Pawan Kumar

3.(i)(ii)(iii)(iv)(v)(vi)(vii)Was any aPPeal/aPPlication for :i."itioti frieO against above ConvictionRef,"r"t'c"mofaPFauaPPtication :for revision filed,If anY';;* oir,nittg of such appeal/application:For revison.Nu*. of the court before which the :npp"uVuBplication for revision filed'-ffretf,erEesaid appeal/application :For revision has been disposed ot orPending.If disposed of :-(a) Date of disPosaliti Nrt*. of order Passed:ttte pe"Oe"cy of appeaVappliciationfor revision.iii"t , period during which remained on:Bail.Trlo1..laDisposed of /Pending' !o(o!opo4.5.PART-II( In formation under sr"tlorrTl A(1) of the Haryana Municipal Act'1973)Have you ever been disqualified by or under any :i;;i;4" time being i" fot"" for the purposes of;;; to the Legislature of the State of Haryana'Have your ever been disqualified by or under any :ir*rn"d. by the Legislaiure of the State of Haryana'YesA{o /Yes/No /PLACE:KalanaurDATE I lo5/20l3R"-^/Signature of the candidateYesNorflo,,#mPffiF;ts((t6s),fu:lrr

. , AFINEXURE-III( Order No'SEC/E-III/'0{I3/tS31' Dated 06'10'2003)Aflidavit to be furnished by candidate along with nomination paper before theReturning Oflicer'Note:-l.Affidavitshallbepreparedonanon.judicialstamppaper/documentpaper(pucca paper)^ana'I*o* u"ror" ihe First class Magistrate or aNotary public o, u comm"i;;i;;"; of oath apoointed bv the High court oruef; fte sub-pivisisn-of# Givil) /tehsildar / Naib Tehsildar(conferred with the po*"r* ;fi;tt'i"e Magistrate) havins iurisdiction tothe area'Z.****3rd.3.PleasereadthecontentsoftheAnnexurecarefultyandstrikethecontentsnot aPPlicable to Yott'Name), Block - Name)'OR*2. For the election to the oflice of Member for ward No'- of* *PanchayatGram Panchayat--(Name) nr. -o' * 7,ilt ParishadSamit (name) or(Name).,aelection ,3L" pffipe of Member for ward No'-f- of *;;1ffiMunicipar''H;"Council (Name) or?.-Tn; *:,il}#l(Nrme).1 fl",^-."- K.^,^^+:-a :{,?ff shri Fl'vr"/,' g$y+;@rwNo'J,:sub-tehsil:Ka1anaur, ffi.-iU*k "unaffi-utth" ubor. eHion, do herelv1"i"-"ry affirm and state on oath as under:-(strike out whichever not appticable)l.Ihave,inpast,beenconvictedofacriminalof.fenoeinthefiollowingcases and t[r" dttuilt are as under :-l,), ilti}?;" of the Act and description of the offence for whichco*rvictedNote:*** Not appticable in the case of Municipalifies'-**:t*2 Word Declaration has been deleted by notificationNo.,sEc/E'{wzoos t t0527' dated 30- I 0-2003'iii\{c*i}*3HeadNoteNo.2wasdetetedbynotilicationNo.SE{/E.IIU12AO3 t lg 527, dated 30- L0-2003'Dates of conviction

B.Details of Immovable AssetsfNotqPfopertiesinjointownerslripinindicatingtheextentofjoirrtovrnershipwil'lalsobe indicated l.Spouse(s) | DePendent- Sepenan-et- | DePendent-Sr. Description selfName(s) | tNu*" 2Name lrNurn"No.(i)(i')(ii,)(w)(v)AgriculturalIland -locations- lsurveymrmberc-Extents (Totalmeasurement)-current marketvatueNort-AgriculturalLand-locationssurveyNumbers-extent(Totalmeasurement)current marketvatueIBuildings I(commercial Iand residential)-|Locations- Isurrey/door lnumbers- extent(otalI measurement)I",*"tt rnarketI yrlueHouses/APartments etc.Buildings(comrnereialand residential)-Locations -survey/doorNtmbes-Extents (totalmeasurement) -current marketvalueOthers(*chasinterest inproperty)ft;",r"ig5*'?i,ffi0

,e,fiere in below the details of my liabilities/over dues to public financialrnstitutions and govemment dues:-P1ease ve details for eaeh itemsS,No. Description Name and address ofBanVfinancialIn sti tutions/Deoartments(aXi) Loans from Banks(ii)(iii)(bxi)(ii)(iii)Loans from financialinstitutionsGovernment dues (other thanincome tax and wealth taxXNodues certificate to be enclosedin case holding or having heldanv oublic office).Income tax includingsurcharge[Also indicating theassessment years upto whichIncome Tur Return filed.Givealso permanent AccountNumberPAN)I.Vflea'fth Tax'[ Also indicate theassessment year upto whichwealth tax return filedl.Sales Tax [only in case ofproprietary businessl.LT;Rrtt,..LlipNiautXil;-€'(iv) fruprty Ta:rn/;VAmountsoutstanding as on6) My educational qualifications are as under :-( GIYE DETAILS OF SCHOOL AND UMVERSITY EDUCATION)(Name of school/Universtty and the year in which the course was completgd shouldalso be given)PLACE:KALANAURDATED: /0512013\--'DEPOName in fullAddress\0;