FORM.2A

Nomin.do. hFEL.iih to tlE llrisl.riv.Asbly of J.mu rd K.lni.

STruKE Ot? PAIIT I OR PAt{' II BEI.oll WHICIIE\'ER IlI NOT A'?LICAELE

PARI I

Oo bc !..d by conJidor. rl up by G@anis.d po|ni.d Fnv)

I lmiuc s ! o!did,n< ror.lernn, b rhc ltsislcirc arsbly from tr. llillas\-Almbl) t i.srr*mr. Crdid.rc s Ndl

P.n ll(To h. u*d by cand att not sr up by EoSDisd F|ni.rl prv)

w. h.rcby noninak .s crndid c fot €lerion to lhc &*oblv Co.trilu.trcv fom th'_sgs_ Asbly cdnkncl

s f,r.Fd.r s. No, 1\\ ri'PbnNo. -\5

FdlEr.ltddlEir,Hab.rd s lM. \'.:r- s,.

.\:.!$rqJ6- A1EhblY Cc u$.'

Uldlo6l Roll No. ol l'roF)sr

.is.m.Edrrs.No. A:jc- i. P.n No. \as oa

L- \snbly Colrncrt. My t|dft b:!

olP(Sisdatrc of t[. Pr.pG),

F{heie/t{od.r's/Hcb.td! M.

Hj3 M. i5 olcrld .l 5. No. s\6

-

in P|n No

rh. ctdtoblrelt for s F\ As$nrblv CoNtirEftv

W. d..ld $'l w G dcbs ,t rlN ab.r. Assnbtv Conni0ftv and olr M6 G 6Lcdin rlF .lc|oBl oll fo, d. Alshl! ( rtrsritut! G hdicll.d b.low 3td s tpp'id ru 3'e[|lGb.low in !ol.n of subsribins ro rlir no ir\d n)n l

P.nhr||6 ofln. poporr ind lh.i. rian.rlsS. No.

f ull NN Sisflw Dd.

3.

J,

7.

E.

10.

N.B.: Tlft.lsld bc rodab^ rl rh. coniitEE' a FotEd.

(r) d|r I hrv.@pld.d S\

PARI IIII. dE €ndi!.t ngrioGd i. l'f vPrn lt /S.ril. out *l ch i3 mr .ppli6bl.,/ s to lhir

n@iEdd rd lEEby d.cle :

[STRIKE OUTUi) OR |]lirr ItLl.oW WIIICHEVER lS NOT APPLICABLE]

(b) (D rh.| I m sa up at rhis cl.dn'n b $.:(9t\Q pan}. which b F.srisdN.tiodl Pafiy/Sr.t. l1'd) in rhis Sd. &d |h!r $. srnbol @^rd for th. lbo* F.ty

(ii) rhd I m *l ut d rii" cr{rion by lh€cgisl.rc.l unrcc.str'scd polirical pany^hat I rm con|cating rhit clccdon $.nind.p.nd.n cdnrlidar ( Srih. out which b nol opplicabL) srd thll U. th. srnbok Ih.v. cho$. in ord$ oi DBr'cEn.c. c :

(D (iii'_l\L_(c) lh.rnyM.8rdmyfothrr'. notlEartsb€rd slm.h!v.b..no@ yrr.[qraboE

n l-t\.!. (nii).u, rhe langu4c)i

ld) lhll to lh. bd oanr rno\Lr!!e nnd b.li.l I) rr{,Lilrc.,nd bcli.l I m qElifi.d.nd notb.iry ch@n b fi ll rhc \'.n l rhr | (SBt.nkAshbt, ul lhs 9d..

! I funlEr&cl@rhd I dr r lirrrh.roartE r$Sch.dul.d Car. ofdE Slal. olrnDir. d (lstmn in Glarios !o ..o\ .(E)oflh l

I also d.clsrc rbst I har. r.,' l\r.r. rmj sholl nor bc noninaFd ss. clndid.rc 6r lh.Fenr lcRE|.l4rio/lh. h!..t|..,r, . l<'n! h.td {mut|redy. ro dE Lrgist jv. Asmbtyofil'!m!.nd rshhn fom n.E rtr,r h!, t:*mbt, Codiru4y ,< I ^

! Scoc ou fi. words mt .pplicuhtuN.B.: A -Gosni$d Dol'lical nr'r. n(.,n.x Dotni(at pan) Borlird 6,lh. Ltdioo Comnisio.llrc c rr(tro. synbots lR.rh , ,r,.,n,1^ltortu r(h.i t968 inJ.tmu!d Kahnn

PAtrT IV(1o b. fill.d b, ttc

'!'did!t')WharEr d!. C.ndnb. :-

(i) h.t b..n onvicrcd -(.) of uy offc.c(.) !.d.. tuFccrio. (l) of *rion 2' of fi' ,!rno dd Kahmir

R.DEs!.lim of lh. P.oPlc Acl l95l i or

Y"/No

lbl fd drownlid of dv lu lFifcd in Ffli$ lo $F*don (2) of $lid 24 of d€" jamt aad rsrrnir ncpe*nition ofrlE Fod' Act | 9t7 (lv of 1957) ard cn|Cnc'd ro

inFiei|Mt fot d 16 lhtr 3ix mnls : d(ii) hs ben onvicr.d for dt ods olIcft(t fdqhich h' nG b"' ' tr'd to inDnmnmt

for le )tdor '6Ifrh. .t|w t'Yc- . |h. @tdid.a thdt fmitlr rlE fotlo*iq infottrdion I

(i) CtldF'd i.tomlion EPon No /Nc \F{ii) Poli6 sr'do(t Ns Diitict(s)- sr-c-st'r(t)- \\L(iii) sdtionG) oltlF @m.tEd Ac(t.rd bricf&*ri!rio' ofthc otr'ncd3) for shi'h h' ha

b.donviccd sAD.r(s, ol conv'diod n sAC;unG) *hich convicl.d fi.6r|did!1. sc!Putri3hm.nrG) inpos.d lindic.r. t.riod ot imprisonn"(t lnd/or qu'ntum ol

tiid3)! {q\Dar(r,ofEIG4 tmn pri$ $swldwf oy !pFl(3yEvisioi(3) iilcrl !8!iBt abot. onictionc)--sF-Y'tNo

Dllc .d D.nicul6 of apFatGyepliolio(t for Evition fil'd

Nrne of lhc co!rlG) bGfot. vhich th' tPP'!l(3)/'!plic'lion(s) for r'rision

lil.d-jlE-(xi) \vhdlFr lh. ed apFl(sylptlidlid G) fot EvBion h"hav' b'6 disto*d 6'0r ite

pcdins s A(xii). tf lb€ sid opFa(3)hPplicationc) for Evision h67hot' b€cn dirpoed of -

(iv)

(v)

(vi)

(viD

("iiD

(.) D.rc(t otdisPoel -\e.(b) N.!uEof ordcnsrp8$d $S-

Plc, q-\sY'___

PATT V.(Aurhdirdiar of.ga )IS

I .aE 1o &r a i@h ulhori4d !sdt.

.se d d'it Fr.3nta if d iDtiobk

t ddid c d thc rbov. clari@ hcby lutboriz!a* .s- \.\s - < .$.G \ -\i(!. g{ s>\ !PGld A.rdr6s) to d.lild rhk nominlim D!r'...Pt& hlAti

PAXT VIlTo b. filld by rft. Rciuni.g Ofti6,

sai.l No. of@niMrioi poF D6 r_r!-A. .

rhi!-mn]!9rd B d.t,t.rEd ro mG ar ny oflie.r 9.:rprd"_ron _,a..t orllE tod!.duhod:rd.efr /p,!FFr

, PART VIID.cirio! oa R.rrmtnt Ottbd Asclrhg or R.jedns rh. N6tn.rio! pl!.r

^ | hlw tuuEd rhE |m,rrio FFr i. xedrG wirh Khn a7 of dE r.,M!.t d l(.shnrK.tenbtun of rtE P6pl. Acr. t9jTdrddeid.afo osr .

!sd! d iF wd d +rri..bh

"-;ffi i*to;,il'liEiSlTffi '.',t'j"C'iiy,,fi f.faq.Crd,re,ar [tl/q/L g?o. prfte

D". l- ,.'- - lq

PARTYIIIReeipr to. NoDt.rrion t.D.r.d Noli.. of s.dltr,

(To b. h.nded ov.r b rh. FMn pRnring lh. NoniEtidn p.Fr)s.nar No. of hninrrion palcr 0 t,

:i:d#:r.#f ijkffi .Lfff i"i.frb!={L_x',1s*

:s.*-a."wua1"ui

IFT

of $c llousc) fonr llj ltltrltlconinu€nc) (Nmc offtc coturnuenc) )

I#Se:t-\K rii'4

AFUDAVII ro b. riled by rhc clndidarc dons$nh noninarion paDcr

rie Rchin! Ooiccr for ctsrion b J&( Leirlrrir. Ar!.obtr 20tt

l' FT.^

A5 028408

!!! !r!.!I t .\!'!\!\ -r1

3dd(Js)- a cmdidlr. !r fic abo\g €l.cron

(l)l !n a cm,lidarL er up bJ- \.\:r("noe ollhe Fnirical pd]|l.m

(3) lttr ( oni!( ltl.pho.e Nunrbc(s)m) c-nail lD( il uy) is

o'l nj si,l medir

.onrshry d {n lndtl.ndenr

\hnlL(\cr i! nut Jptl'cJhlL)is cnbllcd inigi d..i,,r .!tr- a(Nure ,,r' r[{&J rh€ Sur J.Jr Ynrl No. !.!L _ 'n

Dch'l of Pcmoem Accounl Nun$€(l'AN) lnd sbr!\

^d l! !-,1 ==!-. M,r

PIN

-ft; l]*.,r ; "rG*." .r,.* i"vqr for $hicb rhr Income,l.r r.tunr( in

'xn IncoN ra rlpetr','-.1: _

,rr*m['5ff'#*ffy'-v shh orcnc.G) h.lharr fuDish rhe

'' ##::;i#Hil f;tr,#"i*l]H

(it Th. loltowins @rds) is@ prn,l,nccoSflaie hG br{ by lhe tuun (E6oo.od id irch(i) obovc) :

\\,B\, \662>s\1 \or\

;:ffi_*:*_j-eE;*r:,Tm&ri:"te!e,/p i; L,:#tffimHHgmld;tNt#ii:i:ilif;ffiimaq3, on whkh ,,8-6i;-, ,,;G;;

*T,tBTmtm

T1. dqlib;iGGE rne c -;

'6"e-

r.lcn cosnn ft.,r4rio!4ri;(s-r,F;rs,&d dcqiprion of dE of.!E{J) for f,hich

ocnits of appar<F6itiiiiiili-Gicvisiorl it hy, fit.d osnnr d{ ablte

(6) | lEk beD4EE rcr ben wv,q.d !r orfrnc.ii, { dhd lna oyotrdErt, Etfrd b in suFsnont tj {r 5ub-sdon r2,, d 6v.Edn slFcron (t). ot Krun ,2,t of th. Jdnu ,rd rchnrEFlsltion of rlE P@pk A.r.t9j7 (tv of t957) ,r! bi.!c.d ronpnedc ror oft y@ or hoa.

If thc d.ponor is Mvicr.d ard Dunished s !to@i4 lE 5luInnth |he followiq infomarioi:

h lhc folowiis c.s ,t h!?e b€.n .onvicr.d dt sEld bimFislMt bt c @un of law:

(D lllll I h.vc hfth b.low rh. dcbili df rh. d$G{ IwabL ..dimosbl. ctc) of my*lt my spoe Md dU dcp.!*Ld5

A, D.rlils of mvabL .gbNot :1. A3 ct! itr joi, lme indicndrs llE cxr.nr of joid oM.6hip

*ill de h.vc lo b. enen.

1-/U

(.) Th. dctaib of 6.s srion(s) of $c@Fau 4(3) ed d.sriprion of rheofi€sdt for *nich @trvic1ed

(b) N@ of rh€ coun(r) cse No lnd dir.(tgleds(t:

o Puiih.nt inpos.d(d) WlEttcr ey appal wos/hr becn fited

.gdnlr th. mviclion or.l... lf e. der.intnd lh. Dcmr 3t,tru of (N rDul

ln c& of d.Doriulnv6tna( tlE d.i!il3 imlutlinS sdi.l NMb6, Anoun d.r.of dcrdir th. shrE, Nn. ofdE B&t4Liitlio .dd BtuEh @ lo b. 8'@

V.tE of B@dtshc ha$es 6 pa cu@lin 6p+r of li.r.d cmp.d6.nd 6 p.r boLs

DcD.rd.nr IEe h8 1l* !.G trFins a Nigncd in Explodion(v) ud.rc6otr ?54 ofd!. RcDrwrlrlid ot lh. P€otl. Ac{.1951.

D.bils iftluditrs Imut B ro bG 8iv.n spmrcly in cpel of @c! inv.tuMl-

m.*.r vrl@ in /soct .xch..8pir cg of nGlbtc<l obpsliq

S.No Sclf

-2 r,l1j)(iD :l+qq-<( a6s4.!--

6._6,'s!.nt!+\s^-\i:\oqk +ics.\c$.\a q \\s'lllgi{s et&\f.i$f r.^*r\c er\\la\,:r. ((\-*\ 6,bq\^-rq c* ricH! \60

?,r qas/-9 s g.4G.t a-.-a.trrcrt ;iaa i.srr^.s+v,a--\q\s<-SEa* !,r. -* i\F-tr!1-l\

'"r'^.'.PftQlllirrtB o$-{^<!1$-

NIL

(iii,

l!.{i[-i

B, I,.i.ll oa loD@rbL A!..rr:

Not : I Prep€nid i..ioid owa$ip idicding dr dt na of ,oi ovEahip sill rl$

d4.hrd Cudd bc n@lio|cd

-(t'wK

|r\9CEi, :\.o!re.'\6\lx$.}:*sa'i*,,Gq\a\r Hr \- b\\r\..t.\*::.\iat-ras!gc\\1\\a li-i,.!tr \. s$^e \r.s--9-- *\\(r\c\.!.Cc,.L-.3v-o!\}E6t1ir 1-r.E\a..9\.L(6'\.G-E:'rL. LF r'6\sa \' r\r :-sr ! q

\:i.l.'s'

(viD \sat$

(viiD

(ix) :r\!ur\\/. 31,:,s,"'"/

6-3c'4':e

f.,

s.N S.lf

t-l

D.

(i)

{iD ul:*"*

lru-

('iD

!q. n)

f'"[*

(8) I irt hciran b.loq dE .bni& of

(iv)

Blildi.at

)oog

(v)

(vi)

of(D

irhilni.r'dB 6 Nblio ilu&ld i

4,*u

aI

A@ of 8dr. ittrhd6, drY o. idividd d.FrDr t foc *l ban)

s,N S.lf D. D. D.P

r-3

ID scL tl^i\ a.-rl^-n*aT*,FJi S.!rl,SGq--r.,., .!q-r-tg Secat\\ 'rla!^\an--\$rlr$+:-$ \r \S. Lt\'a.

li.bility

|nbilitic.(iD

(iiD

(iv)

(9) D.tih of For..t@ 6@rid:(dsaf 9&Ar-$^(b) SpoE -S..-$,g.A-

(10) My .d!.ai@l $rlifidioo 'Ddas\\".9,lr.

( ci@ dcbils of hishd Sch@l'IJtrivdit, cd*nid ndtidirs th.tull fom of dE c.nifd.rdiplonu/dcrra @@, nh. of th.Sch@V colL8.rJnircRig &d tlE y6 in s,hich $c @uE *s

PART-BABSTRACT OF fiE DETAILS CIVEN IN O) TO (IO) OF PART

2.L NMba &d n'm of th.

Nnc of the politi.rlp.ny which $t up lh.odid.rc (orhflis wir.

3K RD?

t. (i)lot l .mbd ofF ding cG *l|Rclr46 hlvc be! Ae.dby th. Cod ao. o'IcI6pu.i5hblc wilnimpdenm for two

(iDIoill nub.r oa Fodinsc43 whd ln. @un(3)hlr r.ld @gDiz&Corhd thlr rh. c.stmtioi.d itr iGm (i)

Tdtl NMber ofc'G inqni.h @nvicLd ed$m.n .dimpd$ifun ror oF ye&o' noF ( exc.pr foror.tg Ffcftd b inrukio(llD2) or (3)of sdon24 of J&|(R.Dtsbrior of rb.

.4e-

t. Dalib of A$a udLi.bilitias in Rupca

S.la r.lMoFdl. as$( Tot lvd*) \'\.'d

aL Psbt* prie of rlf&quir.d imov.lblc

@n5ustiotr @s ofimov@bl. pFpcny !n r

lll Apporind. c||ml

(!)S.lf-&quit!d elst

9,

(ii)Los from Bd&fio*i.l i.slrrurid $d

10,

(ii)Les fiod B.dqFiMci.l ilnilurioN ed

ll ridqr cdMlion

( Civc d.roih of hishen

.dErioo mcofioning rh.full rom of th€cenificalddiplomdd.sGcowi tmc of d.Scn@lcoll.so4jniv6ityed th. t@ in which rlE

VERIFICATION

I, thc deFncot above nmed, do h.Eby vcrify &d dalN uar b. @ .nr3of thir rflidali N h& ed orer ro r!. b.sr of my bowt.ds. ed b.licf!,rd m t n of n is fd* aid rcthin8 mrdi.t hs b€n omal.<t rhGnon. I

(a) Tr'@ is m ce ofonvicrion or p.ndinS {4 against mc oth* thdmo* ncndon.d in nem 5 a.d 6 of pln A md B alovc.

(b) I, n, !poE, o. my d.Fn<hnls do rcr hls dy !sr.l o. liabitiry,orher rhe rhor edrion d in ircm 7 $d I of pan A ed n m 8,9 edI0ofpon B rbove.

vdin.d d \ar s.Lnisihc d",r"t ><\\ 4i.,l<DEPONENT

,/,1