Vishnu Dutt

ANNEXURE-IIBefore the Returning oflicerFor election to Municipal Committee -KalanaurFrom 11 Constituency.AffBAVITI vtshnu Euttslo,ildfi/$rthri .ragcLtsh sinsr?Bed 39 R/oW.No. t3V&PO: Kalanaur, tehsil:Kalanaur, disu.Rohtak do here by solemnly affirm and declare1. That I have filed my nomination papers for the above election.2.Tl: lt , in connection with my candidature forthe above election, I am submittingherewith the in formation , under section 8 of the Representation of the people Act,l95l and sub -ssstiur (t) of 'secticrn 'l3A ofttrs I*ffiyarla Mmdcipat AEf, t973ju dre'"prescribed Affidavit & proforma.3. That the information furnished in the enclosed proforma is- true to the best of myknowledge and belief and that nothing material has been concealed there from.Place:KalanaurDate: l wStZ}tl@as follows:-,/-DEPONENTVerified before me)Attested as tOdntife6t *dJ-Eooeutive MagisratrlKaranauiHl{l\l)(Signature of veriffingauthority with seal)

f -'*Election to theFromName of the CandidateMunicipal Committee - Kalanaur11ward.; Wshnu #ttt,Fathevlv$lhe r MtffSlts Name: *Y;rSdish SinghPART.I(Information under Section E of the Representation of the peopleAc!1951)L Have you everbeen convicted :by a Court of [aw:-'tne(i) In any case s1recified in subsection(1) :of the section 8 of the Representation ofthe people Act,1951 and sub- section(1) of Section 13 A of the HaryanaMunicipal Act,1973.(ii) In any case specified in sub-section(2)of section 8 ofthe representation ofthePeople Act.195l.(iii) In any other case, and sentenced toimprisonment for not less than? years .Z. ffyes , giYe detaits , ( in each caseseparately) as below:-(i) Name of the court by which Convicted(ii) Date of Conviction(lJ+ Weleyoua-slttiog meJ.nher of theMunicipal Committee/CouncilOn the date of such conviction(iv) If yes , gtve exact details of such statusas Member Municipal Committee/Member Municilnl Council.(v) Nature of offence committed (withdetails ofthe relevant Act and sections)(vi) Punishment imposed(vii) Period for which undergoneimprisonment, if any .(viii) Date of release from prisonYesA.{o* rv\g,ftv(-

. AI\INEXURE.III( Order No'SECIE-IIU,0O3I8ES l' Dated 06' r0'20S3)Allidavit to be furnished by candidate along with nomination paper before theReturning Oflicer'Note:-1. Affrdavit shall be prepared on a non-judicial stamp paper/documentpaper(pucca paper)_ana'l*orn u"rore ihe First class Magistrate or aNotarvPublicoraCommi"iont'ofoathappointedbytEHighCourtorbefore the sub-Divisi;-of# €ivil) ttehsilda / Naib Tehsildil(conferred with the po*"r" ofiott'ii'e Magistrate) havingiruisdiction to)J.*1.the area.,1.***3ri1.PleasereadthecontentsoftheAnnexurecarefultyandstrikethecontentsnot appliea,ble to You'Name), Block(Name).ORrcz. For the election to the office of MemberGram PanchaYat-(Name)Samit (name),r3.Gram PanchaYat(Name).ORFor the election to in" office of Member for wardMuniciPal CorPoratiot

v)vi)Punishment imposed (indicate period of imprisonmentand, lor quantum of fine imposed).Details ifappealdrevision etc. filed abve convictions.awarded{V-{Wo2' That I have in the past been discharged /acquitted in the foilowingcases:-A /!/V' gi) Section of the Act and description of the offence with whichii)iii)t")v)charged.Case No-Nanre of the Court by which acquitted/dischargedDate of acquittall dischargeDetails of appeals /applications for revisior/review, If any , filedagainst above acquiuaVdischarge.lVo{/o3' That I have , in period ending six months prior to the date of firingThe present nomination, been accused of the following offeirceg'/,Punishabte with imprisorment with two years or more , and in wrricha charge has been framed or cognizance taken by the court asindicated hereunder:-(Note:- This excludes the cases mentioned in (l) and (2) above).r)iDiii)ir)v)Section of the act and description of the offence withwhieh ehargpd /eogrizance taken:uThe court which has framed the charge/taken cognizance:Case No.Date of order of the court framing charge/takingcognizance:Details of appeals/applications forrevision etc, ifany, filedf Y o{l/ oftoagainst above order fralllir,*S /taking cognizance./or Sftike out which is not applicable.l

4) That I give herein b-qlow the details of the assets ( immovable, movable,balance etc.) of my self, rny spous€ aruldeper,rdents*:A. Ihtails of movable assets( Assets in joint name indicating the extent ofjoint ownership will also have to begiven)D.escription Self SpouseDependentDependent-Depemdent-S.No.NmreI Name-2 Name3 N'arne(i)CashlO7 ovv(ir)(m)(iv)(v)(vi)(vii)Deposits inBanks, FinancialInstitutions andNon BankingFinancialCompaniesBonds,Debentures andshares inCompaniesOther Financialinstruments, NSS,Postal Savings,LIC Policies, etc.Motor Vehicles(details of make,etc.)Jewellery(givedetails ofweightand value)O+h€r assets, suchas values ofclaims/interests.\,@ (--./i9rn; ?{,)f olooord i!Nofe: Value of BondVshares/debentures as per the latest market vahre instockexchange in respect of listed companies and as per books in the case of non listedcompanies should be given.*Depeadent hre means a person substantially depeadents sn.he income ofcandidate.

-%! r=-t,,jir;_IB.Details of Immovable Assets[Notc ppp611igs in joint ownership in indieating the extent ofioitt owners*rip will alsobe indicated l.Sr.No.Description self Spouse(s)(i) Agriculturalland -locationssurveymrmbers-Extents (Totalmeasurement)-current marketvalue(ii) Noqr -AgriculturalLand-locationssurveyNrmrbers-exteffi(Totalmeasurement)current marketvafue(iil) Buildings(commercialand residential)-Locationssurvey/doornumbers- extent(totalmeasurement)eurrent nrarkctvalue(iv)(v)Houses/Apartments etc.Buildings(comrnercialand residential)-Locations -survey/doorN'umbers-Extents (totalmeasurement) -current marketvalueOthers{srchasinterest inproperty)lv;*ili

.,eftBre in belowthe details of,my liabilitieVover dues to public financialmstitufidns and government dues:-"d,,$ease give separate details fo each itemsS.No. I DescriptionName and address ofBanVfinancialInstitutions/Denarf m enls(aXi) Loans from BanksAmountsoutstanding as onl... '(ii)(iii)(bxi)(ii)(iii)(iv)Loans from financialinstitutionsGovernment dues (other ttranincome tax and wealth taxXNodues certificate to be enclosedin case holding or having heldany public office).Income tax includingsurcharge [Also indicating theassessment years upto whichIncome Tax Return filed .Givealso permanent AccountNumber(PAN)I.weatrn rax I Also mdicate theassessment year upto whichwealth tax return filed'|.Sales Tax [onlyin case ofproprietaly businessl.Propurty Taxrtivfl/ 1'V*rrt i-Eili-?rl;L6) My educational qualifications are as under:-( GIVE DETAILS OF SCHOOL AND TINIVERSITYEDUCATION)(Name of schoor/university and the year in which thr;;;. e'Irv wasalsocompretedbe given)vvu'shouldt)PLACE:KALANAURDATED: t9/0s/2013S>iDEpONENTName in full ,rZ i( l^ad,^ DhttsAddaas , *r.._--l,rz^ -iE2'f*,A _ A*h.l-,tf