fi-cqtq qqtCertificate No.

Certificate lssued Date

Account Reference

Unique Doc. Reference

Purchased bY

DescriPtion of Document

Property DescriPtion

Consideration Price (Rs.)

Flrst PartY

Second PartY

Stamp DutY Paid BY

Stamp DutY Amount(Rs.)

"t'Flfi

IT{DIA NON JUDICIAL

Government of Nati onal CaP ital Territory of Delhi

e-StamP

16-Jan-2020 11:39 AM

tr\,4PACC (lvy d1713403/ DELHI/ D

s u B I N - D LDLT 1 3403299 1 02059847 1 7

Arricle 4 Affidavit

Not Applicable

0(Zero)

SAHIRANI

Not Applicable

SAHIRAI\4

100(One Hundred onlY)

I

-,6'"..

Please write ortype below this line-----"-'-

-*rplr

o

S

tN-DL1 05877272197395

P

f*.

(ja\-

T

Form 26

(See rule 4A)

&'

sr.lt

r:-1,

(:!

LUa

0iani

1..L-

AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINATION

PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TO LEGISLATIVE

ASSEMBLY OF NCT OF DELHI (NAIvIE OF THE HOUSE) FROM AC-52

TUGIILAKABAD (NAN{E OF THE CONSTITUENCY)

PART A

I SAHIRAM x*sorldeugherl,'vife-of, Late Shri Suraj Mal Aged 59 years, resident of

H. No.321 Churiy'a Mohalla, Tekhand Village, Nerv Delhi-110020 (mention full postal

address), a canCidate at the above election, do hereby solemnly affirm and state on oath as

under:-

(1) I arn a candidate set up by AAM AADMI PARTY

(**nanie of the political party) / xx .

(**strike out whichever is not applicable)

and the state), at Serial No. 1005 in Part No. 86.

telephone number(s) is/are 9910049797 and my e-mail id (if any) is

c12@gmail.com and my social media account(s) (if an.v) isiare

www. fac ebook.com/pehalwansahiram

(ii) Twitter: www.twitter.com/pehalwansahiram

(iii) Instagram : www.instagram.comlsahiram.tuglakabad

\',li ; :

l-ra

O

dj

(-r:

i.)

,!_ I

,. ,)

name rs

()

I(4) Details of Permanent Account Nurnber (PAN)* and status of liling of Income

tax return:

five Financial Years

as on 3lst March)

otal income

in Income TaxRupees) for thefor

the

ax

been

st.No.

Names

9-20: Rs. 3,75,580/-(i)

18-19: Rs.3,17,170/-(ii)

017-18: Rs.3,11,530/-(iii)

(iv) 17: Rs.2,84,0901-

15-16: Rs.2,69,9701-(v)

2019-20AACPR3838BSelf

)(Sahi Ram

NOT APPLIC,ABLE(i)NOT APPLICABLE1l( )

NOT APPLICABLE(iii)NOT APPLICABLE(iv)NOT APPLICABLE(v)

AppLtcesrPNOT

No PAIrI aDotted.Spouse

(Smt Balesh)

NOT APPLICABLE(,NOT APPLICABLE(ii)

NOT APPLICABLE(iii)

NOT APPLICABLE

NOT APPLICABLE(v)

NOT

LE

NOTAPPLICABLE3

HUF (If Candidate

Karta/Coparcener)IS

(i)

NOT APPLICABLE(iii)

NOT APPLICABLE(lv)4

NOT APPLICABLE(v)

NOTAPPLICAB

LEAPPLICABLENOT

Dependent 1

U!tU

0J,

OaNOT APPLICABLE(i)

(i, NOT APPLICABLE7

NOTAPPLICAB,LE

NOTAPPLICABLE2

I

tr

PAI\

I

(ro

APPLICAB

NOT APPLICABLE

NOT APPLICABLE,(ii)

(iii) NOT APPLICABLE

(iv) . NOT APPLICABLE

(") NOT APPLICABLE

(i) NOT APPLICABLE

(ii)NOT APPLICABLE

(iii) NOT APPUCABLE

(iv) NOT APPLICABLE

6

t? (v)

Dependent 3NOT

APPLICABLE

NOTAPPLICAB

LE

NOT APPLICABLE

is mandatory for PAN holder to mention PAN and in case of no PAN, it-t

be clearly stated "No PAN allotted"

(5) Pending criminal cases

that there is no pending criminal case against me.

(Tick this alternative if there is no criminal case pending against the Candidate and

write I\OT APPLICABLE against alternative (ii) below)

'o*

(ii) The following criminal cases are pending against me: NOT APPLICABLE

pending criminal cases against the candidate, then tick this alternative

(i) above, and give,details of all pending cases in the Table

.*Table

ia

vI

i

NOT APPLICABLEAPPLICABLE

(d\ ilR Nqr.yj& name andr{ddre536f Police Stationconcerned

I

l

NOT APPLICABLE

NOTAPPI,ICABLE |NOT

APPLICABLE(b) Case No. with Name of theCourt

t

I

NOT APPLICABLE

I

(a)

!:)C7.-t

';-\

y/**.

(c)

(give no. of the Section,Section.......of IPC,

of concernedinvolved

APPLICABLENOT NOTAPPLICABLE

(d) description of NOTAPPLICABLE NOTAPPLICABLE

(e) charges have

YES or NO)framed

APPLICABLENOT NOTAPPLICABLE

.oruuo

C.

l!

,t)

answer against (e)is YES, then

charges weredate on

APPLICABLENOT NOTAPPLICABLE

YES or NO)

against thehas been

APPLICABLE NOTAPPLICABLE

(6) Cases of conviction

OR

been convicted for the offences mentioned below:

(If the candidate has been convicted, then tick this alternative and score off alternative(i) above, in the Table below)

r-a

..::

t

5*,il-

Section(s)NOTAPPLICABLE

NOTAPPLICABLE

NOT APPLICABLE

lNor

APPUCABLE

NOT

-

./'(ii) ldaveV

(-

Table

I

I

i

FrR NO.127l97PS:OIAState Vs. Sahi

Ram Pehalwan &Ors.

FrR NO. 379/99

PS.: OIAState Vs. Bahadur &Ors.

FIRNO. s34l16

Cr. Cases 1262812018

PS.: OIAState Vs Sahi Ram Pehalwan &Ors.

(a) Case No.

I

I

(b) Sh. DharmeshSharma, Ld. MM

Ms. Gurmohina Kaur,Ld. MM. Saket, ND

Order on Quantum ofSentence passed by Sh.

Anubhav Jain,Ld. MM,Saket, ND

Name of the

Court

Sh. Sarnar Vishal, Ld.ACMMTPHCA{D

C*:.*

l-L-

Uls 3 ofThe West BengalPrevention ofDefacement ofProperty Act,1976.

Under Section| 47 I t48l r49l 186133213

53 IPC

Under Section 3241341 I 506134

of IPC(c)

lPC, etc.).

t:

...... of

Alleged involvement inan altercation at thetime of incident whendemolition drive was

being conducted byDDA with the help ofPolice.

Pasting of posterBrief description

of offence for

which convicted

Wrongfully restrained andassault upon complainant byaccused for an issue ofconstruction of road by MCD inthe area.

(d)

i0.07.1998& Lok Adalatorder dated02.08',1998'.

Order of Conviction:0s/07/2017

Order,on Quantum ofFine: 15/1212017

Order of Conviction:3y07/2018

Order on Quantum of Fine:06lwl20t8

(e) Dates of orders

of conviction

Fine of Rs.1,000/-.Fine of Rs.30001- and

benefit of section 428

Cr.P.C.

Fine of Rs.2,00,500/-.(0

ri\\

,;*

I.

(,-('-1

ii l,jNONO

I

ry,i''/

lPl,.,o"t aor'!'..,t

lAnB"ul has been

_4_t

t/

I

J

t

) I have given full and up-to-date information to m5i political party about all pending criminalcases against me and about all cases of conviction as given in paragraphs (5) and (6).

:i IIiL,YIEW OF ENTRIES IN 5(i) and 6(i), abovel

Note:

l. Details should be entered clearly and regibly 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 bementioned 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) ThaJ I gtvghglein below the details of the assets (movable and immovable etc.) of myself, my

A.

ln name indicating the extent ofjoint ownership will also have to be given.

the details including Serial Number, Amount, date ofName of BanVlnstitution and Branch are to be given.

I$t.'

Debenfures as per the current market valueanies and asperbooks in case ofnonlisted

in Stock Exchange incompanies should be

filed against

conviction order

fMention YES

or No)

(h) If answer to (g)

above is YES,

give details and

present status of

appeal

CA.No.136l20l8Patiala House CourtSahi Ram Pehalwan & Ors Vs.StateDisposed off on 15.12.2018

tr..IOT APPLICABLE NOTAPPLICABLE

glven.

oflisted comp

,: ,.

J

L

Note: 4. ,Dependent' means parents, son(s), daughter(s) ofthe candidate or spouse and any other

p"r*, relateJ to tG candidate *trettet by btrood or marriage,.ryt-'ottave no separate

means of i"!o*e *a *no 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'

Explanationr- 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' ;

Deoendeit-tDep.eldeIITIF DenegdeSpouse(Smt. Balesh)

Self(Sahi Ram)

S.No.

Description

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Rs"25,000/-Rs.25,000i-(i) Cash in hand

o.158601000001

alance as on1.s.0t.2020

) Bank of India-

10100009203

c

I

Phase-1

1,952.00

No.

as on

5.0'.1.2024

8,680.54

Bank of India,

10100013260

HDFC Bank,

109910049797

3,93,743.40

BantotnAia.

101 10013264

5,10,000.00

as on

1Phase-

Phase-1

No

5.0t.202050.70

Phase-II,

No.

as on

5.0r.2020

Account)

as on

5.01.2020

ls of deposit in,ank accounts (FDRs

erm Deposits and all

ts including

al Institutions,

on-Banking

Cooperative

cieties and the

1r

types of

accounts),

with

Companies

in each

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NILNIL(iii) Details of investment

in Bonds,

Debentures/Shares

and units in

companies/ Mutual

Funds and others and

the amount.

NOTAPPLICABLE

NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NIL

(iv) of investment

NSS, Postal

instruments

Post office or

m an)a

Company

the amount

Insurance

and

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NIL NIL

(v) Personal

loans/advance given

to any person orentity including firm,company, Trust etc.

and other receivables

from debtors and the

amount.

(vi)

i-p ut-Is" *rl>-" g.lPdCJf/ < -'rF{'I r'r

I .'

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Motor Vehicles:

a) Maruti Swift VDIRegistration No.DL8CDTOOOTPurchase in 2015 forRs.6,80,000/-

b) Maruti BrezzaZDlRegistration No.DIICAEOOOIPurchase in 2018 forFts.10,24,7831-

NIL

NOTAPPLICABLE

Motor :

Vehicles/Aircrafts/

Yachts/Ships (Details

of Make, registration

etc. year ofand amount

NOTAPPLICABLE

a) Gold-350gmValue approx.Rs. 13,45,000/-b) Silver-500gmValue approx.Rs.27,000/-

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Gold-200gmValue approx.Rs.7,69,000/-

(vii) Iewellery, bullion and

valuable thing(s)

(give details ofweight and value)

<l

l

NILNIL

other assets such

value of

18,97,632.5434rl1,316.70Total value

B. Details of Immovable assets:

Note:l.Propertiesinjointgyl",:h,pindicatingtheextentofjointownershipwillalst have to be indicated

Note:2.Eachlandorbuildingorapartmentshouldbementionedseparatelyinthisformat

Note:3.Detailsshouldincludetheinterestinorownershipofoffshoreassets.

Dependent-:Dep.qde

1HUFSpouse

(Smt.Self

(Sahi Ram)S.No.

NIL

P Nagar

Dabas,

NIL

24-05-2011ourchase inself - acquired

ofof

NIL1,60,000/-(in case

J

DescriPtion

15 acrein acres)

NIL

NIL

Land

0

Any Investment on theland by way ofdevelopment,construction etc.

NIL NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTh.pprtcABLE

Approximate Currentmarket value

RS.9,00,0001-NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(ii) Non-AgriculturalLand

Location(s)Survey number(s)

NO NIL

NOTAPPLICAtsI.E

NOTAPPLICABLE

NOTAPPLICABLE

lNor[rurcABLE

Area (totalmeasurementin sq. ft.)

N/A NILNOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

property(Yes or No)

Whether inheritedN/A NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

rO I

ofpurchase inof self - acquired N/A NIL

NorAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Land (in case

.r,purchase

) at the NIL NIL CANOTAPPLICABLE

NOTlq.ppucABLE

NOTAPPLICABLE

::'

.{-

,,;-i tl

on theof

etc. NIL NILNOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

OT

LELIC

Approximate currentmarket value NIL NIL

NOTAPPLICABLE

CLE

NOTAPPLICABLE

(including apartments)

S

NIL NIL

OT

Area (totalmeasurernent in sq. ft.) NIL NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Built-up Area (totalmeasurement in sq.ft.) N/A NIL C C

NOTAPPLICABLE

,A

e'.FtL

<1

NOTAPPLICABLE

NOTAPPTICABLE

NOTAPPLICABLE

(iii).. .r.'

NOT.APPTICABLE

NOTAPPLIC.ABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

inheritedN/A NIL

OT

ofpurchase inof self - acquired N/A NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

ofproperty (inofpurchase) at

time ofpurchaseNIL NIL

[.{oTAPPLICABLE

DrorAPPLICABLE

NorhpprrcABLE

Nor -APPLICABLE

etc.

lnvestment on theby way of

NIL NIL

NorAppucaBLE

lxorhpprrcABLE

Nor -LAPPLICABLE

NIL NILNOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE(iv)

i,U

!4#e

l(includingapartments):-Location (s)-Survey number(s)

H.NO 321

56 TekhandDelhi

T-

Mohalla. TehkandDelhi

OT

NIL

OTC

LE

7200 sq. ft.

900 sq. ft. NIL

NorNPPLICABLE

NorhppucABLE

[Norh.pprrcAeLE

ffii,r*""[neasurementlin sq. ft.)

(Total

NIL

Nor -APPLICABLE

hqorhpprrcABLE

NorAPPLICABLE

es or YES

inherited

BLE

NOT. .

APPLICABLE

NOT

NOT

ofpurchase inof self- acquired

NILC C

NOTofproperty (in

time ofpurchaseofpurchase) at

NILNOTAPPLICABLE

NOTAPPLICABLE

NorAPPLICABLE

rWhetherDroDertv[veis oiNo;

NOTAPPLICABLE

NOTAPPLICABLE

Approximate currentmarket value NOT

APPLICABLE

NorAPPLICABLE

7200 sq. ft.

900 sq. ft.

NIL

NOTAPPLICABLE

.::1,

lworAppucABLE ABLE

{

) NOTCABLE

Investment on the

by way of

etc.

NIL

NIL NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

currentvalue

) Rs.60,00,000/-

) Rs. 14,00,000/-NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(v) (such as

ln NIL NILNOT.APPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(vi) Total of currentmarket value of (i) to(v) above

83,00,000/- NIL

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

pl,I give herein below the details of liabilities/dues to public financial

and government:-

Pleasegiveseparatedetailsofnameofbank,institution,entityorand amount before each item)

F:;n

LL.

$

tDepende DependenDenende

rit-tHUFSnouse

(Smd. Balesh)DescriptionS. No.

NOT ]

APPLICABLE

NOTAPPLICABLE

outstanding,ature of loan

I( I

NOTAPPLICABT,F

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NILNIL

or dues to anY

individuals/other than

above.

Self(Sahiram)

APPLICA)toT

BLEAPPLICANOT

BLE

NILNILor.:

Name(s), Amountoutstanding, nature ofloan

\Oi NOTAPPLICA IAPPLBLE

IBLE

NOT

IAPPLT

Iru

ICA CAB\OTAPPLICABLE

NILNILAny other liability

xor -lor lxorAPPLICA ]NPPIICE IAPPLICABBLL lsLL l.u _

NOTAPPLICAB[,E

NILNILrand total ofbilities

(A)Has the Deponent been in occupatiotr ofaccomtlodation provided by the Gor"ernn'ient i'it all)'

time during the last ten years betbre the date ofnotification of the current election ? NO

(B) If answer to (A) above is YE,S, the follorvingdeclaration may be furnished namel\':-

(i) The address of the Government acconltlodation:. NOT APPLCABLE.... NOT APPI,CABLE .... NOT APPLCABI,E ...

(ii) There is no dues payable in respect rrf above

Government accommodation. towards-

(a) rent; NOT APPLCABLE

(b) electricity charges; NOT APPLCABLIi

(c) water charges; and NOT APPLCBLIT

(d) telephone charges as on ...NOT APPLCABLE"(date)

fthe date should be the last date of the third month prior to

the month in which the election is notified or any date

thereafierl.

Note- 'No Dues Certificate' fiorn the agencies coucerned

respect of rent. electricity charges, water charges and

telephone oharges for the above Governmetlt

accommodation should be submitted.

s to departmentswith

111 )NO'fAPPL,ICABLE

NOTAPPLICABLI]

NOTAPPLICABLE

NILNIL

s to department

uding aircraftsincl

withtransport

aLI

ornf,

Z:)

OTPPLIC,\

-S"Jb

fF

|(irl Income Tax dues

NIL NIL(v) dues

NIL NIL

l('t)NIL NIL

(vii) other dues

NIL NIL(viii)

NIL

P

NIL

NIL

total of alldues

if sq mention

which it is

any otherare in

amount involvedthe authority NIL

{{

of profession or occupation:

Social Worker/ political Activist/Farmer

Spouse : Housewife

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

(a) Self1. Incomefrom Salary2' [ncome from House property (for rentar.income from the owned properties)3' Income from other sources (foi interest income rro* rurtg accounts).

(9B) contracts with appropriate Government and anypublic company or companies(a) details of contracts entered by the candidate. . . . . . NIL. . . . ...(b) details of contracts entered into by spouse ......NIL.(c) details of contracts entered into by dependents ... NIL..(d) details of contracts entered into by Hindu undivided Fam,y or hgst in which the

<- 1.,L-

ft'

GST

tD

candidate or spouse or dependents have interest ... NIL .(e) details of contracts- enraror .i_*^ ra"p",4",#;""il1.":t#i":i:T:::hip Firms in which candidate or spouse oro

$3i*t8f,:fulT:t#i:1"*ii1.:yp.rivate companies in which candidate or spouse or

(10) My educational qualification is as under:1ltr Class from Govt. Boys. Sr. Secondary School

(Give details ofhighest School / Unidiploma/ degree coursg name of theversity education mentioning the full form ofwas completed.) School /College/ University and the year

=s.-, \(^the certificate/

in which the course

Ct

l.

(}

rYt

Badarpur, New Delhi, l9g0

PART _ B

(11) ABSTRACT oF THE DETAILS GIYEN IN (1) To (10) oF PART - A:

SAHI RAMame of the candidate

H. No. 321 ChuriYa Mohalla, Tekhand Village, New

1 10020postal address

AC-52 Tuglakabad, NCT ofDelhiumber and name of the constituencY and

Aam Aadmi PartYame of the political PartY wcandidate (otherwise write

hich set up

Independent')

NILnumber of pending criminal cases

03 (Three)otal Number of cases in which convicted

Total Income ShownYear for which last Income TaxReturn frled

PAN of

Rs.3,75,580/-2019-20AACPR38388a) Candidate

NILNILNO PANallottedBalesh)

NOTAPPLICABLE

NOT APPLICABLENOT APPLICABLENOTAPPLICABLE

-3Spouse

(Smt.BaIesh)Self

(Sahi Ram)Description

NotAnplica

NotApplic

able

NotAnpflcab

NotAonlic

dtiteRs. 18,97,632.54Rs.34,11,376.70A.

Moveable Assets(Total value)

B. Immovable Assets

NotAnnlicab

NotApplic

ableNIL

I

RS.1,60,000/-IPurchase Price of self-acquired immovableproperty

Not Not

5/ApfiI'u -{poLic

itite

F

z.

State3.

4.

).

6.

NOT APPLICABLENOT

assef),in rqPeesand Liabilities (includrug offshoreAssetsof8.

cost of imrnovableafter purchase

applicable)NIL NIL

NotAnolic

dtite

Notb

NotAnolica'lile

NotAnnlic

dtite

Not

Market Price -(a) Self-acquired

assets

(Total Value)

(b) Inherited assets(Total Value)

RS.9,00,000/-

RS.74,00,000/

NIL

NIL

Not Not NotApplic

able

bilities

NIL NIL

others (Total) NIL NIL

that are under dispute

(Total)dues

NIL NIL0.

from Banlq

others (Total)Institutions NIL NIL

I lft class from Govt. Boys Sr. Secondary school, Badarpur, New Delhi, l9g0

educational qualifi cation:

ofhighest School /University education mentioninsname of the Schobl lCollege/Universitf

form of the certificate/year in which the course

theand

tuilthe

bil

F?

II

III

9.

(i) Government dues(Total)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

N}OT

APPLICABLE

(iDNOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(i) NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(iDNOTAPPLICABLE

11.

sill*

\rERIFICATION

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. 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 A and B above;

(b) I, my spouse, or my dependents do not have any asset or liabilitv" other than those mentioned in

items 7 and 8 of Part A and items 8, 9 and 10 of Part B above'

Verified at...New Delhi.. this the. ..20th...dayof.....' January, 2020"""

Y ffiDEPONENT

.ro:Y Ptrfi$.trd*ri."1

i23 .UN zgegL-

,:]

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

Note: 2. Affidavit should be swom before an Oath Commissioner or Magistrate of the First

Class or before a Notary Public.

Note: 3.411 columns 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

r , : .. casemaybe, shouldbe,mentioned. , r,.: r, , ,,. , .

Note: 4. The affidavit should be either typed orwritten 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.

7