column should be filled up and no column to be left blank. 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. ‘The Affidavit should be either typed or written legibly and neatly. 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.