~~/

SCHEDULE.A - GHMC ACT,1955FORM-8

NOMINATION PAPER(SeeSection 36)

as amended

Election to the MUNICIPAL CORPORATIONOFTHECITYOF KHAMMAM/2016.

1. Name of the ward 15T

2. Name of the candidate DHARAVATH RAMMURTHY

3. Father's jHusband's name DHARAVATH BHEELYA

4. Age 43 Years.

S. Address H.No:l0-06-1983L12.

BURHANPURAM1 KHAMMAM-S07 002.

6. If the candidate is a member 5T

Of the scheduled castesor

ScheduledTribes orb BackwardClasses.

7. Numberand name of the Ward 1STWARD

Electoral rolls in which the

Name ofthe candidate is included.

8. Part Number and serial number of PART .NO. 142[2661 5ERIAL.NO:41781 34th Ward.( ........

the candidate in the Ward electoral roll.

9. Name of the proposer

10. Part Number and serial Number

TEJAVATH BALU

: PART .NO. 96[106. 5ERIAL.NO:27941 1STWard

Of the proposer in the ward

Electoral roll Concerned.

11. Signature of the proposer

DECLARATION BY CANDIDATE

I hereby declare that I agree to this nomination.

N~ri U f+-Date: &!y- 0),- :.tOI <0 ~\"'..J.~G~U~NDIDATE

RETURNING OFFICER .-t{)~~4--Khammam Municipal Corporation

~~ll

~fCE~~~DSTA':tiA" 139596L.No. 22-08-00211$88

R.l. No. 2'2-08-1)0112014~.NG 2-2u9t3, Gan.dhi Chew-It,

KHAM rviRiW-0070oerie" ~ft51141a

Declaration to be obtained from the contesting candidatesRegarding Criminal Antecedents, Assets & Liabilities.

(Order No.588/SEC-F1/2011, Dt. 20-12-2011.)

For elElbtionto KHAMMAM MUNICIPAL CORPORATION (Name of the MunicipalCorporation).From. 1ST Ward (No. & Name of the Ward)

_ DHARAVATH RAMMURTHY, Son/DaughterlWife of: DHARAVATH BHEELYA

Aged: 43 Years, Resident of H.No.l0-06-1983/12, BURHANPURAM, KHAMMAM-S07

. 002. (~ention' full Postal address), a candidate at the above Election, do hereby

solemlly affirm and state on oath as under:-

(Strikiout whichever is not applicable)

1). I am a candidate set up by TELANGANA RASTRA SAMITHI (name of thepoliticil party) am Gontesti~ as-aA ~ndependentcandidate.

• •~ ·"VAS"'A·SUP\lLETI SRll'Ur B.Com.,LL.B.,

~. deAlE & NOTARY ... AD~5-189163'AIMustafaNag~~,,"No.or ..i.<4 Cel\:9399324'Lv

___ ____:_·K_HA~M'''''·'''' _ . _

(1) 8·fa~- - . - ------------

#

I

'</I (2). Details of Permanent Account Number (PAN) and status of filing ofIncome tax return:

The financial year Total income

SI.No Names PAN for which the last show in income-income-tax return tax return (inhas been filed Rupees)

Self: AMWPD5952C 2014-2015 Rs.7,16,179/-1. DHARAVATH

RAMMURTHYSpouse: ATJPD6292P 2012-2013 Rs.4,34,OOO/-

2. DHARAVATHBHARATHI

3. Dependent-1 NOTNOT APPLICABLE NOT

APPLICABLE APPLICABLE

4. Dependent-2 NOT NOT APPLICABLE NOTAPPLICABLE APPLICABLE

5. Dependent-3 NOT NOT APPLICABLE NOTAPPLICABLE APPLICABLE

(3) The following case (s) is/are pending against me in which cognizance hasbeen taken by the court:-51. offence DescriptionNo.

The details of cases where the court has(a) taken cognizance, sections of the act and -Nil-description of the offence for which

cognizance taken:

(b) Name of the Court, Case No. and Date of -Nil-order taking cognizance:Details of Appeal (s) / Application (s) for

(c) revision (if any) field against the above order -NiI-(s):

4. Cases in which I have been convicted by a court of law (other thosereferred to in Form 26):

The details of cases, section(s) of the(a) Act(s) and description of the offence (s) NIL

for which convicted

(b) Name of the Court(s), Case No. and NILdate(s) of order(s):

(c) Punishment imposed NIL

(2)

- - - - - - - - - - -----------------

,~~(bll Details of investment in NSS,". of ..I.!!.e~,,-eostal Saving, Insurance

~CJ<V I-<i"l ~~~Iicies and investment in any~ P~SUPlruI11'.rWI\,~~ncialinstruments in Posto B.COm.,t.L.O., * tI• I Advocate & Notary ::a;~ Mu,tafa Nagar, KMM. ~ ~

;to.,. G.O.M.S.No.354 ~~

• OJ:' A:P. 1/.~t-.

~5) That I give herein below the details of the assets (movable and immovableetc.) of myself, my spouse and all dependents:(t\. Details of movable assets:

Note: 1. Assets in joint name indicating the extent of joint ownership will also have tobe given.

Note: 2. In case of deposit/Investment, the details including Serial Number, Amount,date of deposit, the scheme, Name of the Bank/Institution and Branch are to begiven.

Note: 3. Value of Bonds/Share Debentures as per current market value in stockexchange in respect of listed companies and as per books in case of non -listed companies should be given.

Note: 4. Dependent here has the same meaning as assigned in Explanation (v)under section 75 A of the Representation of the People Act, 1951.

Note: 5. Details including amount is to be given separately in respect of eachinvestment

Spouse: DepeDHARAVATH Depen ndent

dent-IRAMMURTHY BHARATHI -2

Self:DHARAVATHSI.No Description

(i) Cash in hand Rs.15,000/- Rs. 5,000/- -NA- -NA-I--:-::::---t--:~:-:-:-----:----:------::--:---=----:-+-;-:-=:-:-:-:-::::-:-::-=-+-:-:--::.-::-:=-=::---;---t-:-:-:---t-::--:-:---_J(ii) Details of deposit in Bank 1).SBH,M.S.M.E 1). DCB Bank, -NA- -NA- I

accounts (FDRs, Term Branch,Nc. PeddathandaDeposits and all other types of No.00000258689. Branch,Kmm.deposits including saving Balance Alc.No:0152.accounts), Deposits with 2R)S'C1,36,401°B/- k Rs.3,00,000/-Financial Institutions, Non- . entra anof India,Banking Financial Companies Khammamand Cooperative societies and Branch,Nc.the amount in each such NO.6119.deposit Balance

Rs.5,0001-3).IOBBank,Nc.No:2502,NayudupetaBranch.Balance:Rs.5,0001-

(iii) Details of investment in Bonds,debentures/shares and units incompanies/Mutual funds andothers and the amount

-NA-NIL NIL -NA-

1). L1CPolicy.No:689509321.Rs.1,60,0001-2).L1CPolicy

(3)

NIL NIL NIL

~ office or Insurance Company No:688200512.and the amount Rs.67,500/-

f(V) Personal loans/advance given NIL NIL -NA- -NA-to any person or entity includingfirm, company, Trust etc., andother receivables from debtorsand the amount

(vi) Motor Vehicles/ Manufacturer: 1).Honda -NA- -NA-Aircrafts/Yachts/Ships (Details 1).Fortuner Car Activaof Make, registration number AP20TV3338, AP20EE9052etc. year of purchase and Model:2013. Rs.65,OOO/-amount) Rs.25,OO,OOO/-

2).JCBAP20TV3884.Model:2012.Rs.20,OO,OOO/-3).Tractor:AP20T2258Rs.4,OO,OOO/-

(vii) Jewellery, bullion and valuable 30 Grams Gold 50 Grams -NA- -NA- 'thing(s) (give details of weight Value of Gold Value ofand value) Rs.75,000/- Rs.1,25,000/-

(viii) Any other assets such as value NIL NIL -NA- -NA-of claims/interest

(ix) Gross Total Value Rs. 53,63,9001- Rs.4,95,000 1- -NA- -NA-

B. Details of Immovable Assets:

Note: 1 Properties in Joint ownership including the extent of joint ownership will alsohave to be indicated.Note: 2. each land or building or apartment should be mentioned separately in thisformat

Depe DepeSI.No Description Self: Spouse: ndent ndent

-I -2(i) Agricultural Land: Peddathanda, Arempula: NIL NIL

Location(s) Sy.No:167/A and Sy.No:117.Survey number(s} 168.Area (total measurement in 2 Acras Inherited 2 Acras 36 NIL NILacres) 4 Acras Self guntas

AquiredWhether inherited property YES YES NIL NIL(yes or no)Date of purchase in case of 1998. NIL NIL NILself-acquired propertyCost of Land (in case of Rs.8,OO,OOO/- NIL NIL NILpurchase) at the time of

_.__. purchase,,""@'¥ii~~ investment on the land NIL NIL NIL NILv~ ~~ ~i\: way of development,PASU~~~IlLIIIVII~~ll struction etc.

B.Corn.,lLB., * i~ (4)

g.~~Advocate & Notary I~•Mustafa Nagar, KM-M. ~ .

~ G.O.M.S.No.354 ~~. _ .... ~o~".p:.!j!JI:::.....~ _

..._ Approximate current market Rs.60,00,000/- Rs.3,00,0001- NIL NILvalue

({ii) Non-Agricultural Land: C/o: Peddathanda, NIL NIL NILLocation(s) Khammam.Survey Number(s) Sy.No:190/E1,1901

E2, 190E3 and190/E1, 190/E2, 19OE3,190, 184, 169.

Area (total measurement in 1083 Sqyds NIL NIL NILacres)Whether inherited property NO No NIL NIL(yes or no)Date of purchase in case of 2012-2015 NIL NIL NILself-acquired propertyCost of Land (in case of Rs.8,00,0001- NIL NIL NILpurchase) at the time ofpurchaseAny investment on the land NIL NIL NIL NILby way of development,construction etc.Approximate current market Rs. 10,83,000/- NIL NIL NILvalue

(iii) Commercial Buildings: NIL NIL NIL NIL{Including AQartments}Location(s)Survey Number(s)Area (total measurement in NIL NIL NIL NILsq.ft)Built-up Area (total NIL NIL NIL NILmeasurement in sq.ft)Whether inherited property NIL NIL NIL NIL(yes or no)Date of purchase in case of NIL NIL NIL NILself-acquired propertyCost of property (in case of NIL NIL NIL NILpurchase) at the time ofpurchaseAny investment on the NIL NIL NIL NILproperty by way ofdevelopment, constructionetc.Approximate current market NIL NIL NIL NILvalue

(iv) Residential Buildings: 1).H.No:5- 1).H.No:5- NIL NIL(Including apartments) 103(G+2), 109, Pedda-Location(s) Peddathanda, thanda

" " Survey Number(s) Khammam.. )r...L'l' Ii~a (total measurement in 260 Sfts 340 Sfts NIL NILrjj;'}! ~ c . ~5"X::U~ ...~"~":..l: Area (total 2000 Sqfts 3500 Sqfts NIL NIL

..J* I B.Co", ii.:A. ~w ement in sq.ft)e Ad ."~".~ ~ 'V'~'.! I~.

f}~o Mustafa Nagar, KMM. ~ (5):to;. O.O.M.S.No.354 ~~. 0", - ",!.\.\?-.A.p.-

~ Whether inherited property YES YES NIL NIL(yes or no)

( Date of purchase in case of NIL NIL NIL NILself-acquired propertyCost of property (in case of NIL NIL NIL NILpurchase) at the time ofpurchaseAny investment on the Rs.30,00,000/- Rs.10,00,000/- NIL NILproperty by way ofdevelopment, constructionetc.Approximate current market Rs.40,00,000/- Rs.12,00,000/- NIL NILvalue

(v) Others (such as interest in NIL NIL NIL NILproperty)

(vi) Total of current market value Rs.1,10,83,000/- Rs.15,00,000/- NIL NILof (i) to (v) above

(6) 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 individualand amount before each item)

51.No. Description Dependent-2Self:

(i) Loan or dues toBank/financial institutions (s)Name of the Bank orfinancial institution, amountoutstanding, Nature of Loan

1).Turm Loan:lOB Bank,Nayudupeta Br.Khammam.Rs.15,33,441/-2)Car Loan:Central Bank,Rs.16,40,707/-3).JCB Loan:lOB Bank,Khammam.Rs.4,81,762/-4).Housing Loan:H.No:5-103,Rs.9,22,0801-

Spouse: Dependent-I

NIL

Loan or dues to any otherindividual lentity other thanmentioned above Name(s),Amount outstanding, natureof loan

NIL NIL

NIL NIL NIL

-oi" Jii;;'7y" ~-&nyother liabilityifA'vv c~ "",r~nd total of liabilities.f p~~u~~~SY"' ..No I B com.,lL.B., J*.. 1 Ad'loc~te sNotary ~e tAu!otataMagar, I{MM. SO~ G.O.M.S.No.354 $:.)t 'l':.0];'- ~~A.P.

NIL NILRS.45,77,990/- NIL

NIL

NIL

(6)

NIL

'" (ii) Government dues: NIL NIL NIL NILDue to department dealing

( with governmentaccommodationDues to department dealing NIL NIL NIL NILwith supply of water

Dues to department dealing NIL NIL NIL NILwith supply of electricityDues to department dealing NIL NIL NIL NILwith supply oftelephones/mobilesDues to department dealing NIL NIL NIL NILwith government transport(including aircrafts andhelicopters)Income tax dues NIL NIL NIL NIL

NIL NIL NIL NILWealth tax dues

Service tax dues NIL NIL NIL NIL

Municipal/Property Tax dues NIL NIL NIL NIL

Sales Tax dues NIL NIL NIL NIL

Any other dues NIL NIL NIL NIL

(iii) Grand Total of all NIL NIL NIL NILGovernment dues

(iv) Whether any other liabilities NIL NIL NIL NILare in dispute, if so, mentionthe amount involved and theauthority before which it ispending.

(7) Details of profession or occupation:

(a) Self

(b) Spouse

DHARAVATH RAMMURTHY

DHARAVATH BHARATHI

BUSSINESS

HOUSEWIFE

(8) My Educational qualification is as under:-

B.A, 2010, ACHARTYA NAGARJUNA UNIVERSITY, GUNTUR.

PART-B!

(9) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A:

3

NIL

Sri.lSmt./Kum : DHARAVATHRAMMURTHY

1 Name of the candidate

H.No.10-06-1983/12,BURHANPURAM, Khammam,Khammam District,Telangana State, Pin - 507002.

Number and name of the constituencyand State

2 Full Postal address

112 - KhammamAssembly, &Telangana State.

Name of the Political Party which set upthe candidate (otherwise write"Independent")

4TELANGANA RASTRA SAMITHI

(a) Total number of pending cases wherecharges have been framed by the Courtfor offences punishable withimprisonment for two years or more

5

.(b) Total number of pending caseswhere the court(s) have takencognizance [other than the casesmentioned in item (i) above]

NIL

NIL

6 PAN of Year forwhich lastincome taxreturn filed

Total incomeshown

(a) Candidate AMWPD5952C 2014-2015 Rs.7,16,179/-

(b) Spouse('c) Dependents

ATJPD6292P 2012-2013 Rs.4,34,000/-NILNIL

7. Details of Assets and Liabilities in Rupees

Description

Rs. 53,63,900/-

SpouseRs.4,95,000 1- NIL NIL

Self Depende Dependnt-I ent-2

A. Movable Assets (Total Value)

B. Immovable Asset

I. Purchase Price of self­acquired immovableproperty

II Approximate Currentmarket price of Asset(Total Value)

Rs.16,00,000/- NIL NIL NIL

Rs.1,10,83,OOO/- Rs.15,OO,OOO/- NIL NIL

NILNILRs.45,77,990/- NIL

(8) f)~

NILNIL

NILNIL

r',-<- others (Total) 1 j I J9. ~ Highest educational qualification:

B.A, 2010, ACHARTYA NAGARJUNA UNIVERSITY, GUNTUR.

(Give details of highest School/University education mentioning the full form ofthe certificate/diploma/degree course, name of the School/Collage/Universityand the year in which the course was completed.)

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of thisaffidavit are true and correct to the best of my knowledge and belief and no part of itis false and nothing material has been concealed therefrom. I further declare that-

(a) There is no case of conviction or pending case against me other thanthose mentioned in items 3 and 4 above: (b). I, my spouse, or mydependents do not have any asset or liability, other than those mentionedin items 5 and 6 above.

Verified at \~-!:.~:??~~~ this the 0:~.'~ day of 2016.

f)~"'~ENT

Attestation: The Deponent Sworn before me on oath by admitting the above contentsas true and correct and signed before me.

Hence, attested at Khammam on this ~paYI Feb 12016.

(9) ~