Empowering India : Candidate Affidavit

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Affidavit to be furnished by candidate alongwith nomination paper Before the Returning Officer

for election to Assembly (Name of the house) from Ludhiana Rural constituency (name of the constituency) Punjab (name of State)

I , Hira Singh Gabria ,son/daughter/wife of Gian Singh aged 59 years, resident of H.No. 12478, Street No. 10,Vishavkarama Colony, Ludhiana Punjab candidate at the above election, do hereby solemnly affirm and state on oath as under:- (strike out whichever not applicable)

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

ii) The court which S.No. i) Section of the Act and has taken cognizance description of the offence for which cognizance taken 1 N.A

iii) Case iv) Date of v) Details of No order of appeal(s)/application(s) the Court for revision etc., if any, field against above taking cognizance order tasking cognizance

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Empowering India : Candidate Affidavit

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(2) That I give herein below the details of the assets (immovable, movable, bank balance, etc.) of my self, my spouse and dependents:A. Details of movable assets: S.No. 1 2 Cash Description Rs.150,000 Self Spouse1 (Solwinder Kour)

3 4

5 6 7 8

Deposit in Banks, Financial Rs.117,924 Institutions and Non-Banking Financial Companies Bonds, Debentures and shares in companies Other Financial Instruments NSS, Postal Savings, LIC, Policies etc Personal loans/advance given to any person or entity ( Indica, Qualis, Scooter) Motor Vehicles Jewellery,bullion and valuable things Any other assets such as value of claims/interest

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S.No. 1 2

Description Cash Deposit in Banks, Financial Institutions and Non-Banking Financial Companies Bonds, Debentures and shares in companies Other Financial Instruments NSS, Postal Savings, LIC, Policies etc Personal loans/advance given to any person or entity Motor Vehicles Jewellery,bullion and valuable things Any other assets such as value of claims/interest

Dependent1 (Rakhwinder Kour)

Dependent2 (Balwinder kour)

3 4

5 6 7 8

B. Details of Immovable assets:

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S.No. 1

Description Agricultural Land -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value Non-Agricultural Land -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value Buildings (commercial and residential) -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value House/ Apartments, etc -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value Others -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value

Self -N.A -N.A -4 Kanal 21 Marla (N.A) - Rs. 13,868,000(N.A)

Spouse1 (Solwinder Kour)

-N.A -N.A -N.A -N.A

-N.A -N.A -N.A -N.A

-N.A -N.A -1030 Sq Yd (N.A) - Rs. 7,340,000(N.A)

-N.A -N.A -N.A -N.A

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Empowering India : Candidate Affidavit

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S.No. 1

Description Agricultural Land -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value Non-Agricultural Land -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value Buildings (commercial and residential) -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value House/ Apartments, etc -Location(s) -Survey Number(s) -Extent (Total Measurement) -Current Market Value Others -Location(s) -Survey Number(s) -Extent (Total

Dependent1 (Rakhwinder Kour)

Dependent2 (Balwinder kour)

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Measurement) -Current Market Value

Give herein below the details of my liabilities/ over dues to public finance institutions and government duce

[Note: Please give separate details for each item]

S.No.

Description

(a) (i) (ii)

Loan from Banks

Name and address of bank/ Amount Outstanding as on financial institution(s) / 23/1/2007 Department(s) N.A Rs. 0

(iii)

(0) _________________________ _________________________ _________________________ Loan from financial N.A Rs. 0 Institutions _________________________ _________________________ _________________________ Government dues: N.A Rs. 0 (a) dues to departments dealing with government (0) accomodation _________________________ _________________________ _________________________ (b) dues to departments N.A Rs. 0 dealing with supply of water (0) _________________________ _________________________ _________________________ (c) dues to departments dealing N.A Rs. 0 with supply of electricity (0) _________________________ _________________________ _________________________ (d) dues to departments N.A Rs. 0 dealing with telephones (0) _________________________ _________________________ _________________________ (e) dues to departments dealing N.A Rs. 0 with Govt. transport(including aircrafts and helicopters) (0) _________________________ _________________________ _________________________ (f) other dues if any N.A Rs. 0 (0)

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(b) (i)

(ii)

(iii) (iv)

_________________________ _________________________ _________________________ N.A Rs. 0 Income Tax including surcharge [Also indicate the PAN - AZVPG2905Q assessment year upto which Income Tax Return filed. Give also Permanent Account Number (PAN)] _________________________ _________________________ _________________________ Rs. 0 Wealth Tax [Also indicate the N.A assessment year upto which Wealth Tax return filed.] _________________________ _________________________ _________________________ N.A Rs. 0 Sales Tax [Only in case of proprietary business] _________________________ _________________________ _________________________ Property Tax N.A Rs. 0

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Empowering India : Candidate Affidavit

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MY EDUCATIONAL QUALIFICATIONS ARE AS UNDER:

[GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION]

S.No.

Academic Qualification

Name of School/Univ

Year in which course was Completed

N.A

VERIFICATION: 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; no part of it is false and nothing material has been concealed therefrom. Verified at Ludhiana this the 23th day of Jan ,2007

Deponent

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