) L-a

,t+\<oL*l*rr,1
\'3jQ$^ 10849-Electron-lr--u^ '' " P.pld.

FORM
\>')l tq"
26 \
Rublrn rc^c..,rLe 4Al fy
H[a
* Area FaridrFt-

ffl*.fr,#ffi'
s)
ATIFIDAVIT TO BE FILED BY THE CANDIDATE AIINT"
RETURNING OFFICER FOR ELECTION

ro.L.F.s.tst-..s.J.Y.8-....ft sF..€.$El..y-...:ift fJf;di.4rrHousE)

rnorrr.....3.P;,...IJ.9.4.?..N1.........*...-coNsrrruENCy (NAME oF rHE coNsrrruENcr,

PART-A
r.R.eKrt....N*$.n*.......**son/dar*ghrrfwituor .yc$h,P.*Ll3f"d .......3p.... years,
resident or...h:.N.9.:.h1.7.r..5.ECf.9K:Ih.r..fA.Rtn aaADr..HA(YAtiA...--..t2..t.ep.7...........
..--*-.....[mention full postal address), a candidate at the above election, do hereby solemnly
affirmand state on oath as under:
(l) I am a candidare set up uyLN.P!*tJ....ry.*-r.PNnk...CLcJ$9551**n"*e of the
political party)/* (t*strike out whichever is

(2) J;'::I]:":r?n,orrca in.ss.:rs.*jp.ap.Xp,=(:-6..qr*Hlrf-.A..jrlglJ

constituency and the State), at Serial No..1.9.Q.*....in Part No. ..I.8[
:Lffil'lrtfurA NA
(3) My contact telephone number(s) is/are.....1.3.1.1.9,P..9..1.1..\..................and my email id (if
3Iy) is hphi-rss$qt*.1134..n.tr*L&:.C9!)r......................and my sociat media account(s)
(if any) is /are
(i) . Crrt)
(ii) { c"D
C.K'l-#") {-i
(4) Details of Permanent Account Number,(PAl,l)* and status of filing of lncome Tax return:

sl. Names PAN The financial year for Total income shown in In- come- Tax
No. i
wfiichthe lhst return (in Rupees) for
Income- the last five
tax return has bBen Financial Years completed
filed fas on 31st
1. Self
BMOPN )oL3 -2e>\ i) 2D>\->a21,| 5,g5.o88 /.
Rotttr l3t{ 3C ii) LoL>-)o23 : q. lo. a\{ I =

NAqA( iii) 2-o>l' 2D>>1 N'A'

iv) Zo2D-2o:-l : N .A'
Iv) Zoll -2o'zo: N.A.
c,q
r ffi"" R/rtNil heU4, 'L*^o€/tt4

N.N.

Note : It is mandatory for PAN

, case of no PAN it should be clearlr.
stated "No PAN allotted".

ts) Pending criminalcass

I declare thatthere against me.
\-y ant
(Tick thi\ alternative e pending against the Candidate
write NOT APPLICABLE (ii) below)

(ii) The following criminal cases are pending against me:

(lf there are pertding criminal egotnst the candidate, then tick fhis altcrnative
cases
and score off alwrnative (i) above, and give detoik of all pending cases in the Toble
Below) N. N.

2 SEP ?O?I
 3

TABLE

a FIR No. with name and address of Police Station

concerned. l.l 'N, N.A, N. A,
b Case No. with Name of the Court N.A. N.A. NA.
c Section(s) of concerned Acts/Codes involv3d
(give no. of tn" Sectiory eg. Section .1\llA... of
IPC etcJ
N"A, N'A' N.A'
d Brief description of offence N.N' t,'A' N.A,
e Whethercharges have been framed (mention
YESor NO) T\.4' N'A' N,A,
f If answeragainst [e] above is YES, then give the
date on which charges were framed N"A' N .A' N,A,
o
b Whether any Appeal / Applicarion for revision
has been filed againstthe proceedings Nft' N n' N,A ,

(Men6on YES or NO)

6. Cases of conviction

,JY I declarethat I have not been convicted iorany criminal offence.

(Tick this alternotive, tf the candidate has not been convicted and write NOT
(PtlClBt E against alternative (ii) below)
oR
A,
( ha\been convicted for the offences mentioned below: N . N ,
*{ f\*Aandidote hos been convicted, then tick ihis alternative ond score off alternative
(i) opop ond give details in theTabte betow)
o\
\o f ,,,'/
TABLE
(Casti
? No.
N ,N' N..N. N''A ,
b Name of the Court
N,N' N'\' N'4,
c Section(s) ofActs/Codes involve-d (give no. of
the Sectio4 e.g. Section........f$.*.4 ...... of tPC, etc.) N'\' N.A. N'A'
d Brief description of offence foiwhich
convicted N.\' N.A. N.A"
e
Dates of orders of conviction
N.N" N.N. N'A'
f
g
Punishment imposed
N'A N. A. N'N'
WhetheranyAppeal has been filed
against conviction order (Mention N.A. N .A' N.A'
YES or NO)
 ,4

h If answerto (g) above isYE$give

details and present status of appeal
N.N' N.A. NA.
pending criminal
t6A) I have given full and up-to-date information to my political party about all
cases against me and about all cases of conviction as given in paragraphs t5)
and (6). NoT A?PL\ cABLE lN l6W otr
V ENT R.\ 65
tN 5 Ci ) ar^d ( C> a'bove
fCandida,tes to whom this ltem is not opplicable should
cleorly write NOT APPLICABLE IN
VIEW OF ENTRIES IN 5(i) and 6 (i), abovel
Note:
l. Detoils shoutd be entered clearly and legibly in BOLD letters.
2. Detoils to be given separately for each case under different columns against each item.
3. Details should be given in reverse chronological order, i.e., the latest case to be mentioned
firstand bockwards in the order of datesfor the other cases.
4. Additional sheetmay be added if required.
5. Candidate is responsible for supptying alt informatian in compliance of Hon'ble Supreme
Cour* judgm.entinW.P.l No.536 of 2011.
6. That I give herein below the details of the assets fmovable and immovable etc.) of myselfi,
my spouse and all dePendents:

A. Details of movable assets:

Note: 1. Assets in ioint name indicating the extent of joint ownership will also have to be given-
Note: Z. In case of deposit/lnvestment, the details including Serial Number, Amount, date of
it, the scheme, Name of the Bank/lnstitution and Branch are to be gtven

Bonds/Share Debentures as per current market value in Stock exchange in

listed companies and as per books in case of non-listed companies should be

ns parents, son(s), daughter(s) of the candidate or spouse and any other

1(^*ffi'd.ffiI* ted to the candidate whether by blood or marriage, who have no separate
- come and who are dependent on the candidate for their livelihood'

icluding amount is to be given separately in respect of each investrnent

Note: 5"t itr should include the interest in or ownership of offshore assets. Explanation - For
the purpose of this Form, the expression "offshore assets" includes, details of all deposits
or investments in foreiggr banks and any other body or institution abroad, and details of
ail assets and liabilities in foreign countries.

vy $ 2 SEP 1$I4
 5

Sl. No. Description

ielf Spouse IIUF Dependent-I Dependent-2 tlependent-3

:0 Cash in hand
As o^ f of A f r{' Dtr,z Q= N.0 N.A. N .N' N"N . N, F-
Details of deposit in Bank
accounts IFDRs, Term De-
posits and all other tlrpes
lAs
of deposits induding saving
lru^- NN. N'A N'&' N^4. N's-
ii) accounts),Deposits with (
I

Financial Institutions, Non- lAn,e;

banking Financial Companies
and Cooperative societies and^
T
the ambunt in each rubtK \2t99) ofl-
deposit As on 1olo1 I
Details of inves,bnent h""r_.f
i

Bonds,debentures/ shares
(iii) and units in companies/
Mutual funds and others and N'A N.A. Ir'N. N.A' N .N, N.A-
the amounl A6 on tol q l+
Details of investment in NSS,
Postal Saving Inzurance
policies and invesEnent in any
(iv) N'Fs' N.A. x'4. F}.4. 0\'N' N" A,
Financial instruments in post
office or Insurance Cornpany
and the amount As on loloifz\
Personal loans/adrane given
to :u:ly person or entity
-rft,F= lScluding firm, company, Trust N.A. NA. N^A^ N'A\-' N"N: N'0r"
./
,,,/
t'. .\
'l
br
iTA g$1and other receivables
v7 qt$4\t"*iJfJqerTryunr
ii(,t, ,t.
Rubina H
t$ip.- VehiclesT lUrrrrnsZ
#*, i
Advr
Area Farid
e"6niNo i
r,Yachis/Ships (Details of Make.
:,#.g#E tipn number erc. year NA. N,N' NA N'4 At"4. ,\ ^4 ,
\$ i:'l.. o f p.rgchase and amount)
-"- 149<. on loloq[>]
'&qt I
{: r.{ $,u{ery,bullion and valuable qad N.N.
N"A.
N.A.
vnr:*-=- fhing(s) (give de- rails of As on f"roeltt
\
N'A' N'4 ,
weight and valueJ lol o{ I zh rorc Z/Y,,6 D,=
Any otherassets such as rralue
viii) orf claims / interjsi N.A. N,N $r'A N-A' N'&" N "+,
(ix) GrossToalValue '.
"f,,il
-tE
r{"ft'
31,1\ 6rl- N'ft N.A. N.A,
B. Details of ImmonableAsseB:
Note: 1' Froperties in joint ownership indicating the
extent ofioint ownership will also have to be indicated.
Note: 2' Each land or building or apartrnent should be rnendoned
separately in this format
Note: 3. Details should include the interest in or ownership --_
of offshor" rrr"L.-

W)P |2 sEP
?Ql
 5

SI. No. Description lelf lpouse IIUF Dependent-I Dependent-2 Dependent-3

Agricultural Land Locationfs] Ap*

Survey number(s) fL N.A. N.A. N'4, N.A .
N-+ -

Area ftotal measurement in ('

acres)
ANNT
N.F, It\'h N.N N A. N "4.
T-
Whether inherited property
NO N'A N.A. N.N. N.N- N"N,
[Yes or No)
Date of purchase in case of
self- acquired property
AilroE
E N.A. N.N. N.A- N'Ir' N,+,
Cost of L^and (in case of ANNE
purchase) at the time of
purchase L N.A' N'\. N'N. N,A' N,A,
Any investment on the land ANNBJ
by way of development,
f- N'N' N.k N.N. s\.tr' N'4.
construction etc.
Approximate current market ANNE
N.A: N.A,
N.A. N.N. N.A'
value tr-
Non-Agricultural [,and:
Location [s] Survey t{'F' N'A/ N^r N"S' N"A. N"h'
number(s)

N .4.
Area (total measurement in
sq.tu)
tt"D'
N'N, N.D' bl"o' N'h'
Whether in herited property N.h' N.N' N.N tr l'A' N"\' r{.N'
(Yes or No)

;D d+-urchase in case of I\'A'

N'f\^ f\.s"
fe!frag+iqd property N'N' N"A. N-A'
,,q, -ffidrfot(i{r
case of
attfie
,,pnarthad) -' time of [\'n' N'N' N.N' N.A' N's. N'A "
pS*{f.t$e ,
fl A

on the land
lent, N.N' N.N' trl"N' N 's' N.A ^
N.A
b,x
^

'rl-r" t
a\ ' rla&t"current market tr'Dt' N.F' NN N.N' 0'l'A' N^A'
^
value
Commercial Buildings
N'A'
(i ncluding apa ranents) F\'N N.N $.I'N N.A ^ F\'A '
-Location(s)
-Survey'number(s)
Area (total Measurement in
sq. ft )
N.F.. N'A' N'e N'ft' N"N, N,A '

@^y tf?"sEP ;or\ ,

 Built-up Area (toal
rneasurement in sq. ftJ Nft' N,&, N.N. N.N' N.N' N).+',
Whether i{rherited property
[Yes or No)
5l'A' N.N' N.N N.A' N.N .
N.A,
Date of purchase m case
sel f-acq uired propert5r
of N'q N'ts'
N.Dt' N.N' N '$r' N.A,
Cost of property (in case of
purchase) at the tirne of
N"N
N. D' I.l'tr N-N' N.A. N.N.
purchase
Any investment on the land
N'N'
bywayof development, N: N'
N-N' N.Pr' N.N, N"Nl
construction etc.
Approximate current market Nl'N N.A,
value
N's' N-A' N. f+' N.s'
Residential Buildings 5t'A N-r' N.N'
uding apartrnents)
(i ncl N.N' N.N'
-Locationfs)-Survey
N.N,
nurnber(s)
Area (total Measuliement in N "!t N,F' N"N. N..h' N'N. N.A .
sq- fr)
Built-up Area (total \T,N
rneasurementin sq- ft.) N'h' N.N' N.N. N.\. N- A,
I,Vhether inherited property N.A.
N'4, N.h. N.N' N.A .
N.A ,
[Yes or No]
of purctrase m
;Qte N.h' $.1'k'
t\.N' N.A. N.A,
)u \dfr&rope4y 4Spf seffi-aoquired property
N.A,

Ji
*l/
rbinr &
Advr,
(in case of
tn\rctrallt at the time of
g"iet't"H-
N'A' N.F' N.k' N .h' $.,1. N ' hl. A,
t 'ea Ferida
gn. No. l{
:Itfltn#trnent on the land N.k' "k' N"k' .N N.A,
sx
ry Dau. l0rJ
N FI
l N'N.
OF #ffi*""i:Prnent'
i{$ronmate current ma rket \.4 N'N' N"k' N.k' N.A. N'A'
value

V
Others (suchas interest in Nl'A' N.F. r\.k' I\ .N' N,N' N.A.
property
Total of curent market value
of N "F' N.A' N.A. N.N' N.A.
ri
(i) to
(v) above .tNq rr, )o, o( mol-

@P
 8

- 8- I give herein below the deails of liabilities/dues to public financial institutions and
government- (Note: please give separate details of name of bank institution, entit5r or
individual and amount before each item)

s[ Omiptlon ielf ipouse TUF Dependent-I Dependent-2 Dependent-3

No.
(r) Iran or dues to
Bank/ financiat
insdtrtion(s) Name
of the Bank or N"N. N.A. N.A. N.A, N "N. N. N,
financial institution,
Amount
outstanding Nature
of toan
L@n or dues to any
Other individuals/entity
oth.er than N'A' N.A- N.N NA. N'N' N. A,
mentioned above
Name(s), Amount.
ouBtanding, nature of.
Ioan
Anvotherliabiliw N,N.
.A'
N.N, N.A' N'+, N ,A. N'tr
Grand total of liabilities N N'N. N .A' N.+, N^A' N,A,
(ii)
Dues to deparhmenb
A llas the nepmc* been in Grpdkn of
ammnnoa*im fouild hy tte Goveramtr d
[tslxo \-
(Pl. tick
dealingwith aryttorc hst&n frrs befrrc fu de
eniryth the
government ofnffi c*im ofthe qurcmdecf iur? appropriate
accommodation B tr a*er b (A) *oye b l,E$, fre trbrrtry alternative)
dedr*ion rybe frrniH rnm$r:- ,!
''
[0 Ih dftess d OE Gouerrffi ;*r
i ttt :7"'r ,
ammd*ftm
t/' 11( i ..-.-.-..,.-.N.:-h.:..-.-.-
-J,\ t
L"1-:-': .....-.-....-t*.*:.*. ,:.

/ Y N :A:
/
ftgl-,ina
G0Tfterc b no dues patrable in rtspcct of above
x auel f'r ,,.labad
Flrt'i I'
.Jtl45
GCIrerument
(a) RmS
mmod*ioq bmrds
?.1\ L
s
,,.{r1 i'i' '"tt
(b)nmtitv&arye$ nltU
t \\.. ttraerdargeqand Nl
,l t'
(c) L
.-\- T@rcne durgesason (daE) E ede$ouH
(a)
- be dE last dae of fte third month prior o tlle
-=__ mcilt in wltidl dr ehction is notified or any
darctlpreafter. trlt,U
N@-No Dues Certiffi hom the agmcies
onoenrcd in rcspect of rent, eletrcity cturge$
uraEr drarges and Elephone &arges for the
above Crovernment ammmodation drould be
srbrnitEd.

VY JTS
 ( iii) Dues to department
dealing with
governnlent
transport (including
N\U N\L
air-crafts and
helicopters)
N'A. N.A .
N.A. f{'A N"N- NA,
(iv) lncome tax dues Self Spouse HUF Dependent -1 Dcpendent-2 Dependent - 3
(u) GST Dues N"N. N. A. N.A. Fl A' N"A ' N.A,
1vi) Municipal/Property tax
dues
N.N. N.*' N.s' N.A, r..\ - l\ ' N ,4,
(vii) Any other dues N"N' N. h, N'A' r\,4 .
N .A' ^J-A,
Grand totalof all
(viii)
Government dues N.A , N.A, N'+' N' A' N.A N.A'
Whether any other
liabilities are in
N.A, NF OI"A' N.S' r.l.A N.fi
dispute, if so, mention
(ix) the amount
involved and the
authority before which
it is pending.
9. Details of profession or occupation:
( a ) self....AQR\c.VLTu&\ET %. LoNSUUTANT
( b ) spour"............N..:.4.:....
(9A) Details of source(s) of income:
(a ) serr...s..!|&\-.c.]l.Hl.P,s1..8T k coN tpl-14NCY
(b) spour"...........1$.:h.:.................
c ) Sources of income, if any, ofdependents,..........-.fl..:..h..:.
with appropriate Government and any public company or companies
details of contracts entered by the candidate Ntu
details of contracts entered into by spouse
Arcr Faridrlad
Reon. No. $715 d eta i ls of con tracts en tered into by a.p.r,a"rrt" .......N..:.S.-...
erriry uru' 3ry/N t?5
details of contracts entered into by Hindu Undivided Family or trust in
whlch the candidate or spouse or dependents have interest N ' A '
details of contracts, entered into by Partnership Firms ln which candidate
or spouse or dependents are partnbrs N.A '
(0 details of contracts entered into by pr{y?te gompanles ln whlch candldate
. or spouse ordependenE have share.-.-.-,Drt.-&;*
(10) My educational qualification is as under:'

B.*c\d**....et....S*.K....in.....trus.r
"*$lT;a;,S;-" - ;t' E jh. y-dl0- ;;6 ""-"""""""""'u
i;^9k\-.k...n"nn*.r"ms*-....-9-l*.di*......L**.n"
(Give detalls of liighest Schodl/University educatlon mentioning the full fornr of
the
certificate/ diplomar/ degree counse, name of the Schoot/Colleger/University and the year in
n'hidl tbecourse was completcd.)

w ,lsrp
w"
 10

PART-B
(11) ABSTRACT OF rHE DETAITS GIVEN IN (1) TO (1O) 9I r4lr4
I Name of the Candidates Sh./Smt./Kum. RoU N AC{AR. rt
t-tr.r; 611, s,qtoL-l,H , ES@elSNAqAI
2 Full postal address E:AA\SARAI) RAR.VA'NA l2l Oo7
and State
{o -tt g6s,sl .'Leq\.s\ah\< As6er'^b\*q
3 Number and name of the constituency /nnr-li+ira-yr(rr' rolj Uant o-r\A
4 Name of the political party which set up the INDIAN "NXrto.Oni_
candidate (o&erwise write'lndependent') coNlqRESS
5 Total number of pending criminal cases NIL
6 Total number of cases in which Convicted N\L
7 PAN of Year for Total income
which lasi shown
income Tax
return filed

[a) Candidate $t qPN l3?ZC f'Y'2-o23-21 5/8 5/ o88 I

[b)Spouse ^ N'N' N.N' N .4,

(c) HUF N 'N' N"A' N -A'
(c) Dependents N 'R ' N.A N -4, .

B Details of Assets and Liabilities (including offshore assets) in Rupees N t l-

Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3

I 2 3 4 5 6 7 I
Moveable Assets
A
(Total valuel rN(
31,\Llq -N.4. N'l\ N. A, N.A, N.\'
N-N' I'\ 'h
B lmmovable
Assets
Qive-.
flt.\o\,r) N"\^ N.F' N'A' '

I Purchase Price of ,t
lobnt
self ,.quilE$
N'A' N.A. N- N' N"A ' N"l\'
\i\ immovable
f iQevelopment/
l$- cbnstruction cost
i'l?'l
E\ of\' immovable N .A' N:A'
.l ,rJ*

iarl ol property after N\L N.N .

Ft,h' N.A'
,1
. {, 4't
s75f
I ,purchase (if
\ v'nr ' I '\it;' . apBlicable)
/Al

Wo\ ;V fi* I -.- Approximate lil( D',,-, o' "*t-

K-\:: Current market
price - a) self-' Q t'rtu
N'A' N .A' N"A'
acquired assets
fTotal Value) (b)
r-\'r' N.A.
inherited assets
(Total Value)
9 Liabilities rv \L N'N' N.A ' N.A, NA N'4.
p'h' N'ft' .A'
I Government
dues (Total)
Nil/ N.A' N A' N

@cW- t 2 SEP ZUt

 11

II Loarrs from Bank,

Financial
Institutions and N\L N.N, N-A N-h' NA^ N'F'
others fTotal)
10 Liabilities that
are under NIL N.N' N"h' N,A' N.A Nfi.
dispute
I Government
dues (Total)
N\L N'N ' \l"k' N.A' Nft, N-A'
II Loans from Bank,
Financial N\L N.l\ N-
h' N'f\' N+, NA-
Institutions and
others (Total)
11 Highest educational qualification: fGive details of highest School/ University education
mentioning the full form of the certificate/ diploma/ degree course, name of the
School/CollegelUniversity and the year in which the course was completed).
BclL\e\oA- ot 'cioace- I't nr Rttg\ne-&]
M-q<cro..ce- \ Rrtg\ ne-&] & fnav".oq e-rv\er\r- S\.,.tic-f -(,o.o,.^
&
ftaav".oq€-rv\er\r'
Untv *,\ V U VERIFICATION

l, the deponent, above named, do hereby veriff and declare that the contents of this
affidavit are true and correct to the best of my knowledge and belief and no part of it is false and
nothing material has been concealed therefrom. I further declare that:-

(a) there is no case of conviction or pending case alainst me-other than those rnentioned in itents
5 and 6 ofPartA and B above;

use, or my dependents do not have any asset or liability, other thatt those mentioned
B of Part A and items B, 9 and 10 of Part B above.

..this ${...$ES g...day of

Far rdabad
W*u*
w
. No. 1ti71!
should be filed latest by 3.00 PM on the last day of filing nominations.

t should be sworn before an Oath Commissioner or Magistrate of the First Class or

ry Public.
^.oE72
g
i 7
E .r^Nffi; 3. All columns should be filled up and no column to be left blank. If there is no information
iltrI:lt,
{, E q:to furnish :-in -^^-^-!
f-^--:^L ^s any
respect of :*^*
^-.. item, ^:+[.^, "Nil" ^-
either "Not applicable",
or "IU^] -^^li^-].!o" oc ]ho
as the case mrr, ]ro chnlrld hp
^.c6 may be, should be
E7 (J
c ii F,mentloneo.
=L 0
4. The Afftdavit should be either typed or written legibly and neatly
I E b",e:
9: >r
3 E 6trte: 5. Each page of the Affidavit should be signed by the deponent and the Affidavit shoulC bear
4 .En each page the stamp of the Notary or Oath Commissioner or Magistrate
'l>-
E before whom the
!+: 3-b .finiaavit is sworn.
<'.n h
ATTESTEBAS tDENiIFtED
Z
? I

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