Annexure 15
A
PAR
]_]Fr=anreoTThffi
It
l\umlter
and name of Constituency
'7
III
Nanle or State/union Territory
1V
Narure or Llection
(Please mentlon whether General
Election to State Assembly / Lok
Sahha / Bye- election)
Date ol cleclaration of result
VI
VII
c*
$r,.an2*-( sf
I
.J-harP.l"-er"oL
SttutL ft<szrub
Lg
23 - tJ- 2otll
Name and Address of the Election
Agent
Ir candidate is set up tly a political
parLy, Please mention the name of
ihe political party
vvnerner rne party ts a recog
political part/
ke sfiri
6l.,a,r-9l.,ytzro
'
q;'-6{.aa-+
4,J=9* n )i
h t ara-a:y
Ja-^a-fP-
Yes/No
yaA
Date:
Signat rE of the Candidate
Place:
Name
t0i
)
bt|
Vi^I^ K*l.t**
,;il
iir
(3)+(4)+(s)
Itlir
ill!li
lli1
lill
ll1
il:
lii
ill
l,i
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{1
etc.:-
ili
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:
Expenses in public meeting, rally,
procession etc. (ie: other than the ones with
Star Campaigners of the Political party
(Enclose as per Schedule-1)
r. D : Expenorture rn puolrc meeung ralry,
procession etc. with the Star Campaigner(s)
(ie; other than those'for general party
propaganda) (Enclose as per Schedule-2)
mpaign materials
tlre public meeting, rally, procession etc,
menticned in S.No. I above(Enclose as per
Schedule-3)
i:j
il.
il
'1,
-$o*"
Egs13
6%6q9""
2Ybl5'*'
mpargn/
L
lrll
ifl li
I
including cable network, bulk SMS or internet
and Social media (Encloge as per Schedule-4)
xpenditure on campalgn venicle(s
candidate(Enclose as per schedule-5)
(Ehclose as per Schedule
baooo
73oVlt-
)f
al$ )zor
NTL
-6)
rL
l3 0z 5s
PART
III : ABSTRACT
OF SCIURCE OF FUNDS RAISED BY CANDIDATE
5o 5 ooo
(Enclose as per Schedule - 7)
sum amount received from tne party (les) In cash or cneque etc.
(Enclose as per Schedule -B)
persons etc. as loan, gift or donation etc.
(Errclose as per Schedule -9)
toooooo
AotLs pj-o{7 0
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104
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t
w/o,
of
hereby
[:]J,,]?[:K:ffiil:?:::F;ffi,ffihe
senerar ere*ion/bye
ef{ion-fg
rhe House
o*he
peopre
/
.....*'g,.rj'iljrTl:,::.,,A';;;il,1#l.in;;;*,ir-,.,j:ffi7#-ffi*.',ft,.:";
(2) That l/my election agent
kept a separate and correct
authorised by me r_ry "utu.tior'ug.*'t,,
a11ou_1t of ail expenditure
incurred /
.onnuaion*,in
,rr. aboveerection between
on which r *t-t"n,itl*'oj'i.o
the date or deciaration
fi|ti,rflX':
or tne ier-rit-t-nur.or, borh days
(3) That the said account
was maintained in the Register
furnished by the Returning
Registeilttt#'ir rtnexed
for the
ilu rrpporting vouchers/birsofficer
mentioned
purpose and the said
the said account.
',ir.lo'*[r-,
in
,r,!r,d:, ur ih,T' of e,e*ion
si!?t,.T?,:,:,i.{1,.",j:fri,.,:,;;1T,,'I%-I3;,[i
3ffi1]'l?,1^r"::r.
me' oLher associarions
t bodv;iH;#;;1a,i9i;Tifal;ffi{:ilil:i,ffi"rfs]
election' and nothing tras
neen;il;;[i"rwithherd/srpplrr.o
thetefrori lother.ttran the expense
covered ov
on
77 (1) or rhe Representation
or the
r-ii.#lr. ,'llo"lff::[T:lion
trffi:T.filTi'
(5) That the Abstract
statement of Election-Expenses
annexed,as.Annexure
inctudes a, expend*rru
in.rir*Jor:irliorir.;-il;;;
ii,,TifrlT#,?;
oLher associarioni
Ii
to the said account
;**,;;
/o*, ,i *"# ;l? #'.rt,no,u,ouars supportinsplriti.ur parry which
me, in connection
(6),That the statements
in the foreooino ^_-_.
uno u.ri.r,
fl.:y,,ffil,,'rffiT#
,ii,.lru.r,on
*,"],l-,n,;g;,;;;;.;;;,#;,flfil:3#3i;#H,,:l,i;,H:
to rhe best of my knowredse
Deponent :
"r/
Solemnly affirmed/sworn
by .
..
f*
arso
jt... ...
at .1*x..this day of 20tS......before
me.
.
!:ffiH;f:?fr:?:,,JliiAttestingauthority,i.e,MagistrateofthefirstClassoroath
,\* uffi,,
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r to 9:
schedules-
Detaits of Elections Funds and Expenditure
of candidate
$iehedute-I
Expenses in public m
S,
YdLUrc
her than those itith Star Campaigners of the politicat party)
ut trxpenotturg
Total Amount
in Rs.
No
Source of Expenditure
Amt, incurred
Auth. by
/
Candidate
agent
\/ahi-l^^
r^
2
Frorl-inn,y ulqvu,
C+^
rrPUt Ltng vtsttors
roilud!
poles etc.
o(
3
4
Flowers/ garlands
5
,,,r ury Lrrlru spedKefs, lvllcfopnone/
amplifiefS,
2b6T 5
usl I tLdugs gLL.
ot.,lts,
tr*
r,,
uvEr ur\c
vvdLef/
Ltrct,
-k^
COIO
OflnK, .1UiCe etC
10
lll,mi^-li^-;r^-^^
11
L^.prr.rJEr ur I
'Prdy, rt uJeLtor otsplav/
12
rh
Ne bendt
Lr
qQ, J!!ur
^^;,
..
C)
o
;;ffi
Others expenses
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13
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5{rO
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qe83tz
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t550vi
f 269439
,#ftfllT?Ji
-
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e
_{voe
o
Boardinn & lnrlninn 6vh^h,
E.
(3
/
gefierator cnarges
including Star Campaigner
2tt
C
o
Rent for venue
I
l>
c)
e
SDco
ilgnts, ooards etc.
cl tsljUrt, Hellcoptef/ aifCfaft
rPlrur r/
Tnl=
O
c)
(,
Campaigner)
i6
o
Zlboo
vehicles/ boats etc. charges ( for self, celebrity
or any other campaigner other than Star
rty
2L615
2tr 5 L3
other artists remuneration etc.
pa
o
O
LApEnrEs uil LeteoilUes, payment tO mUSiCianS,
G
()
Zlaac
uilt>/ lJdiltpnlets, banners/ uut
hoardings
Ct t rrrl.
6
o
ZCIbo
tickers boards, 3D display
14
by others
k^^.JL:rt-F
rrqrru
l-)iniirl T\/
13
/
o
a
2oDD
o
comparers etc,
6
5
o
rutllture/ FlxtLjres/
o- D^--:--r,-F
,Arnhn^
r, ur rur q
Dnclar-
Amt. incurred
Paty with
4
-)
1
Amt.
incurred
by Pol,
name
-
-)
1
/
101
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1,911e
ano
lVertue
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lrrrame
ortl.,".|r1,
& Narne of Party
lCampaigner(s)
I
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jAmount or rxben,titrre on pubtic meerins Rematl<:,, iI a
r.ally, procession etc. wiur ure SL.rr
I
lCampaigner(s) apportioned tr-r thc r:arrriirlalr
I
tns other th;rn hrr
qt'neral
luropaganda)
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l.r
.l#!l#.y:lAn.a+E_h*htsie,1l-_="nLstu,
'l I"&;'!:: Ink^'_-_A"6L(r_Di _ -t't;;:;_
;r;rrly
irr Rs.
,";e-l1a'al16f6,a
Ihl.ait:; ot'rrxl:errcliiure.on ca,r,Paigrr niater.iai;; lil*G;Ab,rrr, p.,iiil5its,
;,"ste*,lrcarcii,r.fs, batrrrr:r s, cul
rrillr:'6 r,,,11 ;:rrrlio rairoilr-15-, {-[5/ I-r\/[5, 1.3, ,11 tp"rt,"ri,-^,rrnrin"ir,
ra)f'tr,r,,r,r,t r li,.t,l'rr, 'i l\
;'11r116:s,
.),
ffii;i
Nature of Expenses
l-otal Anrount
in Rs,
I\l<i.
bou, cer or rxJre
Arnt. By
candidate
agent
rrcl*i turle
Attrt.
t3y Pol.
ot1[.1;1, r_1;.tl.q1;
1ii.;1 rl;
r,, .'!
[l,r:trr;,rtl<s,
r
il ;l
ry
By oLlrers
/
4
tt".Q lr;ll
?Lr6J5^--
eqb95
2V 6e5
2\ $Af
t-tclails ol expenditure on campaign tlrrough print and electronic
media inclucling cable rrelwor.k, l.rr,rlliaMS ;;
:ocial rnedia etc. lor candidate
(ckrcll-ouir:,/
print)
arrd
cluration
Nlame and.address
Name and address o[
ol' rrtr:rlia pt ovirkl"
iJUenLy, l'cpor [.0i , sU.inqr..:r,
filntpiiny 0r any pcrsor.r lr)
(print /eler:tronk:
lsms
lvoicel
etc.) ;
cable
-
whom charges
Total Anrount
irt [{s"
Aurl..
l?'y
candidate/
agent
/
commission etc" paid/
payable, if any
Sourcr:s of
L::<lte
nrlilrrrt:
l\t rrl
.
|'ol"
Parly
Col. (3) +(4)
1
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,)
A
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-lolal
fvivrl
tl;d,oqL",
4oo o
-Yy\_f:3::'
Da*i k $fu+lxa,r
Fr*-b\"| \4-\^L."(
(9 ooo
l0u
in1.cr-nel
X-roaa
_0
O
€aoo
2s0Dr)
-_o
6sooo
c)
o
/tr111.
ol.ltr.tft
I
)
.
ol'expenclitrrre o
enditure 0n veh cle(s) for canclidate's etection carnpagn
egn. No, of HirinO Charges of vehicle
ehicle &
I
No. of
tor l1,L,.t ct,anleo loriver.ru
I lir irrrl o[' (ll not
cltaroi,s
v,,lrit lc / l,'ov,:rerl l(rf niit
llct rilr r trrrt l..rr
irrq) ir,,r,r,",.,
( I'
j
ltrnrlcr
liltc
|
rr r;,rir
r,r
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--:--
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Arnt. By
userl
carnditlaLel
aqr:rtL
T-l
An rl..
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t,arty
Ily l,ol Arrrt.
Liy
{ }{ I
illr
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t;
ltririrrs)
3r,
ir
I
which
I
I
Source of Ex renditure
lTotalamt.
lincurred/
laLrtlr, in tls.
Days for
tl
ir.
t_
J.
,
6
u
l7bTH. 73oVb?-,
)
a
r
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D
1
4
li;i,,rl
$cheriul n-G
l.ti:t.iril:; uI ex;it:rrdituru orr Canrpairln workers
('
li I,:l
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Nlu
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i
73ovbd.-
_--...---.----...--
V3o'761-
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C)
.
/ ag-rt,
.t
r: ;rrirl
lfxllt:r rses 0rr Caml:aign workersI iltil
lil.,l,-,, .,,i 1 ..r,,.,,.,,.
l,i It-,'5 I,'ii,.-.-Tr,l{u. iil wtl
Qtv.
I
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/
lJ.i
3tl
l<t,rrs
,,it,;t:t ti.l;
Total t nrt.
incllrrr dt
it r rt lr. I rr lts"
u-
3c
I
Sr:urces of I xpenditLrre
l\rnl.. tty
carrdiilatc/
agent
r\rnl. lry
7
o
()
[';rrly
l,ul.
l
/\rrrl.
ri,,,
lrrl,lri,r..
ql
I(-anrp;riqn worl<ers
i
llonnrill-fu
111r/
salary
jelr
I
Bo;rri.li,r( t
I
I LocJgirrg
t_
Otlrer s
Nt u-
NtL./\rl r-
NL L-
L-
l;'L-'l
$ched llle- 7
,^J
UL
NLE
l',-
rlli,rl,,
I
it-;r:lr
r
I
DDI Chetlue nu. etc. with
Ilrrr:ri,-
lrlr'lirils ol rli ,twr,l lr;1lk
-Iotal
l\rnount in
I
1
:t
a
"l
4
e'-tr" 20i[
j3: ll:-?4f9
Lb oooo
i8't\ !!\r'lL,znty
5;8DaC)
9'lz-:2o*u
"Tot
I09
Z8 oooe
5o5soo
)lro-
NJ
-;;-
A,t L-
.+_*_.
l\trl0tlnt-0r0Wnl.ttndttsedforthe'elffi:.
l,)r::l;rill t;l
i
Nt.t-
(v\v
l{,1;'tl
lil,
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f\/] L
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t_^/t
LN\L-
-..-irs'Jule-
E
l'e:ar s of Lump sum amount received from'i:nr= ,':f lhe polilicai pai-ty DaLe
L
3
I {,'1 it
DD/ Checlue no. etc.
4
with rle{:ails cf
i,:;nli
rJ
B.s" v.
l5.l'r. l te
RTq
E*f.S'
L. l1
f-r 6S
1
-)
Cash
IY
dra,,a,ree
Toial Anrount
in P.s,
an\/
6
S
-S. oo ooD-S-ouooo
)
!
I o,
I
Rernarl,.:-;
l:;u:,ttq'du!e
?
3::?liltj#inp
of, oDD ^
sum amount received rrorn ar
[,,lanre ::nd atldress
Casli
DD/ Clreque
no. etc, with
cJelails of
drawee bank
lulention
Remarks
whether loan,
gifl or
donation etc.
_.,_._*
Note
--1-_,_
;
1. In Sclredule 5:-
(a) copi' of the order containing list oi all vehicles for
which permit issued by the Returning Otficer to
enclosed,
tre
6iui;t vehicle is owned.by the cancJidate/his.relar.ive/agent are used for eleclion purpose, notional
cost of hire of all suclr vehicles, except one vehicle
if owned'uno ,u.J uv ah" ffi,;;;e, notional cost of
fuel and <lrivers salary for such vehicle, shall be incruouJln
tJtat amount'r vr
or UAF/L'
.rJ.noiture
rur
in ,re above
table.
2' in all schedules't
on goog: and services, provided by the potitical party;
or provided
Y:I|*nditure
person/ companv/.firm
/associati;nV
body
p.;;;;;;rc,
on behatf of ilre candidate, then the
!I,3',
noiio|ral market varue of such goods or services are "i
to be inoicateJ, i,
3. Tn
rhe
Lump-srim
-III,
,r'art
,n. poriricat parby or orhers or the
candidate's own funds, should be mentioneo
oate *L". i.iri']u.r,..r", nr.h .mor,.,ts are required
to
be iir;t deposirecr in the Lranr. accounr or tne canoc;i;,
f*
4. Ear;h page of the Abstract statement shourcr be
"iu-.rb,,
signed'by G:iandiclate.
;;;r;r';i"ir;J ;;;;r#;*,
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il;r;:;"
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