S0120190326010732.pdf

A lno dtl 168 2018dig r5 ogt thaiigetiahasii streat

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A l/Not'drleV631/ 20 18 Dtl 16{8-2018DIG R&5, OGt THAIIGETI.A(HASII' STREAT, ONMTE, Prakrsam Of *ria, 14.e.1, lfbn 18
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VERIFICATION I, the deponent, above named, do hereby verifi and declare that the contents of this affidavit are true and conect to the best of my knowledge and belief and no part of it is false and nothing material has been concealed there from. I firther declare that :- (a) there is no case of conviction or pending case against me other than those mentioned in itemsS and 6 of Part A and B above; (b)I,myspouse,ormydependentsdonothaveanyassetorliability'otherthanthosementioned in items 7 and 8 of Part A and items 8,9 and l0 of Part B above' ADVOCATE & NOTARY Appld, Gort of A,P. f,cgd.tlo. l?{2(r8i,?Lt l:1011 Rene$al No. Al/tlotarler63 t/?ClE Dt: 16-08-2018 DIG R&S. OGt DEPONENT THANGELTAKHASIM STREET, OI'IGO ]: Prakasam ustrict, (A.P), It{etA ll0lAffi lIAUD UPi0 :5.i2-l0i I DArE:.*.S;.93.=)-s\J Note:l.Afiidavitshouldbefiledlatestby3.00PMonthelastdayoffilingnominations. Noter2'AffrdavitshouldbeswornbeforeanoathCommissionerorMagistrateoftheFirst Class or before a Notary Public' Note:3.Allcolumnsshouldbefilledupandnocolumntobeleftblank'Ifthereisno information to f.,*itt, in ...pi.t of any item' eithet "Nil" or "Not applicable"' as the case may be, should be mentioned' Note: 4. The affrdavit should be either typed or written legibly and neatly' Note: 5. Each page ofthe Allidavit should be signed by the depon-ent and the.Affidavit should bear on .Jp"gt the stamp ofihe Notary or Oath Commissioner or Magistrate before whom the Aflidavit is sworn' (Ministry of Law & Justice Notification No' H I l0l9 (4)/2018-Leg'll' dared 106 October' 2018 l"i i.rJin"",,*, No.H- I l0l9/13/2016-Leg' II' dated 26u' Februarv' 2019) 19 (-^t^u,.(- Verified at
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P I o OriginaV duplicate (Original to be kept with nomination paper and Duplicate to be handed over to candidate) Whether filed (write yes/no) (if there is any defect/shortcbming in the documents, the same should be Affidavit in Form 26 (a) Whether all columns are filled up (b) Ifnot, which are blank column(s) (please speciff). (c) Whether the affidavit is swom before an oath Commissioner or Magistate of First Class or before a notary public. Cenified extract of electoral roll (when candidate is an elector of a different constituency) Forms A and B (applicable in the case of candidates set up by political parties) F*[o- Copy of caste certificate from competent authority (if the candidate claims to belong to sc/sT) Security deposit (whether made) Oath,/affi rmation (whether taken) Cond. Name of constituency .... qf"t\O...N- Name ofthe candidate f^ Date and time of filing nomination paper . Sl. No. of nomination paper Ajl I SNo Documents I Y"r> 2 3 4 5 6 -\t2 -"
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(a) (b) (c) The following documents which have not been filed should be filed as indicated below: should be filed latest bv Above mentioned columns in the Affidavit in Form 26 have been left blank. You must submit a fresh affidavit with columns duly filled up before the commencement of scrutirry of nominations, failing which the nomination paper will be liable to be rejected. should be filed latest by Received (^,.",,U^[*.'4' (Signature of candidate) Date & time: Place: N.B. 1. The Affidavit in Form 26, Forms A & B have to be filed latest by 3.00 P.M. on the last date of filing nominations.
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