;----------j--- ---

- ~516

Amt. Incurred/ Amt. Incurred/ Amt. Incur -ed/ - To·;;j- ·-., Auth. by auth. by Pol. auth, by or crs li'.lc.:ction

Candidate/ Party (in Rs.) (in Rs.) expenditure Election agent (.3)+1-t)-1·(5i

in Rs. -' . _

I

I I 8Yo

I r. I

I 'O. i

I ! Fxpenses in public meeting, I 1 rally. procession etc. :-

1 L a: Expenses in public

! meeting, rally. procession 11

etc, (ie : other than the ones ".;th .,....,,. f'..,,.,...,,._..,;"n"''""' Af fh,,

/ Political party (Enclose as ! per Schedule- I 1

, ---+, L _ r· ---:- --~--:~---.J.-__ .......... ~ .. I .•.. _ _,,:_ ---LI:_ -----

PART-II: ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE 0 CANDIDATE

Particulars

D te: \\lt'-' ~o\J, 2.o\'-\ P ace: ~"--'~a, ~.j:\. ·

Yes~

VI i If candidate is set. up by a political party, Please

·1 nJenti~n rhe name of the political party ·

Vl 1 Whether the party is a recognised political party

VJ Name and Address of the Election Agent ~o.~oJ. \/o\.M..sl. \...\ ::; ~ A2.' vvf)~_._,_

\-\ ~~ co-, ci.. Lo"~\:--

.~

PART-I l----~-N-an_1_e_o_f_th_e_C_a_n_di_d_fil_e ---.-~-h-./_Sm{ __ ~--n-1~.~;--o---..---T\~~--1~rrrk91-=-~--t--:::---~- · 1-----1------------------t-------.,..-----=---.:---t-·--- - - '

11 Number and name of Constituency 04 f'ilVlloo.19'. &rdt ifrl · Name of Stare/Union Territory -- - -1 ~--·-N-at-w-~-.o-f-E-.l-~-t-io_n_(_P_le-~-e-m_w_t_io_n_w_h_e_~-e-r---+--~~~~~----~.------1.

General Election to State \j 1 ~\'\ ~a.1~ G,e.'t'\.9. ~\ £ \~~~ I Assembly I Lok Sabha I By- election ~ 0 l ~ I

V J Date of declaration of result \ q-t~ cJ:. :Lo\~

r .;i . r,I . ~ .. Vi ./ . ~if .. ----<1-------------------------------r---------,

f;'.. ABSTRACT ST A TEMENT OF ELECTION EXPENSES - r=

1· r . l

\

with the Star Campaigner(s)

(ie: other than those for

meeting rally, procession etc.

general party propaganda)

I (E11close as per Si..:heclule-2) I ·------------'-------J- .. -------1---·---~- -

1

'

ere.

(Enclose as per Schedule-8) rfirnn~LL~u;m~p~s~u;iu~am;;;;o~u~n~t~re~c~e~iv~e~d;fr~o~m~an~y-:------------------l------------_J~--~~

perso11'company/firm/associations/body of persons etc. as loan,

gift or donation ere. I (Enclose as per Schedule-9) JI ~1---l--Total ·~-----------------~·~---_._------------i----- ,----1-------~---------l __ b_~~

Amount of own fund used for the election campaign

I (Enclos•; as pe1· Scl1edult; -7) 1-'--r -- - - ·- - I II I ""'r' im unoun! recei ;;c(f from lh' P"'' ~ (;,;·, ·,.. '"·''"'"'''.''"'

sr. No.

I Amount (in TI 1.)

1-

-

- - I I

\ \

-

.. -L-

I<

Expenses of campaign workers/agents (Enclose as

\ L

per Schedule-6)

I \i

. .Ll~~------~·~-l------------1---------l----~- Any othl'."r campaign

I e,pendiwre ~ - - ' ~ J LJLJ._:_--------------+----~----i----------1-:----------1--------

1

Grand Total .c ' S2i'-I00. -. · 5,b4c:P\, '\ \~1--J.-------------'-------J-------J----------'--------l [ I I p ART lll : ABSTRACT OF SOURCE OF FUNDS JWSED BY CANDIDA TE

., l_l_l __ C_.__mp-ai_g __ n_m_a-te_r_ia-ls_o_t_he_r_--r- _,..\--- - - ----i---....,1-

~ \ t an those used in the public \ ~ I r oeting, "\\y, prncession \OYC\C\ ~'~I~ ( c. mentioned in S. No. l u~ f,t':,11~~,'. bove (Enclose as per ! chedule-3) I ~"~ ~'(, 11I Campaign, through print and

't~'. elecn:onic media including < ; cable network, bulk SMS or

internet and Social media f~- (Enclose as per Schedule-4) [ ' __ J--------------i-------i---------i----~----r---~~ ...-l ~!~ .. ''· ,__ rJir Expenditure on campaign

fi.~~ \ vehicles(s), used by

~ 1i,:,

candidate (Enclose as per

''~ \ schedule-5) ll~ L.JL-----------1-------1------+-------t-:--·__.+,.---i

11 r v l\'t1

i~ ~· fJ: ~ 1~1 !<'

That I kept a separate and correct account of all exp nditure

That I was a contesting candidate at the general electio of the C..11<-~ ~ \t1 r,

Vidhan Sabha Election-2014 of Haryan8. from 01-Am ala(se)\"~~

<>--"--0ntorv r.onstituency the result of which was de tare on \ \ C\ • \. 0 • 'l..,O~\.\ LI ' - k\,1 '

29 09 :20 i . r '~ w;t\,\.YLt -

I .. Mehak Khanna daughter of Sh. Shakti Kumar Khanna a ed 37 'a years. resident of H.No.1-B, Dayal Bagh, Ambala Cantt, Hary na, do

h~reby solemnly and sincerely .st.ate and declare as under:-

i 1.

Bf fore the District Election Officer Am bala

State/UT. ~ Affidavit of Presently at .. a .

555922 AFFIDAVIT

6. That the statements in the forgoing paragraphs (1) to (5) are

LI UC Lo the b t f k l o e 0

my now edae and belief' that no thin is false

and nothing material has been concealed.

5. That the Abstract Statements of Election Expenses anne ed as Annexure II to the said account also includes all expe diture

incurred or authorized by me, my election agent the olitical

party which sponsored me, other associations/body of

and other individuals supporting me, in connection

election.

4. That the account of my election expenditure as annexed h reto includes all items of election expenditure incurred or autho ised

by me or by my election agent, the political party sponsored me, other associations/body of persons and connection with the election and nothing has been concea ed of

with held/ supprcissed there from (other than the expen e on travel of 'Leaders' covered by Explanation l and 2 under s ction

77 ( l) of the Representation of the People. Act, 1951).

3. That the said account was maintained in the Register furnis ed by the Returning office for the purpose .and the said Regi ter

itself is annexed hereto with the supporting vouchers/ ills

mentioned in the said account.

I

16 OU"" '"P""'" _ -+c ~2 - ' -- ~~~-- -~i~t : ~

Expenditure in public meeting rail ro ----- --- I thau those '°' geoeral partv pmp~,g~nd~~"'"° etc with the Stac Campalguec(s) as apportlo' ed 00 candidate 1i;;;thec I _____ !

- - - - - __,_

- -

- - Boarding &. lodging expenses of self, celebrity, partyl functionary or any other campaigner inc ud1ng Star Campaigner

11 Expenses on transport, Helicopter/ aircraft / vehicles/ boats etc. charges ( for self, cel~brlty or any other campaigner other than Star Campaigner) l.1~2-T.~~_.:.----~~~--~-~--i-~~~-t-~~~--W---~-l-~~ 1'9wer co11:>urnptlon/ 9"n<>r::>tor charoes

Illumination Items llKe se11111 11\:l111;11 1.i .... .-.1 .. ~·~ 10

·.: \

Expenses on celebrities, payment to musicians, other artists remuneration etc. ·

I -----~ - Arches & Barricades etc.

9

6 Posters, hand bills, pamphlets, Banners, Cut· outs, hoardings - \--+-----:..--------------- -··-----+-·-l---

7 Beverages l\ke tea, Water, cold drink, juice etc. - >---"-- ---·--'·-------'- ---- - -·- -- ....

B · Di,gital TV -boards dlsplav. Projector display, tickers boards, 30 display ~-.;..---------.:.-------~~·~---1------~-~,--1----4---

4 Flowers/ garlands ~------ -·------·-~-----~-------.i-_..--~1----------- 5 Hiring Loud speakers, Microphone, amplifiers,

comparers etc.

3

-----·----~--i-~--_---1-----_----------+_----i---~---~1 2 · Erecting Stage, Pandal & Furniture, Fixtures,

poles etc.

1 Vehicles for transportln~ visitors

- 1 2

3 6 5 4

No Nature of Expenditure s.

·---------- --- -

Schedule· l Expenses·;n public meeting, ,,11y, procession etc. (10' othO' tnen those wltti St" eampa19ws of th Polltital partvl 1---.:.-......---_:_---_;_:..:.--------;__-..-·----_,...-----:.----+------··~ Total Amount Source of Expenditure In Rs. _.i..------ Amt. Incurred / Amt. Amt. incurred

Auth. by incum l I ov others candidate / by Pol agent Partv with

name

Scl>edules- 1 to 9, Details of Electlons funds and Expendltu'e of candidate

.... ·!·

I

' ''

, I

-- i-- -· -·---

.

S. No Date and Name of the Star Amount of Expenditure on public meetlr g Remarks, If any

1 Venue Campaigner(s) & Name of Party rally, procession etc. with the St r

Campalgner(s) apportioned to the candlda e (As other than for general pary propaganda) In Rs. --·--·-

1 2 3 4 5 - -- 1 ( L-'

.z=r:" -- 2 3 ~ ---- 4

Total

Schedule-3 Details of. expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners cut-outs, gates & arches, video and audio cassettes, CDs/ DVDs, Loud speakers, amplifiers, digital TV/ board display , 3 D display etc. for

·candidate's election campaign ( le: other than those covered Jn Schedule- 1 & 2) • -·---·- s. Nature of Expenses Total Amount Sources of Expenditure Remarks, If any I

No. in Rs. Arnt. By Arnt. By Pol. Amt. By others I candidate I Party J agent

1 4 3 4 5 6 7

1 ~~&wllh. 7J111<t) } ri.C1(1 -- ----- 2 f t..n a ,,f)' 1~oo :~ c Q 0 --- --

3 ~OYJ.1.~ . {f4t:-n jj~o - _., -- 4

.. ~. I

Total Io c.t£f'f \DL\~C\ Sched4le- 4 -- ----·----, Details of expenditure on campaign through print and electronic media Including cable network, bulk SMS or Internet or I social media etc. for candidate I -~ ·-·· .. ----1 s. Na,ture of Name and address Name and address of Total Amount Sources of Ex1 endtture : No medium of media provider agency, reoo: ter, stringer, In Rs. Amt. By i-~rnt." B~ 1 (electronic I (print /electronlc company or any person to Amt. 6y

print) and /sms / voice/ cable whom charges / candidate/ Pol. others

duration TV, social media commission etc. paid/ agent Party '--~ etc.) payable, If any Col. (3) +(4)

1 2 3 4 5 6 "I • - 1 --- --....----·-- 2 -=-------- -·-·- J ~·~

- ·----l -·· 4 --- i ---- --1 Total

I

-·· ... ~--'

\~/

.... 3 __ .__,_ -·------!·-- .--1-------t-·--~-·--·--"- ---·····'

L4---~·------'----------·'---·---··----------'-------+-"--_ .. .. 1

~-1-------- . .__ _

2

\

!~1:_=--- --+-J<-"3 iz 5 _ _:13i2- _:R~= =: -~ J ~ ~' <t -\~I ~~~::g o~li 'i>ofi I /') 0 oo-~i-o z: ·=- ~---·r -.=:.--·\ 1----LT_o:..:..ta~I --'~~3~2~5~--l\l.j-V L.L,---..L....----'i'--t-1---_--t -=1

1_s_c_h_e_du_1_e_- _1 __ ------------------·-------,· _ L-------------{

1_D_e_ta_il_s _of~A_m_o_u_n_t _o_f _ow~n- _fu_n_d_u_s_ed_fo_r_th_e_e_l.,..ec_tl_o_n _c_am_;_pa_lg:...n ~.,-------+--.----------~

s. No. Date Cash DD/ Cheque no. etc. with ·.. Total Amount Ir Remarks \ details of drawee bank Rs. I 1-----1------1---------+-------------4------1---+--·-·-------· .. --,

1 2 ) 4 5 6 I "----1------i-------1----------1-------1-+--·--------I 1 C.°' SEP'r·ll-i t\OQ,,._Q.._,.0""-----1----------·---_annT 1- ,__-:- __ , __ . .. ~\

-1.;J.~l·l'-1 2

-- ---··---·---- --- "\

Nature of Expenses Qty. No V,enue

Details of expenditure on Campaign workers I agents ------------------.----- 5. Date ano Expenses on Campaign workers Total amt. Sources of Expen' lture Incurred/ ----_..1.--------1

No. Of workers auth. In Rs. Amt. By Am . By Pol. Amt. By / agents candidate/ Par y others

~1--+2--~-~3_a -t-3_b_--1_3_c +6-----+~-g-en_t_--+s-+-·~---~---==-J

1 campaign workers j honorarium/ salary etc.

f----+='_LL!!!~l.l-=--=---1----~---"-Ll!(§::.....il),)_a Mw'j 1-..~...L..·7 ~~· 0_0_-J.~7 S ~ ~- . --- ---==-11

~~'--"'-'-!.J-U.<~~__...1-------+-·--l-l(lJUW( ,7 3 oo 1~ ~ J:::: . 1~ DA·~ I<; ooo""-__.__..\l..c..-:;o 0_0-1-1_::::::- __ . __ 1_::::._j I -·1------1

1--~.::...lL-=-------------___.1~~.L.:c:::f:::OQ==...__-:~::...:::Dc...::>fl:r.=::j-L-__...-J.. .. --~

5 4 3c 6 7 B

Amt. By Pol. Arnt. Party By

other s

Amt. By candidate/ agent

r-s_c_h_e_du_l_e_-_s ~-+------·-1 Details of expenditure on campaign vehicle (s) and poll expenditure on vehlcle(s) for candidate's elect on campaign

1

S. Regn. No. of Hiring Charges of vehicle No. of Total arnt. Source of Expehdlture No Vehicle & Days for Incurred/

Type of Rate for F I h D . , whlch auth. In Rs. Vehicle ue c arges river s used

Hiring of (If not charges vehicle / covered (If not malntenan under hiring) covered ce under

hiring)

.r-- · ·· '/··' ' . ·' . .' ~ ~

, . ~ I

! ·i ,.

Total

I

1---1--·------'------i----------------------+-----1----i----·--- - -- I ltlCTi bo I .J

5 4 3 2 6 1---if-------+-----+------+------+-------+----T--·-i-·-------- ~1-~~)kil!\.llQUl_;"~--:u,~;.J:·-wrc:11?_ ~-~(')r-rr.:-J.:'4il-\.!O.IC\n;.:u..CJ~C')-1-------·- G, tfT _JO_OOJ D____,._::- _J

- I l-=2~-1-J~t.11:.)t::\MltlJA~l!O........X:lr"J:llHt:!-IQ'lB..------1------1------.:J:.,..------i----l--+-I ---·--·-· -l \

1-3--+---------i1------+--------1·-----1--------+-·------- - __ J__ - ..... - ~ 4

7

Cash Remarks Mention Total Arnot nt whether loan, In Rs. gift or donation etc.

DD/ Cheque no. etc. with details of drawee bank

S. Name and address Date No.

f---..--------,------..------,------.-------..----t---.---~·~ Details of Lump sum amount received from any person/company/firm/associations/body of persons e c. as loan, gl~ or donation etc.

--------------'------"-·---------'------+--'---·-·-

t---t----------+-----~----·--+---------+----+--+-------·

5 4 7 6 3 1 2 l

2 3

4

Total - Schedule- 9

Remarks, If any

S. Name of the Political Party Date Cash DD/ Cheque no. etc. Total Amount No. with details of drawee In Rs.

bank

Schedule· 8 t-------------------------·----------+--------- Details of Lump sum amount received from the partv (ies) in cash or cheque or DD or by Account Transfer

50000 Total

6oDOD I r---------"'---------'-- ---------~-- ---- _,,_ ... :

...• :­ ....

j:

I

8