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State: ………………………………….. Lok Sabha Applied for…………………….………….. Form-A

LOK SABHA CANDIDATE DETAILS

(PERSONAL INFORMATION)

Name: ----------------------------------------------------------------------------------------------------------------

Gender: -------------------------------- D.O.B.: --- ------------------------------

Phone (Mobile): --------------------------------------------------------------------

Phone (Landline): ----------------------------------------------------------------

Photo

E-mail: ……………………………………………………………………………

Education Qualification: ……………………………………………………… Year: …………………………………………………………..

If Student then College Name: --------------------------------------------------------------------------------------------------- Address: ------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- Whether you belong to any special category ………………SC …………………………… ST ………………… OBC ……………

Details in electoral roll: S.no. …………………………………………………In part no.…………………………………………………… Vidhan Sabha ………………………………………………………...Lok Sabha…………………………………………………………………...

Note: Where ever the word used ‘Family,’ It means Parents, spouse (Husband or Wife) and Children (If unmarried, then family means Parents only.)

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1. Your activity towards Janlokpal, Any other Andolan and Social Service etc. (Please give details on separate sheet and enclosed with this form)

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2. Details of Family members:

S.no Name Relation Age Gender Occupation

3. Have you or your family member ever been convicted for any offence or any Case/FIR’s pending. If yes please give the detail below& enclosed detail report along with this form.

S.no. Name of the Person Case No.

Detail of Section Detail of Case

In which year case has been started

Present Situation

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4. Do you or any of your family member are part of any political party. If yes then mention.

S.no. Name of the Person

Party Name Post From Up to

5. Have you or any of your family members ever contested in any election? If yes. Please Mention Below.

S.no. Name Contested Election

Year Party Name

How much Votes you got

How much money you spent

Result

6. Are you or any of your family members a part of any social/revolutionary organization if yes. Please

mention below.

S.no. Name Name of organization

Post From Upto Main activities of organization

Your Role

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7. Source of Income (About self and family members).

S. No. Name Average yearly income Source of income

8. Detail of property (About self and family members).

S.No. Name of property owner

Details of property

When purchased

Value at the time of purchase

Current market value

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9. Why do you want to contest the election? ---------------------------------------------------------------------------------------------------------------------------------------------

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10. Why should you be selected as candidate over other applicants?

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11. If you have not been selected as candidate. What will you do?

Contest as independent candidate.

Try to get ticket from some other party.

Other (Please give details)………………………………………………………………………………. …………………………………………………………………………………………………………….....………………….

12. Why do you think that you will win the election?

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13. For decentralization of power, have you read the SWARAJ book? What is your opinion about that?

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14. What strategies would you adopt to win the election? And how much expenses would be required?

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15. Do you have a team apart from party volunteers? How many team members/volunteers you have in each Vidhan Sabha?

Vidhan Sabha No. of members/volunteers

(List of members/volunteers with name and phone numbers has to be provided)

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AFFIDAVIT

(To be submitted on Rs.10 Stamp Paper)

Date: …………….

I………………………………………….son/daughter/wife of ……………………………………………………

Resident of ……………………………………………………………..……………………….…………………………………………..

I take an oath to contest the election from Aam Aadmi Party for

Lok Sabha ……………………………………………………………………………………………………………………………………..

I will follow the under given points after winning the election:

1. I will not take Red Beacon Car.

2. I’ll not take any unnecessary security. Security should be dedicated for Aam Aadmi & not for

their chosen candidate. Leader should not take any security more than awaited to Aam

Aadmi.

3. I’ll not take any big bungalow & shall live like any other member of the society.

4. I agree with the concept of Swaraj & that governance should be directly in the hands of public

& not in their chosen representatives. I’ll give my full efforts to bring such a law but till time

such law is not passed, all the work in local area shall be done in consultation with the local

public.

5. I’m committed towards Janlokpal bill & Electoral reforms. I’ll put my full efforts to bring such

law/s at the earliest.

6. Govt. should not acquire any land without the permission of public. I’ll put my full efforts to

bring such law/s at the earliest.

7. I have gone through the ideology & principals of Aam Aadmi Party and have also understood

the same & fully believe in it. I have also read the candidate selection process & fully agree

with the same.

I above name deponent do hereby confirm the above contents are true and correct to the best of

my knowledge & belief & that nothing has been concealed.

Deponent

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List of 100 Proposing Voters from EACH VIDHAN SABHA of respective Lok Sabha

(E.g. if there are 8 Assembly Constituencies in a Lok Sabha then 800 proposing voters are mandatory)

We undersigned are the resident and voters of …………………………………… Vidhan Sabha and we

proposed the name of ……………………………………………………………………………………………………………. as

the candidate of Aam Aadmi Party from ………………………………………………………………….Lok Sabha.

S.No. Name Complete Address Vidhan Sabha Part No. & S.No. in Voter list

Phone No.

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100 Note: - Your application shall be deemed rejected for giving wrong and incomplete information of the proposer’s.