EB 131776

Affidavit to be Furnished by".candidate along with Nomination PaperBefore the Returning Officer

for election to Maharashtra Legislative Council (name of the House)from Maharashtra Legislative Assembly Constituency (Name of the Constituency)

I, Chavan Prithviraj Oajisaheb son of Chavan Oajisaheb aged 65 years,resident of 243/0, Patan Colony, Shaniwar Peth, Karad, Taluka-Karad, Oistrict-Satara (mention full postal address) a candidate at the above election, do herebysolemnly affirm and state on oath as under:-

(1) I am a candidate set up by Indian National Congress (name of the political

party).

I

I

Cont. - 2 -

The financial

years for which Total income shownSI. Permanent Account

Names . the last Income- in Income TaxNo. Number (PAN)

tax return has Return (in Rupees)

been filedI

1 Self ADCPC9048H 2009-2010 7,22,676

2 Spouse. AEPPC9222F 2009-2010 2,84,257

---------3 Dependent · No Dependent i Not Applicable Not Applicable

I

\ r' 2)\~ \'., \ .- ~

\'~V' I (I: l;

iiJ/\\."\0/0/. ;::

. /, .~/..~.

- 2 -

Details of PAN and status of filing of Income tax return:

Nil

(3) The followin casE'(s) is/ are pending against me in which cognizance

has be n taken by thf~court:

SI.No. Offence Description

(a) The details of :;ast?s where the court

has taken cognizance, Sections of

I ~he ,Act ?rd cies,:ri-:-tinn of tile offence

(b)

(c)

ame of the Court, Case No. and

Date of Order tal<i'lg cognizance:

, Details of Appeal(s) / Application(s)

I "'')r r .vision (if any) aoainst the above

I Nder(s} .

Not Applicable

Not Applicable

(4) Case~ in which I ha P, een con rieted by a court of law (other those

referred t in Form 26) :

-SI.No. Offence Description

(a) I The details of cases, Sections of the

ct and c!escri::>tio'l cf the off8'1c,_ for Nil

whic!' ~onvicted :

(b) I Name of the Court(s), Case No. and Not Applicable

'Jate(s\ of order(s) :-

(c) I Punishment imposed: Not Applicable

,Cont. - 3 -

3j tj;Jthat. I oive here in below the details of the as~et~ (immovable movable. bank balanceMl rJ of mvself mv soouse and deoend'ents :.

~tJ#DETAILS OF MOVABLE ASSETS:~~rr. CHAVAN PRITHVIRAJ D. MRS. CHAVAN SATVASHEELA P.

~ no. D' f (SELF) (SPOUSE)escnp IonAmount AmountParticulars (Rs) Particulars (Rs)

(i) Cash in hand 1,50,821 1,35,800-----,-----------------------------1----------- --(Ii) Details of Deposits of I FOR With State Ban~ of India 2,69,784 FOR With Bank of India 2,79,020

Bank accounts (FO s, , .Term Deposits and a;' t-FDR Witn ICICI Bank 47,783 Bank of India, Khan Market, 1,89,553other types of Deposits New Delhi SIB Alcincluding saving Bank of India Okhla SIB Ale 12,734 Bank of India, Miraj Br., 4,74,7 44accounts), D~posits Maharashtra SIB Alewith Financial ICICI bank dmat ale

I'19,589 ICICI Bank, Connaught 89,779

Institutions, Non Place, New Delhi SIB Ale-Bank.ing, Financiai i ICICI ban~ Naida S/8 Ale I 14,019 - -Companies and Co- S'ate Bankof India KaradSIB Ale I 8,08,076 - -operative societies and ~.:3tate Bank of !nd:~ Parliament 16,74,919 - -the amount in each House SIB Alesuch deposit. Provident t-und 47,18,809 - -

I-

(iii) Details of investment in : SBI Mutual Fund 91,200 Shares of lOBI Bank 19,000Bonds, Debentures I S'1ares of Applied Electro 3,18,82,512 Sha~es of Applied Electro 2,30,866Shares and units In lViagnetics, Pvt. Ltd. (4,14,298 Magnetics, Pvt. Ltd.companieslMutual S~are of RS.10 each) (3,000 Share of RS.10Funds and others and ! each)the amount. -=.hares of HPCl (150@373/-) 55,950 Shares of T. Star Share 5,000

Snares of Hindustan lever I 13,800 I - -. (50@276/-) .

426TI Shares of Lohia Machine Ltd. - -203nares) I--- -----

,shares of Urllabex Alloy 3,750 - -__ P.-oduct,25@l501-)

(iv) Details of investment in Kisan Vikas PatraI

20,000 - -NSS, Postal Savings, ------_._-- -

18,824 IInterest on KVP - -Insurance Policies and National Savinq Scheme 2,35,419 - . -- .~ . -investment in any Surrender Value of L1C 5,46,864 Surrender Value of L1C 3,79,048financial Instrument in C'')!ir:ies as ')11 31 March 2011 I policies as on 31 MarchPost Office of Insurance . ' 2011Company and the amount .•

-- --- --- - --- -(v) Motor Vehicles (details Maruti Esteem 'vXI Model 2004;

of make etc.) Regn. No MH-1Z-DS-8865 1,00,000 I - ---

5,00~OOO I Gold ornaments 800(vi) Jewellery (give details Gold 250 gms@ 2000/- gm. 16,00,000of weight and value) .l9rnam_ents L ~~20001-

Sil"er Utensils 11 50~g 6,32,500 - -@550001- kg. I

(vii) Any other assets, sllch as Nil Nil I Nil Nilvalues of c1aimslinterest. i-_.- ------------_._-

(ix) Gross Total Value 4,18,17,719 I 34,~2,810Cont. - 4 -

."

- 4 -(B) DETAILS OF IMMOVABLE ASSETS:

lot Applicable

MRS. CHAVAN SATVASHEELA P(SPOUSE)

Not Applicable

Nil

Not Applicable

Not Applicable

lot APolica!:lle

CHAVAN PRITHVIRAJ D(SELF)

AS PER ANNEXURE· AAS PER ANNEXURE· A

t\,lot ';pplicable----------N t Applicable

lot Applicable

Agricultural Lanct~Location(s) t-Rahudi, Tehsil Phaltan. Dist:

Satara.Survey number(s) AS PER ANNEXURE· A 61/4Area (Total measurements in acres) 3 16 Hact.

-------- ----- ...• - -- ------- -- - ---- ._--Wheather inherited property'(Yes/No) AS PER ANNEXURE· A YesDate of purchase in case of self acquired AS PER ANNEXURE· A Not Applicableproperty

~---------.------Cost of Land (in case of self purchase) 'AS PER ANNEXURE· A INot Applicableat the time of purchase

--------------.-.Any. investment on the land by way of Nildevelopme, t constructlor etc.- ._-- ---- --_.__ . ------ - -- -----------Approximate Current market value Av PER A EXURE • A Rs. 8,25,0001-

--- _._-- -------..--- -- - -----------(ii) Non·Agricultura .and AS PER ANNEXURE· B NIL

Location(s)Survey number(s)Area (Total measurements ill sq. ft.)Wheather inherited propp rv (Yes.iNa) Yes

Date of purcha~e " case '" sel acquired j\~c' a,D..Ai •.lb .~property

Cost of Land (in case of self purchase) Not A plicableat the time of purchase

Any investment on the land by way ofdevelopment constructior' etc-~--- - - ----------------Approxi~atp:_~_~~~_nt ~_~:~:~t_~~u_~ ._ . _ _ N..o__t.A_pplicable

(iii) Commercial Buildings NIL(including apanrnellIs)- Location(s)- (Survey number(s------~------_. - ....-.--- --- --_. - -- ----Built up Area (Total meaC::JrprYlentin sq ft) ~I"tApolicable Not Applicable

Wheather !l1nented oropp", Y"'S'NO) Nc App!IC::lf:"c: ~Iot Applicable-- ----- - ---- --------Date of PUW13, e -. case OTsel acqUirea MPP"catJle lot Applicableproperty

Cost of Land (in case of self purchase) Nor Applicableat the time of purchase

Any investment on the la"d oy wey ofdevelopmenl conSTructlo - t'-- ---- - -- - ._---- ------~. ------Ap_p_ro_x_im_~t,:-~u~Q~t.~,:ar .:'_~~I'_e_ .. : !::.!y_!ica_~l. i ot Applicable

Cont. - 5 -

- 5 -

NIL

Not ApplicableI

Not ApplicableNot ApplicableNot Applicable

(iv) Houses/Apartments etc. . AS PER ANNEXURE· C. ) . eluding apartments)o~' Location(s)

- Survey number(s)Built up Area (Total measurement in sq ft) lAS PER ANNEXURE· CWheather inherited property (Yes/No) Yes

Date of purchase in ca<:e of self acquired JLII}' '003property

Cost of property (in case of purchase) RS.52,00,000/·at the time of purchaseAny investment on the lana by way of '"' DE~ ANiVr:.XIJR.E • Cdevelopment consTruction etc. tApproximate -Cu-rre-nt~-a-rk-e-t-v-a-Iu-e--A-S--P-E-R-A-N-N-E-X-U-R-E-.-C-1Not Applicable

-~--------------~_. _.- -----------,.

(v) Others (Such as interest in property) ~IL 't.JIL-_. ------ ._----_._------------(vi) Total of Current Market V81ue of Rs. 2,21,30,000/· RS.8,25,000/·

(i) to (v) above

Cont. - 6 -

- 6 -ANNEXURE· A

DETAILS OF AGRICULTRUAL LAND

Location(s)

Agricultural Land At. RC'hJdi,Tehsil.Phalatan, Dist. Satara, Maharashtra

Area in Approximately Inheritance Yes / Noacres Value in Rs,6.00 6,30,000 Yes

2 Agricultural Land At. Maldan, Tehsil.Patan, Dist. Satara, MahashtraTotal

3.50 8 00,000 Yes

14,30,000

ANNEXURE·B

DErAILS OF NON AGRICULTRUAL LAND

Sr. Location(s)I

Area in Approximately Inheritar:JceYes / NoSq. ft. Value in Rs

1 Plot at 243/0, Patan COlony, Shaniwar 2534 15,00,000 YesPeth, Karad, Dist. Satara, Maharashtra-

I415110Total _____________________ J 15,00,000

ANNEXURE·C

DETAIL HOUSES AND APARTMENT

Sr. Location(s) Area in Sf'! I Approximately Inheritance Yes / Noft. present

Value in Rs,1 Flat No. B-601, Kaveri, Appts. 1300 80,00,000 Yes

Alaknanda, Delhi-09I

2 Flat No. 201, Venus BhCJ:'.: I ~OJ2

I~2,OO, ~OONot by inheritance.

Park, Wadala (East), Mumbai Purchased from Anik DevelopmentI I~orp. Bhakti Park, Wadala (East),II Mumbai on July 2003

3 House At. 243/0, Patan I 5992 60,00,000 YesColony, Shaniwar PetnKarad, Dlst. Satara, IMaharasiltra-4'j 5'j 10Total I 1,92,00,000

----

Cant. - 7 -,

J'

- 7 -(6) I give here in below the detail of my liabilities / dues to public financial institutions andgovernment:-

MRS. SATVASHEELA P. CHAVAN(SPOUSE)

Name and address of Amount Outstanding. Bank Financial as on 20.04.2011

Institution(s)/Oepartment(s)

NOT APPLICABLE NIL

NOT APPLICABLE NIL

NOT APPLICABLE NILNOT APPLICABLE NIL

NOT APPLICABLE NIL

NOT APPLICABLE NIL

I

If 'OT APP ICABLE NIL

II NOT APPLICABLE NIL

I N-Or APPLICABLE NIL

NIL

NIL

NIL

NIL

NILNIL

NIL

NIL

NIL

Amountoutstanding ason 20.04.2011

NOT APPLICABLE

NOT APPLlCA'3LE

PRITHVIRAJ CHAVAN(SELF)

Name and addr.ess ofBank FinancialInstitution( s)/

Department(s)I NOT APPLICABLE

Description

(i) Loan or dues to Bank IFinanciallnstitution(s)Name of Bank or FIAmount outstandingNature of Loan

Loan or dues to any I NOT APPLiCABLEindivid~als/Entity other thanmentioned in (i) above.Name(s)Amount outstanding INature of Loan I

(ii) Government dues:- NOT APPLICABLE._--- --- ------------~--

Dues to departments dealinq NOT APPLICABLEwith governmeptaccommodationDues to departments dealingwith supply of water

Dues to departments dealing I NOT APPLICABLE I

with supply of electridty_. _._----------

Dues to departments al!, ~ NOT APPLICABLEwith telephones I Mobiles

Dues to departrnents dealingwith government transport(including aircrafts and I Ihelicopters) IIncome Tax Dues - ---- - -~O:- AP':)~-0A3LE i

Wealth Tax JuesMunicipal/Property Tax DuesSales Tax DuesAny other dues

(iii) Grand Total of all Govt. Dues

NOT APPLICABLENIL

NOT APPLICABLENOT APPLICABLE !NOT APPLICABLE i

NILNILNILNIL

NIL

I

I NOT APPLICABLEI NIL

NOT APPLICABLEi NOT APPLICABLE

I NOT APPLICABLE

NILNILNILNIL

NIL

Cant. - 8 -

- 8 -

(7) Details of profession OR occupation:a. Self: Industrialist and Farmerb. Spouse: House-wife

(8) My Educational qualifications is as under:

(Give details of highest schooll 'niversity educationwith full fO(1fI of tl18 c.entfiL.ate/dlploma/degrE:e course)(Name of the School/ College/University andthe year in ..vl1ichthE:cOurse was completed)

L-- _

1) B.E. (Mechanical) in 1967 from Birla Instituteof Technology Pilani, India2) M.S. in 1969 from University of California,

I Berkeley, USA.

(9) A STRACT F rHE Dt: TAilS GIVEN IN (1) TO (8) ABOVE:

---_._--- --Chavan Prithviraj Oajisaheb1 Name of the Candidate

- - - --2 Full postal address 243/0, Patan Colony, Shaniwar Peth, Karad,

Taluka-Karad, Oistrict-SataraMaharashtra

3 Number and Name of the Constituency and Legislative Council of the State of MaharshtraState elected by lvIembers of Legislative Assembly

-4 Name of the Political party which set up the Indian National Congress

candidate (otnerwise write 'Independent')- ---------

5 (a) Number of cases in which conviction order Nilpassed (other than those referred to in Form26)

------- ----l--1----- -- -- -------(b) T0!31 '1'Jr'1btr of Perv1ing f'ase~ where the I ilcourt(s) have taken cognizance !------ ------- I Years for which last6 PAN of Total Income Shown

Income tax return filed~-------_.

(a) Candidate: ADCPC9048H 2009-2010 7,22,676

(b) Spouse : AEPPC9222F 2009-2010 2,84,257~-- -------- -

\ J) De'J<l'lcle'1 ' . "0 ~"'~:l,,(I~nl .. )t Applicable Not Applicable- -- --- -

Cont. - 9 -

-9-

Not Applicable

Not Applicable

Not Applicable

I Not Applicable

Spouse Dependent34,02,810 No dependent

Nil

Nil

Inheritance

IRs. 8,25 000/-

Self4,18,17,779

Nil

As per An'1exure A-B-C allthe properties except VenusBhakti Park, Wadala"

I Mumbal (Purchased for Rs.3.58 lacs) are by inheritance

I -.----(ii) Approximate CurrentMarket Fl"iceor Asset(Total Value)--------

8 Liabilities-------- ._-------

(i) Government .-lues(Total)(ii) 'Loans from BankFinancial Institutions andothers (Total)

----------9 Highest edu (!tio!'1a! qualification'

(Give details of highest school/L ni iersity education 1) B.E. (Mechanical) in 1967 f'om Birla Institute ofwith full form of the certificate/dl:>loma c.egree course) Technology Pilani, India(Name of the School! College/University and 12) M.S. in 1969 from Berkeley University, California,the year in w~icr the course wa3 completed) I USA .

7 Details of Assets and Liabilities in rupeesDescription

A Movable Asset (Total Value)mmovable Asset

(i) Purchase price andDevelopment Cost ofImmovable Property(Total Value)

ERIFICATIO

I, the deponent, above named, do hereby verify and declare that thecoments of this affidavit are True and correct to the best of my knowledge andbelief; no part of it is false and nothing material has been concealed there from. Ifurther dA Jare thS>.t.(a) there is no case of conviction or pending case against me other than thosementioned in items 3 and 4 abovE::;(b) I, my spouse, or my dependents do not have any asset or liability, otherthan those mentioned in items 5 and 6 above

Verliled at Mumbai ~his tne 2Ct •.. day of April, 2011.

DEPONENT

BEFOR~~~_Cit ~~-- ~GREGORY W. D'SOUZAADVOCATE & NOTARYKalpak Estate, Bldg. No. B-11,

Shop No. 40, Antop Hill,rU1BAI-AnQ 037.

~O Y (" ,(, N1J \ () l---

Gen ~ -.C.I II· '~I IV urn 2,

l.SV No.694 IMA~ARASHTRA

2 5 A 2 11 Iffif"§r .~

, HRI ~ s. 8AM8LE9

I

•

EB 131775

Affidavit to be furnished by tbe, candidate before the returning officer fori!i

election to Maharashtra Legislative Council (name of the House) from

I Maharashtra Legislative Assembly (Name of constituency) Constituency.

I, Chavan Prithviraj Dajisaheb son of Chavan Dajisaheb Ramrao

aged 65 years, resident of 243/0, Patan Colony, Shaniwar Peth, Karad, I

Taluka-Karad, District-Satara (mention full postal address) a candidate at

the above election, do hereby solemnly affirm and state on oath as under:-

Cont. 2/-

',.

-2-

I 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 Not Applicable

(ii) Police station(s) Not Applicable District (s) Not Applicable State(s)

Not Applicable

(iii) Section(s) of the concerned Act(s) and short description of the

offence(s) for which the candidate has been charged

Not Applicable

(iv) Court(s) which framed the charge(s) Not Applicable

(v) Date(s) on which the charge(s) was/were framed Not Applicable

(vi) Whether all or any of the proceeding(s) have been stayed by any

court(s) of competent jurisdiction

Not Applicable

2. I 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 mqre.

~--- ..Cont. 3/-

- 3-

·If\~e'¢.eponent is convicted and punished as aforesaid, he shall furnish the'1' I ):l" !1

....i~fol CWtJJrginformation: .. . IVa "" J

",52 . /r~ II/'~J II

" ..",. no" /'.;." :;.-' ' L.J /j ..

.~'.r~""I;'/:-0 (i) Case/First information report No./Nos Not Aoolicable..•..__ ..,~,_..~.

(ii) Court(s) which punished _N_ot_A_pp_l_ic_a_b....•le _

(iii) Police station(s) Not Applicable District (s) Not Applicable

State(s) Not Applicable

(iv) Section(s) of the concerned Act(s) and short description of the

offence(s) for which the candidate has ever been charged

Not Applicable

(v) Date(s) on which the sentence (s) was/were pronounced'

Not Applicable

(vi) Whether the sentence(s) has/have been stayed by any

court(s) of competent jurisdic.tion Not Applicable

Place: Mumbai

Date: 20th April 2011

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 Mumbai this the 20th day of April, 2011.

Signature of Deponent. I ) BEFORE ME~ lA." ~~~

GREGORY W. D·SOUZAADVOCATE & NOTARY

~ jalPak Estate, Bldg. No. 8-'11,) , /Va '0 Shop No. 40, Antoo Hill.