Download Nomination paper for Lok Sabha Election

Conduct of Election Rules, 1961 (Statutory Rules and Order) FORM-2A (SEE RULE 4) NOMINATION PAPER Election to the House of the People............................................................................................... STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PART I (To be used by candidate set up by recognised political party) I nominate as a candidate for election to the House of the People from the .................................... .............................................................. ........................... Parliamentary constituency. Candidate's name .................................................................................................... father's/mother's/ Husband's name .................................................... His postal address .................................................................................................................................................................... His names is entered at S. No. ....................... in Part No. .................... of the electoral roll for ............................................................................... *(Assembly constituency comprised within) ................ .......................................................... Parliamentary constituency. My name is .......................................................................... and it is entered at S.No................... in Part No. ...................of the Electoral Rolls for ........................................................................................... *[Assembly constituency comprised within] ....................................................... Parliamentary constituency. Date ..................................... (Signature of proposer) PART II (To be used by candidate NOT set up by recognised political party) We hereby nominate as candidate for election to the House of the People from the............................ ......................................................... Parliamentary Constituency. Candidate's name ............................................................................................... .............. ............. Father's/mother's/husband's name........................................... ...................................................... His postal address............................................................................... .............. ................................ His name is entered at S.No..................... in Part No..................................of the electoral roll for ..............................................*(Assembly constituency comprised within) .......................... ...... ............................ Parliamentary constituency. We declare that we are electors of the above parliamentary constituency and our names are entered in the electoral roll for the Parliamentary Constituency as indicated below and we append our signatures below in token of subscribing to this nomination:- Particulars of the proposers and their signatures Sl. No. Electoral Roll No. of proposer Name of component assembly Constituency Part No. of Electoral Roll S.No. in that part Full name Signature date 1 2 3 4 5 6 7 1 2 3 4 5 6 7 8 9 10 N.B.: There should be ten electors of the constituency as proposers. Conduct of Election Rules, 1961 (Statutory Rules and Order) PART III I, the candidate mentioned in Part I/Part II (Strike out which is not applicable) assent to this nomination and hereby declare:- (a) that I have completed...............................years of age [STRIKE OUT b(i) or b(ii) BELOW WHICHEVER IS NOT APPLICABLE] (b) (i) that I am set up at this election by the.............................................................................................. ...............party, which is recognised National Party/State Party in this State and that the symbol reserved for the above party be allotted to me. OR (ii) that I am set up at this election by the...................................................... ............... party, which is a registered unrecognized political party/that I am contesting this election as an independent candidate. (Strike out which is not applicable) and that the symbols I have chosen, in order of preference, are:- (i)........................................ (ii)........................................... (iii).................................... (c) that my name and my father's/mother's/husband's name have been correctly spelt out above in.............................. (name of the language); (d) that to the best of my knowledge and belief, I am qualified and not also disqualified for being chosen to fill the seat in the House of the People. + I further declare that I am a member of the.......................................... ** Caste/tribe which is a scheduled ** caste/tribe of the State of.................in relation to..................(area) in that State. I also declare that I have not been, and shall not be nominated as a candidate at the present **general election/the bye-elections being held simultaneously, to the House of the People from more than two Parliamentary Constituencies. Date ..................................... Signature of the Candidate * Score out the words "assembly constituency comprised within" in the case of Jammu and Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu and Lakshadweep. + Score out this paragraph, if not applicable. ** Score out the words not applicable. @ Not applicable in the case of Jammu and Kashmir, Andaman and Nicobar Island, Chandigarh,Dadra and Nagar Haveli, Daman and Diu and Lakshadweep. N.B.: A "recognised political party" means a political party recognised by the Election Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State concerned. Conduct of Election Rules, 1961 (Statutory Rules and Order) PART III A (To be filled by the candidate) Whether the Candidate - (i) has been convicted - (a) of any offence(s) under sub-section (1); or YES/NO (b) for contravention of any law specified in Sub-Section (2), of Section 8 of the Representation of the People Act, 1951 (43 of 1951); or (ii) has been convicted for any other offence(s) for which he has been sentenced to imprisonment for two years or more. If the answer is "Yes", the candidate shall furnish the following information: (i) Case/First information report No./Nos. .................. (ii) Police station (s) ............District(s) ..........State(s) ............ (iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which he has been convicted ................... (iv) Date(s) of conviction(s) ................... (v) Court(s) which convicted the candidate ................... (vi) Punishment(s) imposed [indicate period of imprisonment(s) and/or quantum of find(s)] ................... (vii) Date(s) of release from prison ................... (viii) Was/were any appeal(s)/revision(s) filed against above conviction(s) Yes/No (ix) Date and particulars of appeal(s)/application(s) for revision filed ......... (x) Name of the court(s) before which the appeal(s) /application (s) for revision filed . ......... .............................. (xi) Whether the said appeal(s) / application (s) for revision has/have been disposed of or is/are pending .............................. (xii) If the said appeal(s)/application(s) for revision has/have been disposed of - (a) Date(s) of disposal... ................... (b) Nature of order(s) passed ................... Place .................................... Date ..................................... (Signature of the Candidate) PART IV (To be filled by the Returning Officer) Serial No. of nomination paper....................................................... This nomination was delivered to me at my office at................................ .....(hour) on....................................(date) by the *candidate/proposer. Date ..................................... Returning Officer Conduct of Election Rules, 1961 (Statutory Rules and Order) PART V Decision of Returning Officer Accepting or Rejecting the Nomination Paper I have examined this nomination paper in accordance with section 36 of the Representation of the People Act, 1951 and decide as follows:- Date ..................................... Returning Officer PART VI Receipt for Nomination Paper and Notice of Scrutiny (To be handed over to the person presenting the Nomination Paper) Serial No. of nomination paper.................................................................................................. .... The nomination paper of.............................................................. ........................................ a candidate for election from the ......................................................................Parliamentary constituency was delivered to me at my office at ......................................... (hour) on............................... ..... (date) by* the candidate/proposer. All nomination papers will be taken up for scrutiny at .......................................................... ........... (hour) on......................................(date) at............................................Place. Date ..................................... Returning Officer * Score out the word not applicable. FORM 26 (SEE RULE 4A) Affidavit to be furnished by the candidate before the returning officer for election to ............................ ........................................................ (name of the House) from ................................................... ............................................................. Constituency (name of the constituency) I, ........................................................, son/daughter/wife of ........................................................ aged about ......................... years, resident of ................................................................................................................ candidate at the above election, do hereby solemnly affirm/state on oath as under:- 1. I am/am not accused of any offence(s) punishable with imprisonment for two years or more in a pending case(s) in which a charge(s) has/have been framed by the court(s) of competent jurisdiction. If the deponent is accused of any such offence(s) he shall furnish the following information: (i) Case/First information report No./Nos.................................................................................... (ii) Police station(s) ............................................................... District(s) ............................ State(s) ............................ (iii) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has been charged....................................................................... ............................ (iv) Court(s) which framed the charge(s) ............................................................................. (v) Date(s) on which the charge(s)m was/ were framed ...................................................... ............................................................................................................................................. (vi) Whether all or any of the proceeding(s) have been stayed by any court(s) of competent jurisdiction .................................................................................................... ...................... 2. I have been/have not been convicted of an offence(s) [other than any offence(s) referred to in sub-section(1) or sub-section(2), or covered in sub-section(3), of section 8 of the Representation of the People Act, 1951 (43 of 1951)] and sentenced to imprisonment for one year or more. If the deponent is convicted and punished as aforesaid, he shall furnish the following information: (i) Case/First information report No./Nos.................................................................................... (ii) Count(s) which punished ....................................................................................................... (iii) Police station(s) .................................................................................... District(s) ....................... State(s) ............................ (iv) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has ever been charged......................................................................................... ................................................................................................................................................ (v) Date(s) on which the sentence(s) was/were pronounced ................................................................ ..................................................................... ..................................................................................... (vi) Whether the sentence(s) has/have been stayed by any court(s) of competent jurisdiction ....................................................................................................................................................... Place .................................... Date ..................................... Signature of Deponent VERIFICATION I, the above-named deponent, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief, no part of it is false and nothing material has been concealed therein. Verified at ..................................................... this .......................... day of .........................., 20............. Signature of deponent Note: The columns in this Form which are not applicable to the deponent may be struck off. Annexure-I Affidavit to be furnished by candidate alongwith nomination paper Before the Returning Officer for election to ___________________________. (name of the House) from _____________________________ constituency ( name of the constituency ) I, _____________________________, son/daughter/ wife of ____________________, aged _________ years, resident of ___________________ ___________________________candidate at the above election, do hereby solemnly affirm and state on oath as under:- (Strike out whichever not applicable) (1) The following case(s) is/are pending against me in which cognizance has been taken by the court:- (i) Section of the Act and description of the offence for which cognizance taken : (ii) The Court which has taken cognizance : (iii) Case No. : (iv) Date of order of the Court taking cognizance : (v) Details of appeal(s) / application(s) for revision, etc., if any, filed against above order taking cognizance : (2) That I give hereinbelow the details of the assets (immovable, movable, bank balance, etc.) of myself, my spouse and dependents*: A. DETAILS OF MOVABLE ASSETS (Assets in joint name indicating the extent of joint ownership will also have to be given) Sr. No. Description Self Spouse(s) Name (s) Dependent­1 Name Dependent-2 Name Dependent-3 etc. Name (i) Cash (ii) Deposits in Banks, Financial Institutions and Non-Banking Financial Companies (iii) Bonds, Debentures and Shares in companies (iv) Other financial instruments, NSS, Postal Savings, LIC Policies, etc. (v) Motor Vehicles (details of make, etc.) (vi) Jewellery (give details of weight and value) (vii) Other assets, such as values of claims / interests Note : Value of Bonds / Shares / Debentures as per the latest market value in Stock Exchange in respect of listed companies and as per books in the case of non listed companies should be given. *Dependent here means a person substantially dependents on the income of the candidate. B. DETAILS OF IMMOVABLE ASSETS [Note : Properties in joint ownership indicating the extent of joint ownership will also have to be indicated] Sr. No. Description Self Spouse(s) Name (s) Dependent­1 Name Dependent-2 Name Dependent-3 etc. Name (i) Agricultural Land - Location(s) - Survey number(s) - Extent (Total measurement) - Current market value (ii) Non-Agricultural Land - Location(s) - Survey number(s) - Extent (Total measurement) - Current market value (iii) Buildings (commercial and residential) - Location(s) - Survey/ Door number(s) - Extent (Total measurement) - Current market value (iv) Houses / Apartments, etc. - Location(s) - Survey number(s) - Extent (Total measurement) - Current market value (v) Others (such as interest in property) (3) I give hereinbelow the details of my liabilities / overdues to public financial institutions and government dues :- [Note : Please give separate details for each item] S. No. Description Name & address of Bank/ Financial Institution(s)/ Department(s) Amount outstanding as on ........................ (a) (i) Loans from Banks (ii) Loans from financial institutions (iii) Government dues Name & address of Department Amount outstanding as on ........................ (a) dues to departments dealing with government accommodation (b) dues to departments dealing with supply of water (c) dues to departments dealing with supply of electricity (d) dues to departments dealing with telephones (e) dues to departments dealing with government transport (including aircrafts and helicopters) (f) other dues, if any (b) (i) Income Tax including surcharge [Also indicate the assessment year upto which Income Tax Return filed. Give also Permanent Account Number (PAN)] (ii) Wealth Tax [Also indicate the assessment year upto which Wealth Tax return filed.] (iii) Sales Tax [Only in case of proprietary business] (iv) Property Tax (4) My educational qualifications are as under :- (GIVE DETAILS OF SCHOOL AND UNIVERSITY EDUCATION) (Name of School / University and the year in which the course was completed should also be given.) DEPONENT VERIFICATION I, the deponent abovenamed, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief; no part of it is false and nothing material has been concealed therefrom. Verified at _______________________ this the _______________ day of _________________ 2004. DEPONENT