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    Affidavit-1715340908

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    3 views18 pages

    Affidavit 1715340908

    Uploaded by

    gowrishankar nayana

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 18
    woe sd5 ain ate ANDHRA PRADESH 81AA sea SIN: ye 4 Da: 2G-ol~ a \) Valtoal Site Pe eo rr§ OS. Swarmp de - cade. ee Ne VE Ferwhon, a 4. No. M Form26 fee — ' i (See rule 4A) a i ' AFFIQAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINATION PAPER BEFORE THE RETURNING OFFICER FOR ELECTION (NAMA OF THE HOUSE) FROM 01 ARAKU PARLIAMENTARY CONSTITUENCY (NAME OF THE CONSTITUENCY) PART-A I, LAKE _ASHOK KUMAR , S/o NAGESWARA RAO, Aged 38 Years, resident of Luvvagingi Village, Padabayalu_Mandalam, Alluri Sitha Rama raju dist (mention full address), a candidate at the above election, do hereby solemnly affirm and state on oath as under:~ (iytdm a candidate set up by INDEPENDENT (**name ofthe politcal pary)/ **am contesting san Independent cgnidate, (trike out whiggever i not sppicale) j L VASUDEVA RAO NOTARY ie Athol, Nore a Parvathipurem hianyara (Dist) Celi: 9440871755 _ Q2)My name is enrolled in 28 ARIKU (Consituency) and Andhra Pradesh (Name of the “Constituency and the state), at Serial No. 1041 in Part No. 75, (3)My contact telephone number(s) is 6281301906 and my e-mail id (if any) i social media aecount(s) (ifany) is/are @ NIL Gi) NIL ii) NIL ... and my Details of Permanent Account Number (PAN) and status of filing of Income tax return: SLNo] Names PAN we financial year for {Total income ] vhich the last Income-shown in Income Tax ' kax return has been filed Retura(in Rupees) for the last. five Financial Years completed (as on 31* | atch) 1 Self D l Not Applicable LAKE Ashok AIZPLA886B | Not Applicable fi) ey Not Applicable iii) Not Applicable iv) Not Applicable vy) ‘Not Applicable 2 Spouse iD Not Applicable Lake Indira NIL ‘Not Applicable i) Not Applicable iii) Not Applicable i) Not Applicable () ‘Not Applicable HUF (if Candidate 6) is NIL Not Applicable Not Applicable Karta/Coparcener) @ ieetiia 2 Not Applicable Badnaina (iii) Not Applicable iv) == ze @) ‘Not Applicable BAO 1. VASUDEVA VANOTAR’ a nehela (Cetus anyam (O54) | Dependent 1 NIL ‘Not Applicable i) Not Applicable (it) Not Applicable (iii) ‘Not Applicable i) : ‘Not Applicable $ ) ‘Not Applicable 5. i) Dependent 2 NIL Not Applicable Not Applicable (ii) ‘Not Applicable i) ‘Not Applicable © Not Applicable v) i Not Applicable 6. : i) Dependent 3 NIL Not Applicable Not Applicable i ? ‘Not Applicable i) Not Applicable 5 Not Applicable (vy) ‘Not Applicable | Note: Itis mandatory for PAN holder to mention PAN and in case ofno PAN, it should be clearly | stated “No PAN allotted”. (5)Pending criminal cases : NOT APPLICABLE EF Tdeclare 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 (ii( The following criminal cases are pending against me: Not Applicable (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) Table, (@ | FIRNo. with name and address of Police Station concerned Not Applicable | Not Applicable Not Applicable (&) | Case No with Name of the court Not Applicable | Not Applicable | Not Applicable '(e) | Section () of concemed Act! Codes involved (given no. of the section. 8) Not applicable | Not Applicable | Not Applicable section... of IPC, ete @ _| Brief description of offence Not Applicable | Not Applicable | Not Applicable © | Whether charge have been framed mentioned (Yes orNo) Not Applicable | Not Applicable | Not Applicable ® __| Wf answer against (e) above is Yes, than give the date on which charges| Not Applicable / Not Applicable | Not Applicable were framed @ _ | Whether any Appeal’ Application for revision has been filed against the) n+ anpticable | Not Applicable | Not Applicable proceedings ( Mention Yes or No (6) Cases of Conviction : NOT APPLICABLE clare that I have not been convicted or any criminal offence ( Tick this alternative, if the candidate has not been convicted and write NOT APPLICABLE against alterative i) below ) OR Gi) Ihave been convicted for the offences mentioned below : if the candidate has been convicted, then tick this altemative and score off alternative (i) above, and give details in the Table below ) Table (a) ‘Case No. Not Applicable Not Applicable Not Applicable (b) Name of the Court Not Applicable Not Applicable __| Not Applicable w Maxie TA RAO L Alek (Laer, arn (Dist) 1758 © Sections of Acts/Codes involved (give no, of the Section, eg Section... ete). of IPC, Not Applicable Not Applicable Not Applicable @ Brief description offence for whi convicted of cn | No Applicable Not Applicable Not Applicable © Dutes of orders of conviction /Not Applicable ‘Not Applicable Not Applicable 0) Punishment imposed Not Applicable Not Applicable Not Applicable @ Whether any Appeal has een filed against conviction order (Mention YES Not Applicable Not Applicable Not Applicable he tilde Loraeery Seal or No) Not Applicable Not Applicable _ | Not Applicable (h) | If answer to (g) above is YES, give details and )144 Applicable Not Applicable | Not Applicable present status of appeal (A) 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 S(i) and 6 (i), 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, i.e., the latest case to be mentioned first and backwards in the order of dates for the other cases. 4Additional 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, $36 of 2011. (7) That I give herein below the details of the assets (movable and immoyable etc.) of myself, my spouse.and all dependents: ii ccibesemecnatal A. Details of movable assets: Note: 1. Assets in joint name indicating the extent of j given. ownership will also have to be Note: 2. In case of deposit/Investment, the details including Serial Number, Amount, date of deposit, the scheme, Name of Bank/Institution and Branch are to be given. Nole: 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. 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. ARAO Le ngldeleiy- cunts nikal sm (Dist) 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 lial countries’; jes in foreign S.No Description Self Spouse HUF [Dependent-I jependent-2| Dependent-3 (Cashin hand IL NIL NIL NIL NIL NIL Delails of deposit in Bank accounts (FDRs, Term Deposits and all other types of deposits including saving accounts), Deposits with Financial Institutions, Non-Banking Financial Companies and Cooperative societies and the amount in each such deposit NIL NIL. NIL NIL NIL NIL iii) Deiails of investment in Bonds, Debentures/Shares and units in cothpanies/Mutual Funds and others and the amount. T. Not ly Not ‘Applicalapplicable Not happlicable Not lapplicable |Not applicable Details of investment in NSS, Postal Saving, Insurance Policies and investment in any Financial instruments in Post office or Insurance Company and the amount IL. Not ly Not ‘Applicalapplicable |Not applicable Not ‘applicable Not plicable {e plane Whether inherited I [NIL [Not Not Not [Not applicable propeity lapplicable applicable _— [Applicable (Yes or No) Date of purchase incase [Nil [Not [Not Not | [Not Not applicabie| of self- acquired property pplica applicable applicable [Applicable | le Cost of Land (incase of Not |Not | Not Not Not [Not applicable’ purchase) at the time of appli applica applicable applicable [Applicable purchase able ble ‘Any Investment on the [Not [Not [Not Not Not [Not applicable land | by way of [appli applica applicable fapplicable | [Applicable development, construction cable ble etc. ‘Approximate Current jot [Not [Not Not Not [Not applicable market value ppli applica applicable applicable * |Applicable 1 able ble (ii) Non-AgriculturalLand Not Not [Not Not Not Not applicable \Applicabli hatte) peli pplicn lepplicable applicable . |Applicable Survey number(s) ‘Area (otal measurement Not [Not [Not Not Not [Not applicable! in sq.ft) :ppli applica spplicable lapplicable Applicable 1 ble ble Whether inherited jot [Not [Not Not Not Not applicable property ippli {applica fipplicable applicable [Applicable (Yes or No) able ble Date of purchase in case Not [Not [Not Not Not Not applicable ofself- acquired property [pplilapplica rpplicable japplicable Applicable eable le Cost 6f Land (in case of [Not [Ndfot_|RWot ot ibapplicable | Riot applicablbNc purchase) at the time of — fappligapphitiedapphitiaalte pphitieblle | Applicable [Applicable purchase ble _[blste ‘Any Investment onthe — Not [Not [Not Not Not Not applicable land by way of lapplilapplica fipplicable applicable Applicable development, construction [ablelble ote. ‘Approximate current jot [Not |Not Not Not Not applicable market value ppli applica applicable applicable {Applicable able ole Weudert EVA RAO TARY PURAM yam (Dist) 1755 he Atle Worertaey ®) Personal __loans/advance Not|Not [Not Not Not Not | given to any person or entity |ApplApplicappplicable applicable applicable applicable 7 including firm, company, lica bly Trust ete. and reogivables fiom debtors if and the amount, (wi) Motor _ Vehicles/Aircrafts/ NIL|Not [Not ‘Not Not Not Yachts/Ships (Details |Applicaapplicable applicable applicable applicable Make, registration number. * zs etc! year of purchase and amount ) il) Jewellery, _ bullion IL|Not [Not Not Not Not valuable — thing(s) |Applicalapplicable fpplicable fppplicable applicable details of weight and value) bly (viii) | Any other assets such as Not|Not [Not Not Not Not vale of claimsfnterest_App/Applicalappleable applicable applicable applicable | lica bly (ix) Gross Total value INIL[Not [Not Not Not Not [Applicalapplicable applicable applicable applicable bly B Details of Immovable assets: Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated 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. So Description pouse| HUF |Dependent-I Dependent2 Dependent3 @ ‘AsriculturalLand Nil [Not Not Not Not applicable rags hpplicable applicable © [Applicable Survey number(s) ‘Area (total measurement Ni [Not Not Not [Not applicable in acres) applicable applicable — [Applicable ora Manyam (Dist) Col, 9440871755 I, Atle \ares, Whether inherited fot [Not [Not Not | [Not [Not applicable propeity ippli fpplica fapplicable applicable [Applicable (Yes or No) able le Date of purchase inease Not [Not [Not Not. [Not Not applicable of self acquired property fppli applica applicable fapplicable | Applicable | Kable ble Cost 6f property (incase Not [Not [Not Not Not ‘Not applicable| of purchase) at thetime of fppli applica fapplicable applicable _ }Applicable purchase able ple ‘Any Investment onthe Not Djofor [wot ot ibapplicable| Nubt applicabl land by way of lapplic pe ipbliablsic ppfitiahtte | |Applicable [Applicable development, construction Pble pide \ ete, “Approximate current Not [Not _ |Not Not Not Not applicable market value .ppli applica applicable applicable _ Applicable able le @) ] Others Guch asinterestin Not [Not [Not [Not Not Not applicable’ ‘appli applica ppplicable applicable _ Applicable property) able ble @iy | Total ofeurrent market Not [Not [Not Not Not [Not applicable i value of (i)to(v) above [appli applica applicable applicable [Applicable able ble | |(8) | give herein below the details of liabilities/dues to public financial institutions and government:- (Note: Please give separate details of name of bank, institution, entity or individual and amount before | each item) Deseription Sal Spouse) HUF PDependent-I [Dependent-2 [Dependent-3 Loan dues f Not |Not [Not Not Not ‘Not applicable| Bank/Financial applifpplica applicable plicable Applicable Institution(s) icbalejble Name of Bank or f Financial Institution, ; Amount outstanding, Nature of loan : ‘Loan or dues jot [Not [Not Not Not ‘Not applicable| other in Lpplipplica fapplicable applicable [Applicable entity other ableble 4 mentioned above. be dalek recog. Commercial Buildings [Nil [Not Not Not Not Not applicable i ae Gustlac aaron) pertica ipplicable applicable [Applicable -Location(s) -Survey number(s) Gi) | Commersi ings NT Netot_ [Rot ibt {bapplicable| Rub applicabl ! : i ; ical iailegueaeny Pepi iliehisle appfilizhbie | [Applicable [Applicable -Location(s) c -Survey number(s) ‘Area (otal measurement Not [Not [Not Not Not Not applicable insq. ft) kppli applica applicable applicable ‘plicable ‘cablelble Built-up Area (total lot Era jot jot ibapplicable| Not applicabl| measurement in sq.ft.) lapplicapphilizaapphtielde apphitiehhde plicable Applicable ble tile ‘Whether inherited jot [Not | Not Not Not Not applicable property fappli applica applicable fapplicable [Applicable (Yes or No) able ble Date of purchase in ease [Not [Not [Not Not Not [Not applicable x of self acquired property pep perlica hpplicable applicable Applicable able ole Cost of property (in ease Not |Not [Not Not Not Not applicable of purchase)at the time of [uppli applica applicable applicable plicable purchase kable ple f ‘Any Investment on the jot Novot it [Rxor ibapplicable | Rut applicabl| property by way of ipplicapplilieapphlighlde appbitieblde plicable [Applicable development, construction [ible ‘ble ete. t “Approximate current Not [Not [Not Not Not [Not applicable| market value appli applica fapplicable — fpplicable plicable able ble z (ivy jot [Not [Not Not Not Not applicable (including apartments): peli applica pppliable applicable [Applicable -Location (8) able ble Survey number(s) ‘Area (Total measurement [Not [Not |Not Not Not Not applicable| in sq. f) cable ble ippli applica applicable kpplicable - [Applicable Built up Area (Total ‘measurement in sq. ft.) jot [Ndiot le fot pplidapppbilie-hpphitiahlde 2 fot ‘bapplicable Appbiizblde plicable jot applicabl plicable hs Ahk Louns, ‘Government Dues: (A)Has the Deponent been. in ‘occupation of [YES/NO fpues to departments accommodation provided by the Government at (PI. tick the dealing with, any time during the last ten years before the pppropriate Government date of notification of the current election ? jalternative) accommodation k (B)IE answer to (A) above is) YES, the following declaration may be furnished namely: @ The address of| the | Government accommodation: Not Applicable ji) There is no dues payable in respect of above Government accommodation, | Not towards- i [Applicable (a) rents \ (b) electricity charges; (o) water charges; and (@ telephone ‘charges aS ont _..(daite) [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. Gil) Dues fo department dealing [Not [Not [Not Not & Ne Na a lyith Government transport ppPlicppplica ppplicable wpplicable applicable applicable including aircrafts and pole ple ; ielicopters) k Abbe (ours Name(s), Amount ' outstanding, nature of i Joan $ ‘Any other lability INot NpNot NpNot Nuiplicable| Navapplicable ona Fett iplibkble | [applicable pplicable | | lbte pole i | Grand total of Not Re Not Not | |Notapplicable/Not applicable ppliapplica applicable ppplicable ‘cable ble Tn come Tax dues Not [Not [Not Not Not Not ipplicapplica japplicable applicable [applicable applicable bible fle : GST dues Not Not [Not Not! Not Not ipplicapplica applicable applicable [applicable applicable ible ple : (i) Municipal/Property tax [Not |Not [Not Not ‘Not Not lues JApplilpplica fapplicable applicable | applicable applicable able ple (ii) [Any other due jot [Not |Not Not Not Not lupplicapplica applicable fipplicable applicable applicable lable fle é [Cii Grand total of all Not [Not [Not | Not. Not Not Government dues lappliclapplica applicable fipplicable applicable applicable lable ple t (x) Whether any other Not fot [Nor] No} Noi ot liabilities are in dispute, if applic! ipplica ppplicable applicable applikable applic o mention the amount —_lable le i involved and the authority lbefore which it is pendin; (9) Details of profession or occupation: ) (@) Self : Agricattural (b) Spouse: House wife (9A) Details of source(s) of income: (a) Self : Rs75,000/ | (b) Spouse : No income | (©) Source of income, if any, of dependents No Income. (9B) Contracts with appropriate Government and any public company or companies (@) details of contracts entered by the candidate ... Not applicable (b) details of contracts entered into by spouse .... (©) details of contracts ent t EVA Not applicable 1d into by dependents .. Not applicable RAO \ Athol sol is entered into by Hindu Undivided Family or trust in which the | (@ details of contract interest .. Not applicable } candidate or spouse or dependents have i 4 into by Partnership Firms in which candidate ot | @ details of contracts, entere | spouse or dependents are partners _..Not applicable (b) details of contracts, entered into by private companiés in which candidate or 5 spouse or dependents have share _ Not applicable (10) My educational qualification is as under: 107" Class, 2003-2004. _ Give details of highest School / University education mentioning the full form of the certificate/ dipl ©) © of the School (College! University and the year ‘in which the course was completed.) loma/ degree course, nam« ‘ af ¢ PART-B (a. 7 ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A: | : eal. ‘Namé of the candidate ‘Sri LAKE ASHOK KUMAR f Full postal address ‘S/o Nageswara rao, Luvyasing Village,Pedabayallu |Mandalam, Alluri Sitha Rama Raju dist ‘Number and name of the constituency and State ARUKU PARLIMENTARY CONTITUENCY, ANDHRA PRADESH 4. ‘Name of the political party which setup the candidate (otherwise INDEPENDENT write ‘Independent’) =. Total number of pending criminal NOT APPLICABLE cases 1 Cae (6. Total Number of cases in which NOT APPLICABLE. ; convicted 7. PAN of Year for which last *| Total Income Shown Income Tax Return filed er ay Candidate ‘AVZPLABBGB | NOT APPLICABLE TH] NOT APPLICABLE | y Spouse. Ni NOT APPLICABLE ROT APPLICABLE () HUF NOT applicable | NOT APPLICABLE Ta] :NOT APPLICABLE (d) Dependent (Not applicable [NOT APPLICABLE [NOT APPLICABLE 8. (Details of Assets and Liabilities (including offshore assets) in rupees Description [Self [Spouse HUF [Dependent-I_ [Dependent-: ependent-3 Moveable Assets | Ni NOT __| NOT NOT NOT NOT (Total value) PPLICABIAPPLICABLE [APPLICA PPLICABLE [APPLICABLE he IB. | |Immavable Assets] NU _[NOT __[NOT NOT NOT oT _PpLICABJAPPLICABLE APPLICABLE [APPLICABLE [APPLICABLE Le y Purchase price of self | NIC NOT [NOT NOT NOT or ; APPLICABIAPPLICABLE [APPLICABLE [APPLICABLE [APPLICABLE jacquired Immovable Pe i roperty, Ve Ava (oueeely- ‘was completed.) diploma/ degree course, name of the Sel Jhool /College/ Universit I] Developmenviconst [NOT NOT ROT OT Nor Or =| oe et of AFPLICABLAPPLICABAPPLICABLE APPLICABLE) APPLICABLE [APPLICABLE immovable E Le £18 property after purchase Gf i applicable) Tit | Approximate OT oT ROT or NOT or ae farket Price [APPLICABLAPPLICABAPPLICABLE APPLICABLE APPLICADLE APPLICABLE. —- E Le. (a) Selé-acquired ‘ assets (Total Value) (b) Inherited assets (Total Value) : [Liabilities Government dues NOT or Nor oT OF oT (Total) ROPLICABLAPPLICABIAFPLICABLE [APPLICABLE APPLICABLE APPLICABLE IE Le Gp) Loans from Bank, SOT OT 7 NOT NOT NOT sean Insitutions APPLICABLAPPLICABAPPLICABLE APPLICABLE |appLicaBLe — |4PPLICABLE { Le and others (Total) a 10. ities that are under dispute @| Government dues ]Not NOT [NOT NOT NOT OT (Total) VPLICABLE |APPLICABIAPPLICABLE [APPLICABLE)) [APPLICABLE [APPLICABLE i he ip} Loans from Bank, )NOr Not [NOF NOT or NOT Financial PPLICABLE |APPLICABAPPLICABLE \PPLICABLE \PPLICABLE JAPPLICABLE Institutions and Le others (Total) in Tlighest educational qualification: 10" Class (Give details of highest School /University education mentioning the full form of the certificate/ iy and the year in which the course VERIFICATION 1, the deponent, above namet affidavit are true and correct to the best o} nothing material has been concealed 1d, do hereby verify and declare that the contents of this there fror f my knowledge an belief and no part of itis false and im. I further declare that:- (@) there is no case of conviction or pending case against me ‘ther than those mentioned in items 5 and 6 of Part A and B above; (b) Lu my spouse, or my dependents do not have any ass

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