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FORM 26(See rule 4A)

Affidavit to be filed by the candidate along with nomination paper before the retumingofficer for election to Member of kgisletive Asse mbly ( name of the House) fromWarangal East-I06 constituency (Name of the constituency)

I, ALAKAPELLI KISHORE, Son of SURENDER, Aged 41 years, resident ofH.No. 11-3G501, Thummalakunta, Kothawada, Warangal Urban Dist (mention full postaladdress), a candidate at the above election, do hereby solemnly affirm and state on oathas under :-

(l) I am a candidate set up by SAMAJWADI PARTY (+* name of the political party)

(2) My name is enrolled in Warangal Eest (Name of the constituency and the State), atSerial No 766 in Part No 4.

(3) My contact telephone number (s) iVare 996f,559724 and my e-mail id (if any) isankinenikishorTS@gmail.com

(4) Details of Permanent Account Number (PAN) and status of filing of lncome Tax retum

(s) r m not accused of any offence (s) punishable with imprisonment for two years or(s) has /have been framed by the court(s) of

If the shall furnish the following information :-

o NR

4*

b.*

Ir

st.No.

Names PAN The financial yearfor which the lastIncome-tax retumhas been filed

Total incomeshown In IncomeTax return ( inRupees)

AfB PA 6(rg' K NIL NoT AlDt ,lAt tFI Self2 Spouse

^1, L A/,L NDT APa tt^A, r

alll N fJl APZ traRl F3 Dependent -l l\J 11Dependent -2 N,I- ,\lr L- N 6t- ASot t t^rt F

tlor e* r?AAtr.5 Dependent -3 NIt-^1,

tL-

z.&O

AL

:o(Contd...2)

'IIGI*&INDIA

1 263I d()orrlE171197 IoY 11 2018rlrrr)-rmhtn 17:30R"0000020 pasgl

I

PART-A

4.

*3

(2)(D The following case (s) iVare pending against me in which charges have been framed bythe court for an offence ishable with im t for two or more :-

(ii)

(6) r

The following case(s) iVare pending against me in which cogtizance has been taken bythe court [other than the cases mentioned in item (i) above] :- |i/6T kfPL I LAI9LE

I.

ve not been convicted ofan offence (s) [other than any offence(s) referredto in sub-section (l) or sub-section(2) or covered in sub-section (3), of section 8 of theRepresentation ofthe People Act, l95l (a3 of 1951)l and sentenced to imprisonment forone year or more.If the deponent is cornricted and punished as aforesaid, he shall fumish the followinginformation;In the following casies, I have been convicted and sentenced to imprisonment by a courtof law :

That I give herein below the details of the assets (movable and immovable etc.) ofmyself , my spouse and all dependents :

Details of movable assets :ote : l. Assets in Joint name indicating the extent ofjoint ownership will also have to

o+

ote : 2. In case of deposit/Investment, the details including Serial Number, Amounldate of deposit, the scheme. Name of the Bank/Institution and Branch are to be given.

(Contd..3)

v--l tqlfl3

Ntt-a( ) Case/First Information Report No/Nos

together with complete details ofconcemed Police Stations/Disrict/State.

NDr tPPU:ABLE(b) Sections(s) ofthe concerned Act(s) and

short description of the offence(s) forwhich charged

NaT 4PPq1ABLEc( ) Name of the Court, Case No. and date of

order taking cognizance :Alor *PP/ l.^BIE(d) Court(s) which framed the charge(s)Nor *ppuclBLE

I\ldr hn>UcnatEWhether all or any of the proceedings(s)have been stayed by any Court(s) olcompetent jurisdiction

Nor A\\L(.ABLEa( ) Name of the Court, Case No. and date of

order taking cogrrizance :

NOT IPPLJC^tsLg(b) The details of cases where the court has

taken cognizance, section(s) of the Act(s)and description ofthe offence(s) for whichcognizance taken

Nq nePrtoqBlEDetails of Appeal(s) Applications(s) forrevision (if any) filed against the above.ord.e(s)

(c)

(a) The details of cases, Section(s) of theconcerned Ac(s) and description of theoffence(s) for which convicted

I.laT *?pLtc*tsLE

(b) Name of the Court(s), Case No. anddate(s) oforde(s) NbT 'TPPIIEABLE

(c) Punishment imposed *.lor *pPLt?tsNEWhether any appeal was/has been filedagainst the conviction order. If so, detailsand the present status of the a

Nor n-PPttcABLL*

.l3d. ih. li

)i.tcei

8s.,u.8.NOIABY FOB

^lU

Date(s) on which the charge(s) waVwereframed

(e)

(r)

(d)

t3tNote : 3. Value of BondVShare Debentures as per current market value in stockexchange in respect of listed companies and as per books in case ofnon-listedcompanies should be given.Note : 4. Dependent here the same meaning as assigned in Explanation (V) undersection 75A of the Representation of the People Act, I 95 I .Note : 5. Details including amount is to be given separately in respect of eachinvestment

1

$[oz.

4

Self Spouse Dependent-I

Dependent1

Dependent-J

sl.No.

Description

NIL Nn_ tJt4i*fDuawCasl in hand fDum/. - Altt-(i)

NoT AWUI^gLfiltu Ntr- Ntatl tt-

(ii) Details of deposit in Bankaccounts (FDRS, TermDeposits and all other typesof deposits includingsaving accounts), Depositswith Financiallnstitutions,Non- Banking FinancialCompanies andCooperative societies andthe amount in each suchdeposit

IorA?PUIABLENIL NIL- Nlc-l.llL

(iii) Details of investment inBonds, debentures/shareCand units incompanies/Mutual fundsand others and the amount

AlltL iorftrruc*vt'eArrL [ltL-rl]d--

(iv) Details of investment inNSS, Postal SavingInsurance policies andinvestment in anyFinancial instruments inPost olfice or lnsuranceCompany and the amount

NorAPPttu

NDT*wog

NIL

Ntt-

dlu

Ntt-

NIL

bNhlFL*zgbDg

ApsbNI

al Ps 6r/4s1

NI

20 t+kAA

Personal loans/ advgrven to any person orentity including ficompany, Trust etc.,other receivables fro

achts/Ships (Details ofMake, registration numberetc. year of purchase andamount)

(v)

and the amounttI

ehicles/ Aircrafts/

AlafAPpucaeteA.J ta- Ntt-Ntt-

3tulallopa1-

Jewellery, bullion andvaluable thing (s) (givedetails of weight and value)

NoTAPPU(NMc-Any other assets such asvalue of claimVinterest

(viii)

Il]|]T APPLUIBI)Ntt_ r.it c-3o,mr,l Yrn.mr/IX Gross Total Value(Cortd,.4)

4N

h^-1 lrlas

VETA

(vii)

NIL il tt-AltL

(4)Details of Immovable Assets :

Note : l. Properties in joint ownership indicating the extent ofjoint ownership will alsohave to be indicatedNote : 2. Each land or building or apartment should he mentioned separately in thisformat

(Contd..5)

h^r

S

NoDescription Self Spous : Dependent-

IDependent-2

Dependent-J

Agricultural LandLocation(s) Survey numbe(s) rrl tc- l,.ltL t.ltc- rlor*PPl t /t}.P, FArea (total measurement iracres) I LN Nr-l. NJL ruot Sgp/rea

Nt)te?t"c,/l,^propertyWhether inherited

(Yes or No) N\\. Ntl IN NTLDate of purchase in case ofself-acquired property NJL N'L Nu- Nl\ryl,td'Cost of Land (in case ofpurchase) at the time ofpurchase

Nfl lv1l- ovil ,- t.WWJr"r+

N!1. NTL N!L Pot \141vAny investrnent on the landby lvay of development.construction etc.

(i)

Appoximate current marketvalue r+tl Nit Nrl fVJT MTAPflt+

NIL AllL N tt-- Ailt--^ff

A*-r(Non-Agricultural LandLocation(s)Survey number(s)

NfL NJT NJ.t- M{ Abf flB6/,Area (total measuement insq. ft.)NrL. ll6t ft?4t r4l

Whether inherited property(Yes or No) N'L lrrl- N.TL

$lL Ml-l- ML NJil- . (ttrea^Date of purchase in case ofself-acquired property

r\t L.^Dt

&fluc{

(ii)

Cost of Land (in case ofpurchase) at the time ofpurchase

NlL NTL

AGA

Hi l(arhrl

g$., tLB.NOTARY FOFI

il tr-NI-l-

Nl.l

Nrl .

N\l-

ML

1Af43

t5t

(iii) Commercial Buildings(includine aDartrnents) fl.fte ltL ttte tltr- *rt"*Location(s)Survev number{s) d'L NtL N tt- NIL-' f#r.t'

(iv)

Area (total measurement insq.ft.)Built up area (totalmeasurement in sq. ft.) Ntt- TUL Nt. Ntt-

t

tl,ft'

l-TLW

Whether inherited property(Yes or No)

^l lL NIL Nlt- AllL M'bt.

Date of purchase in case ofself-acquired property NIL Ntu N tt- #,[,*Cost of property (in case ofpurchase) at the time of t*/ t t- NIL Ntr Ntt- M'*purchase

Any investment on the rllL filtL t llr- ,\llL *t**Foperty bydevelopmen!etc.

way ofconstruction MtL ll/L Nlt- Ntt- W**

Approximate current marketvalue

Residential Buildings( includine aDarftnents)

Ntt--tt-*tta'"frt A,.-trL Al,t-

Ll, l-Lt^fu,r7

-Location(s)-Srrrvev numherfs) Nt t--

llrJorI p 9o-5D I AllL N lt-- *,rt.;t'

(v)

(vi)

Area (total measurement insq.ft.)Built up area (totalmeasurement in sq. ft.)

NIL-8E,e

s?-e Nu- Nlr_

-t,UoP

@d-Whether inherited property(Yes or No) NIL Ye) NIL Ntt- fifo,t,u"Date of purchase in case ofsel f-acquircd property NIL. l,:,1,w Nlu N/L *tauCost of property (in case ofpurchase) al the time of NIL #,"u t- Ntt-- t..l lt- *f,*-purchase

Any investment on the land ltrtr_^{

lL- AllL- *{*^aby way of development,construction etc.Approximate current market

Nlt- f.lrL N tt-- NIL W*ovalue

Others (such as interest inproperty)

t ltt-- 6lolta NtL N/t- ffj,,"uTotal of current market valueof (i) to (v) above tht- 6lat44 NIL- Ntc- l{h,"*u'

1

'a,,rA0

,, n (Contd..6)fl

a-^4

.? .,1I1 G

N la-

r..lrc

(j)'2.

ef as

(6)

(8) I give herein below the details of liabilities/dues to public financial institutions andgovernment :-(Note : please give separate details of name of bank, institution, entity or individual andamount before each item

No k-

1 ). I(Contd..7)

f

tt

,.)

at'iA,Y

Dependent-J

Self Spouse Dependent-I

Dependent-2

S

No.Description

gnU"*l.c-N'L NLI- f\rj.l-

Loan or dues toBank/fi nancial institution(s)Name of the Bank or financialinstitution, Amountoutstanding, Nature of Loan

Mrr- trr!- NT-l. r\rJLlvo h

AW\,Lf'l

Loan or dues to any otherindividuals/entity otherthan mentioned aboveName(s), Amountoutstanding, nature of loan

Ndt- $kaeculAny other liabiliW Nll. \ji! rrrl CN.,L uAltPLle'h

(D

Grand total of liabilities N'L Nlr-

^dLNJL

lrrDt-bedutlt-

Govemment dues : Dues todepartments dealing withgovemmentaccommodation

N!L trdL

N'L NJL nrju @ tPn'aDues to department dealingwith supply of waterMJl- nrotqre\olDues to department dealing

with supply of electricity uL NJL t t-rL

N,L ML NJI .I

,\rO fWthhu

Dues to department dealingwith supply oltelephones/mobiles

NJL-Dues to department dealingwith government hansport(including aircrafts andhelicopters)

i4L

NIL Nr)- NIL ArtLNr'1, N'L NEt &PLchWealth tax dues NI\ ^liL|..1U \d]. NJL NrIt- N6bftPfl;@iService tax dues

,\riDl-4^d,l€

TaxMunicipal/Propertydues FrlL N]fL M'L

N.Ft\- ML MILNiLNiL r/,FA?PTUI

(ii)

Any other dues l"ll\^}lL

t'N) (-

}tJll- tdL NJL ArJ,t_AIJ K'

A"tl'ehzt(iii) of allGrand total

Govemment dues

t\rrL ,vlL(iv) Whether any other

liabilities are in dispute, ifso, mention the amounlinvolved and the authoritybefore which it is pending.

f5]-

'tv W^4

nf as

N-tLNrt

I\fJL

MU

FirL

t& fuJLAorMftolartIncome tax dues

MLSales Tax dues

,.t L

(7)

(9) Details of profession or occupation :(a) Self ... ..kLf .. fiLtlPYse(b) Spouse ... .da w€ .. 0l t FE(10) My educational qualification is as under-i'.

.' bAA-!"t ;f . R.!^{f (b"u-) c-z''-?\L)-€-aih'}hrrulL.B.csUz*e . karcalnyg Ur^ivu"tt^l .

(Give details of highest School/University education mentioninB the full form of the

certificate/diploma/degree course, name of the Schoo/College/University and the year in

which the course was completed,)

PART-B(I I) ABSTRACT OF THE DETAILS GIVEN IN (I) TO (IO) OT PART-A :

(Contd..8)

o

\ .s.

Name of the candidate Sh.iSmt.,4(um.4 l&

(8)

VERIFICATION

I, the deponent above named do herty verifu and declare that the contents ofthis affidavit are tnre andcorrect to the best ofmy knowledge and beliefand no part of it is false and nothing material has beenconcealed there from. I further declare that:-

(a) there to no case of conviction or pending case against me other than those mentioned in items 5and 6 ofPartAandB above;

(b) I,my spouse, or my dependents do not have any asset or liability, other thau those mentionedin items 7 and 8 of part A and items 8, 9 and l0 of Part B above.

verified at\r+r,^-cr^.^-\s. -a:+. D mt Ur" \.k C.\d"y"f rEI. s?DEPONENT

T.s

NS

vt cn.fri#

B.Sc., LL.B.Advocale l,;t..,. f

FOR HJqNAfuI(CI{DA & KAzlPETWARANGAL D|ST. T.S. INDIA

N

II DevelopmenVconstruction cost ofimmovablepropertyafter purchase (ifapplicable)

l\r"tL NIJL N!L Mj-4?ld/11-

Approximate Currentmarket price of - NJL .r,!t NJL Ntl- Ntr,hofift)rl(a) self-acquired assets(Total Value) t'Jtf-, ML N9L Nrr- ffi^-'",.

Nsr- 61"Iil' NI.\- N3L-N$Y

Liabilities(D Govemment dues

(Total) N i\ N& N}'L ^EL$wMa

lt( ) LoansfromBank,Financial Institutionsand other (Total)

NTT- NlL N!, MLLiabilities t4at are under dispute

(i) Govemment dues(Total) L}.}l N[n- ,\,,L AAL \rqraft,ti/

10

(ii) LoansfromBank,Financial Institutionsand others (Total)

NTI- N,L Nri- Mlll Hiehest educational oualifi cation :D GrLl_r_( o y o { A ntnnt cx_..CA.ar)ix+-cor^ u+a ik+r{ }4^/ "%6-rnVZ u".v@:;i_.eurI-':'"=

(Cive details of highest SchooWniversity education meniioning the full form of thecertificatey'diploma/degree coLuse, name of the SchooVCollegeAJniversity and the year inwhich the course was completed.)

H

.ic, r'' B

lri 11,1i91

rYi[11

AG;\t

SOlennlV alliry-., --C ainn-_.i belore nE,t ftA..-.-....i..q.-oav cr--..-.L4-.'5 r SOit rryarangal

-

rtfat

ADV-

u.

(b) inherited assets(Total Value)

9.

1,.-tDfi"*P-

Note : 1 . Affidavit should be filed latest by 3.00 PM on the last day of filling nominations.Note : 2. Afiidavit should be swom before an Oath Commissioner or Magistrate of theFirst Class or before a Notary

Public.Note : 3. All column should be filled up and no column to be left blank. if there is noinformation to fumish in respect

of any item, either "Nil" or "Not applicable". as the case may be, should bementioned,

Note : 4. The AIfidavit should be either typed or written legibly and neatly. "

Note : The Principal rules were published vide notification number S.O.859. dated the 15 thApril, 196l and last amended vide notifications-

( I ) Number S.O. 72S(E), dated the 8s Iv{ay, 2007.(2) Number S.O. 425(E), dated the 23u February, 2011.

Note 5: In pursuance of the Judgment dated 13.09.2013 of the Hontrble Supreme Court inWP(C) No.(2) of 2008-Resurgence lndia VS Election Commission of India and and other,regarding the filing of incomplete affidavit of candidates, the candidates are required to fill upall columns therein. No. column can be left blank At the time of frling of affidavit, RO has tocheck whether all columns ofthe affidavit filed with the nomination paper are filled up. If not,the RO shall give a reminder 1o the candidate to fumish information against blank columns. TheHonlble court has held that if there is no information to be furnished against any item,appropriat€ remarks such as ,J.,lil" or "Not" ApplicableU or "Not knownll as may be applicableshall be indicated in such column. They should not leave any column blank ifa candidate failsto fill the blanks even after reminder the nomination paper will be liable to be rejected by theRO at the time of scrutiny of nomination papers.

Note 6: ln para 3 of the afiidavit, the infomration should be fumished as follows:-

"My &ntact telephone no. (S) iVare .L1 (.€. f.5.1.7 2.+

my e-mail id (if any) is . . . . . .

and my social media accounts (if any) are .....N.\L....

b-^.'-4

tulu*