Satnam Kaur

Fls' ' :IIBefore the Returning officerFor election to Municipal Committee -KalanaurFrom W. N0. 3Constituency.ANNEXURE-IIAFFIDAVITI S&TN&H KnuR sutfilo,wo shri sNDmpfiLaged 47 R/oW.No.3V&PO: Kalanaur, tehsil:Kalanaur, distt.Rohtak do here by solemnly affirm and declareas follorvs:1. That I have filed my nomination papers for the above election,2.Tbat,in connectionwith mycandidature fortheabove election, I am submittingherewith the in formation , under section 8 of the Representation of the people Act,1951 and sub -section (1) of section l3A of the Haryana Municipal Act, l973,in theprescribed Affidavit & proforma.3. That the information fumished in the enclosed proforma is true to the best of myknowledge and belief andthat nothing material has been concealedthere from.Place:KalanaurDate2o l0sn01,3--qa"frh #-/1ti , q)\: \Iftr,,

Poforma for furnishins information under section 8 of the Renresent4tion of the1973 by everv candidate at an election to Municinalitim.Election to the Municipal Committee - KalanaurFrom'[{.l0' 3ward.Name ofthe CandidateF ather/Ivlother/llusband' s Name: Seln$SM KAIIR: INDS P&I"PART.I(Infomration under Section 8 of the Representation of the people Act,1951)1. Have you everbeen convictedby a Court of law:-(i)In any case specifie

3. Was any appeaUapplication for : yes/I.Io-- H- ,revision filed against above Conviction(i) Reference No. of appeaUapplication 1 _-. A I ._for revision filed,If any.|Y"(ii) Date of filling of such appeaUapplication:Forrevison- t1t.-''(iii)ffiffi;5:;ffit?;:Jsrff. -Na(iv) whetherthe saidappeauapprication :For revision has been disposed oforPending .Disposedof/pending.(v) - tiaIf disposed of :-(a) Date of disposal (b) Nature of order passed : - (no 'the pendency of appeaUappliciationforrevision.(vii) If yes , period d,.ring which remained on :Bail.M6 ^< f{o_*PART-tr( In formation under Section 13 A(1) of the Haryana Municipal Act.l973)4. Have you ever been disqualified by or under anylaw for the time being in force for the purposes of: yesa.Io [{aelection to the Legislature of the State ofHaryana.5. Have your ever been disqualified by or under any : yesa.{o - N , )lawmade bythe Legislature ofthe State of Haryana.PLACE:KalanaurDATE : 2A/'5/2013Signaturi tif the candidatew--

Ai\tNEXI]RE.Itr( Order No.SEC/E-Itr12003/8831, Dated 06.10.2003)Affidavit to be furnished by candidate along with nomination paper before theReturning Oflicer.Note:-1.2.J-Affidavit shall be prepared on a non-judicial stamp paper/documentpaper(pucca paper) and sworn before the First Class Magistrate or aNotary Public or a Commissioner of Oath appointed by the High Court orbefore the Sub-Division Officer (Civil) /Tehsildar / Naib Tehsildar(conferred with the powers of Executivr h{agistrate) having jurisdiction tothe area.*xx,r3td.Please read the contents of the Annexure carefirlly and strike the contentsnot applicable to you.*1. For the election to the olfice of Sarpanch of Gram PanchayatName), Block(Name).OR*t LtGram Panehayat (Name) or,.!t Zila't3.For the election to the oflice of Member for ward No._ of *Samit_fname)(Name).ORPanchayatParishadFor the election to the oflice of Member t'or ward No. of*Municipal Corporation (name) or * MunicipalCouncil (Name) or * Municipal Committee -Kalanaur(Name).ddJY$, Wo Shri I.NDEnPal,aged 47 years, resident of W.No. 3 , clte Eta pannKulanaur,tehsil:Kalanaur, distt. Roh.ral< candidate at the above election, do here bysolemnly affirm and state on oath as under:-&L[' '(strike out whichever not applicable)1. I have , in past ,been convicted of a crirninal offence in the following :/\I .rcasesand the details are as under:-Case No.Dii) A) Section of the Act and description of the offence for which - ['(u-'^convictedNote'*rtrb Not applicable in the case of Municipalitiesrcrr'ct'?lYord Declaration has been deleted by notifrcationNo.,SEC/E -IIIl20{0'3ll0527, dated 3&10-2003.'i"**3 Head Note No.2 was deleted by notilication No.SEC/E- IIU - A-t t -*,2W3 I 19 527, dated 30-1 0-2003.iii) Dates of convictioniv) Courts by which convicted

v)vi)Punishment imposed (indicate period of imprisonmentand /or quartum of fine imposed).Details if appeals/revision etc. filed above convictions.awarded.- 44"- &1,2. That I have in the past been discharged /acquited in the following *'"'N4 ,Di0iii)lv)v)cases:*Section of the Act and description of the offence with which*Nocharged.Case No.Name of the Court by which acquitted/dischargedDate of acquittaU dischargeDetails of appeals lapplications for revision/review, If any , filed -Nlu'against above acquittaUdischarge.--/,1Vt'- *lt ''€ ['-1"3. That I have , in period ending six months prior to the date of filingThe present nomination, been accused of the following_:*l*:, --*f, _Punishable with imprisonment with two years or more , and in whicha charge has been framed or cognizance taken by the Court asindicated hereunder:-(Note:- This excludes the cases mentioned in (1) and (2) above).Section of the act and description of the offence with -rq' -which charged lcogmnnce taken:tThe court which has framed the chargeltaken cognizance:- lv I .Case No.Date of order of the court framing charge/taking-tVpcognizancet_ L_!o_ -_Details of appeals/applications for revision etc, if any , filed | 'against above order framing /taking cognizance.* Strike out which is not applicable.-Ht 1

-^Tr-.rlIafa-E}Y9flglr;rrr^t^irtrtrtrrvswqi-la*!'tu-(. - -*- -*balance etc.) of my self, my spouse anC dependents*:A. I Details'of movablesss€t$ ,- '( Asseis injoint trame indicating the extent ofjoint ownership will also have to begrven)Description Self SpouseDependent-DependentDepemdent-S.No.Namel Name-2 Name3 Name(i) Cashl3 ru"l(ii)(iii)(iv)(v)(vi)(vii)Deposits inBanks, FinancialInstitutions andNonBankingFinancialCompaniesBonds,Debentures andshares inCompaniesOther Financialinstruments, NSS,Postal Savings,LIC Policies, etc.Motor Yehicles(details of make,etc.)Jewellery (givedetails of weightand value)Other assets, suchas values ofclaimslinterests.3.a.o*o',./.4:1ffis+ (lt dNote: Value of Bonds/shares/debentures as per the latest market value in stookexchange in respect of listed companies and as per books in the case ofnon listedcompanies should be given.*Dependent here means a person substantially dependents on he income of candidate.

[Note: Properties in joint ownership in indicating:,the extent ofjoint ovrrnership will alsobe indicated l.Sr.No.(i),Desoription self S'pouse(s)Agriculhralland -loeations;surveynumbers- , i'Extents (Totalmeasurement)-current marketvalue(ii) Non -AgriculturalLand-locationssurveyNumbers-extent(Totalmeasurement)current marketvalue(iii)(lv)(v)Buildings(commercialand residential)-Locationssurvey/doornumbers- extent(totalmeaswement)current marketvalueHouses/Apartments etc,Buildings(commercialand residential)-Locations -survey/doorNumbers-Extents (totalmeasurement) _,current marketValueOthers (such asinterest inproperly)Name(s)DependentlName2 Namef.'Dependnet-.Dependent-3 NameIi

Il(Xtr: rlGAJtr SgE SEArc OGIaUS IOr eacn fiarnsS.No. Description Name and address ofBanlc/financialInstitutions/Deoartments(aXr)Loans tiom tsanksAmountsoutstanding as on(ii)(iii)(bxi)(ir)(ii0(iv)Loans from financialinstitutionsGovernmeni dues (oiher thanincome tax and wealth taxXNodues certificate to be enclosedin case holding or having heldanv oublic office).Income tax includingsurcharge[Also indicating theilssessment years up to whichIncome Tax Return filed .Givealso permanent AccountNrrtnherfPAN\IWealth Tax I Also indicate theassessment year up to whichwealth tax return filedl.Sales Tax [only in case ofnronrietary businessl.Property Tax6) My educational qualifications are as under :-s3. B,l.( GIVE DETAILS OF SCHOOL AND UNIVERSITYEDUCATION)(Name of school/University and the year in which the course was completed shouldalso be given)PLACE:K.A.LANAURDATE# -05-2013Name in fulla lt-^^ft'(l(lltrSSis false and nothing material has been concealed therefrom.Verifiedat Kalanaur thisthe20 dayof May 2013.PLACE: KALANAURDATED: 2g0sl20l3.SS" ^S-DEPONENTName in full EfrtN&H KaIJR\\H\v 0{ (