Affidavit to be furnished by the candidate along with Nomination Paper

Before the Municipal Returning Officer

For election to ENGLISH BAZAR MUNICIPALITY (Name of the Municipal Corporation
/Municipality/Notified Area)

From 51 ENGLISH BAZAR LEGISLATIVE ASSEMLY Constituency (Ward No.10 ).

I, Shuvojit Mitra son/daughter/wife of Indrajit Mitra, Age 43 years, resident of Indra

Narayan Chowdhury Lane, Kalitala, PS: English Bazar, PO and Dist-MALDA, PIN-
732101(mention full postal address), a candidate at the above Election, do hereby solemnly affirm
and state on oath as under: - ( Strike out whichever not applicable)

(1) I am a candidate set up by COMMUNIST PARTY OF INDIA (MARXIST) (name of the political
party) / am contesting as an Independent candidate.

(2) Details of PAN and status of filing of Income Tax return:

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 The Financial Total income shown
Sl. Year for which in Income Tax
No. Names PAN the last Income Return
Tax Return has (in Rupees)
been filed
1. Self-SHUVOJIT MITRA DPMPM0742 Not Applicable Not Applicable
D
2 Spouse-SUMANA FFMPD59SS Not Applicable Not Applicable
DUTTA R
3 Dependent-1 Nil Not applicable Not applicable
ARNENDU MITRA
4 Dependent 2 Nil Not applicable Not applicable
5 Dependent 3……. NA NA NA

(3) The following case(s) is/are pending against me in which cognizance has been
taken by
the court :-

S.l. No. Offence Description

(a) The details of cases where the court has Not applicable
taken cognizance. Sections of the Act
and description of the offence for which
cognizance taken
(b) Name of the court, Case No. and Date of Not Applicable
order cognizance :

(c) Details of Appeal(s) /Application (s) for Not Applicable

revision (if any) filed against the above
order(s):

(4) Cases in which I have been convicted by a court of law :

S.l. No. Offence Description
(a) The details of cases, Sections of the Act Not Applicable
and description of the offence for which
convicted :
(b) Name of the court(s), Case No. and Not Applicable
Date(s) of order(s)
(c) Punishment imposed : Not Applicable

(5) That I give herein below the details of the assets of myself my spouse and
dependents
(movable and immovable etc.)

A. Details of movable assets

(Note:
1. Assets in joint name indicating the extent of joint ownership will also have to be given
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.
3. Value of Bond / 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.
4. Dependent, here means a person, substantially dependent on the income of the
candidate.
5. Details including amount is to be given separately in respect of each investment)

Depe
S.l Description Self Spouse Dependen Dependent-2
ndent
t-1
No. -3

(i) Cash in hand 1,500/- 500/- NIL NIL NIL

(ii) Details of Deposit in
Bank State Bank of Joint Account
accounts (FDRs, Term India , with spouse’s NIL NIL NIL
Deposits and all other Mokdumpur Br.
mother
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 types of Deposits IFSC Indian
SBIN0014547 Overseas
including Account No : Bank
saving accounts) 33463772432 Account No
Deposits Rs. 8,84,099/- 064701000015456

with Financial Rs. 500/-

Punjab National
Institutions,
Bank , Netaji
Non-Banking Financial Market Br.
Companies and Salary Account
Cooperative societies Rs. 65,799.84/-

and
the amount in each
such
deposit
(iii) Details of investment in
Bonds, Debentures /
shares and units in NIL NIL NIL NIL NIL
companies/Mutual
Funds and others
and the amount.
(iv) Details of investment in LICI, Malda ICICI ,
NSS, Postal Savings, Policy No Prudential
456371091 Policy No
Insurance Policies and SA: 50,000/- 73691772 NIL NIL NIL
investment in any DOC: 11-05-2012 SA-1,20,000/-
Financial Premium
12,000/-
Instrument in Post Office
or Insurance Company
and the amount
(v) Personal loans/advance
given to any person or
entity including firm
NIL NIL NIL NIL NIL
Company, Trust etc. and
other receivables from
debtors and the
amount.
(vi) Motor Vehicles/ Yahama
Aircrafts/Yachts/Ships Fascino
(details of Make WB-66AB-5410 NIL NIL NIL
Rs. 56,552/-
Registration No.etc.
Year of Purchase and
amount)
(vii) Jewelery, bullion and 10gm NIL
valuable thing (give Rs- 48,800/-
details of weight and
value)
(viii) Any other assets such NO NO NO NO NA
as
value of Claims /
interest
(ix) Gross Total Value 1,32,692.83 49,800.00 NA

B. Details of immovable assets :

S.l Description Self Spous Dependent- Dependent- Dependent-
No e 1 2 3
.
(i) Agricultural Land
Location(s) Survey
number(s) Area (Total
NIL NIL NIL NIL NIL
measurement in acres)

Whether inherited
property
(Yes or No)

Date of purchase in case

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 of
self acquired property

Cost of Land (in case of

purchase at the time of
purchase Any Investment
on the land by way of
development,
construction etc.
Approximate Current
market Value

NIL NIL NIL NIL NIL

(ii) Non-Agricultural Land

Location(s)
NIL NIL NIL NIL NIL
Survey number(s)
Area (Total measurement
in sq. ft.)
Whether inherited
property
(Yes or No)

Date of purchase in case

of NIL NIL NIL NIL
self acquired property NIL

Cost of Land in case of

purchase at the time of
purchase
Any Investment on the
land by way of
development,
construction etc.
Approximate Current
market
Value
(iii) Commercial Buildings

(including apartments)
NIL NIL NIL NIL NIL
Location(s) Survey
number(s) Built up Area
(Total measurement in sq.
ft.)

Whether inherited
property
(Yes or No)

Date of purchase in case NIL NIL NIL

NIL NIL
of
self acquired property
Cost of Property (in case
of
Purchase) at the time of
purchase
Any Investment on
property by way of
development,
construction
etc.
Approximate Current
market value
(iv Residential Buildings
) (including apartments)
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 Location(s)
NIL NIL
Survey number(s) NIL NIL NIL
Area (Total measurement
in sq. ft.)
Built up Area (Total
measurement in sq.ft)
Whether inherited
property
(Yes or No)
Date of purchase in case
of NIL
NIL NIL NIL NIL
self acquired property
Cost of Property (in case
of
Purchase) at the time of
Purchase
Any Investment on the
land by way of
development,
construction etc.
Approximate Current
market value
(v) Others (such as interest NIL NIL NIL NIL NIL
in
property)
(vi Total of Current NIL NIL NIL NIL NIL
) Market Value of (i) to
(v) above

(6) I give herein below the details of liabilities due to Public Financial Institutions.
Bodies and Government:-

[Note : Please give separate details bf name of Bank, Institution, entity or individual
amount for each item.
S.l Description Sel Spouse Dependent- Dependent- Dependent-
No f 1 2 3
.
(i) Loan or dues to Bank/
Financial Institutions)
Name of Bank or F1
NIL NIL NIL NIL NIL
Amount outstanding
Nature of Loan
Loan or dues to any
individual / Entity
other
than mentioned in (1)
above

Name(s)
Amount outstanding
Nature of Loan
Any other liabilities
(ii)
Grand Total of
liabilities
NIL NIL NIL NIL NIL
Government Dues :
Dues to Departments
dealing
with government
accommodation
Dues to departments
dealing
with supply of water

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 Dues to departments
dealing
with supply of electricity

Dues to departments
dealing
with supply of telephones/
mobiles
Income Tax Dues
Wealth Tax Dues
Location(s)
Survey number(s)
Area (Total measurement
in acres)
Whether inherited
property
(Yes or No)
Date of purchase in case NIL NIL NIL NIL NIL
of
self acquired property
Cost of Land (in case of
purchase at the time of
purchase
Any Investment on the
land
by way of development,
construction etc. Service
Tax Dues
Municipal / Property Tax
Dues
Sales Tax Dues

Any other Govt. dues NIL NIL NIL NIL NIL

including loan

(iii) Grand Total of all Govt.

dues
NIL NIL NIL NIL NIL

(7) Details of profession or occupation:

(a) Self : Primary Teacher
(b) Spouse : Housewife
(8) My educational qualification is as under: MASTER OF ARTS (M.A)

(9) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (8) ABOVE :

1 Name of the candidate Shri/Smt. / Kum. Shuvajit Mitra

2 Full postal address Indra Narayan Chowdhury Lane , Kalitala
PS : English Bazar, PO AND DIST : MALDA
PIN : 732101

3 3. Number of the Municipal constituency 51 , ENGLISH BAZAR

(Ward) and Name of the Municipal WARD NO – 10
Corporation/ Municipality / Notified Area ENGLISHY BAZAR MUNICIPALITY

4 Name of the Political party which set up the COMMUNIST PARTY OF INDIA ( MARXIST)

5 (a) Number of cases in which conviction

order passed NIL

(b) Total number of Pending cases where

the NIL

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 6 PAN of Year for which last Total Income Shown
Income Tax Return
filed

(a) Candidate DPMPM0742D Not field NOT APPLICABLE

(b) Spouse : FFMPD59SSR NOT APPLICABLE NOT APPLICABLE

(c) Dependents NOT APPLICABLE NOT APPLICABLE

7 Details of Assets and Liabilities in rupees

Description Self Spouse Dependent-1 Dependent- Dependent-
2 3
A. Moveable 1,32,692.83 49,800.00 NA NA NA
Asset
(Total value)
B. Immovable NIL NIL NIL NIL NIL
Asset
(i) Purchase Price NA NA NA NA NA
and
development
Cost of
Immovable
Property (Total
value)
(ii Approximate NA NA NA NA NA
Current Market
Price of Asset
(Total Value)
8. Liabilities NA NA NA NA NA
i) Government
dues (Total)
(ii) Loans from NA NA NA NA NA
Bank, Financial
Institutions and
others (Total)
(iii) Dues to NA NA NA NA NA
Municipalities

9. Highest educational qualification: M.A ( Pol Science), DLED

VERIFICATION

I, the deponent, named above, do hereby verify and declare that the contents of this affidavit are
true and correct to the best of my knowledge and belief, no part of it is false and nothing material
has been concealed there form. I further declare that:
(a) there is no case of conviction or pending case against me other than those mentioned in items
(3) and (4) above;
b) I my spouse, or my dependents do not have any asset or liability, other than those mentioned
in items (5) and (6) above.
Verified at ………………………………………. This the ……………………………day of ………………………
202…..

DEPONENT

The Deponent is identified by me and known to me.

Advocate, Malda.

Note: 1. Affidavit should be filed latest by 3.00 PM on the last date of filing nominations

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2. Affidavit should be sworn before an Oath Commissioner of Magistrate o
3. All columns should be filled in and no column to be left blank. If there f the First Class
or before a Notary Public, is no information
tofurish in respect of any item, either "NIL” or “Not applicable", as the case may be
should be mentioned.
4. The affidavit should be either typed or written legibly and neatly

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