o1l ttl zorVl Ao- z\ Ptu^'*''a'-(r--*.-ltt q', o^ /

,oor-"o

D#",-)?;,!.,sH

PART I(To be used by cuiJ dlrc set op by rccosn ised poli rical pady)

lnominale6a€ndidat lor€lccridr t' rlt t gislativeAseDblvfrod&eAsenDr' ,i trJ'cy., andr'rlre't'rhe b..rlr )n^-;.,t Mt"ibt

i"' - ..--....._,r,V"aa.rn-'uu.ounot

n-d Ara,,l Qb,^^^ Mdya H's po{hlodd*sJ 0

t:15y1:1 "":"::1i:"i,T""*!**;.*, #"r"4,- Ili'nrnL6elkrdrS No. Aaq 0 0nPdNo

Dre,I1:_iLzolg .

PnrtII(To be used bl c ddatc nolselupby

we her€by nominale ss candid.lc for eleclion ro

STRTKE OFF PAR f IgBf,Olrl\iir.rr ir rammu,"a r^rmr

uI tf;,X* *"r.,,ruuo ,s NoTAPPLICaBLE

recoenGed polilical pany)

ihe Assenbly Consritnency lron the

Fathels4!{otheivHubdd's nme

at s. No. __ in Parl No.As*D1bly Consliluency.

We declare lhal we are elecro6 oi I re above Asedbly cohstiiuency and our ndes de entered

in lheeleclorulrcll fo! lhe Assnbly ( (, rsritucDcy !s indicated bcloP and we app€nd our sign.ruresbclow in roken of subscnbinB to thi i.niiatlotr :

Prrliculars olthc pronos€.s.nd lhcir signrr!rcs

Elcctoal Roll No. of ProNsel

2.

L

5.

7.

L

10.

fi-Bi rhde should be ren AsF,'l rlrc con$itudcv d poposeu

PAm tll

. I.lbe caddidate dendoned in lhn l/!an lt Glrike out which is nol aDpliqble) $sent io ss

nosimlion and hcGby &clare :

(s) ftarrhave oftPle&d 66 -YdmofaellsrRrKE oirr b(i) oR bl ii) RDLow wHlcievER ls Noli:l:i:::'

'i;i:i:flil#mlllilli::rll,*--."W'*ffi ;H:H'"T:i:l'#

"'ll:,l,:L11,:.:.l,il;:.1'l.ilii",;*-".".","'",*iii:""f ...l";ii;ffi;il"i,ji;;:lijl ii,'.*; Jh-# is not dppricabrc) dd 'nat

thc $e svnbors I

h,!;.hosen. inoder ofPftfcEie. d€:

\i) NA,.,,t',,.rI* -a.r,o r - ro l l'/hu'band' @e ht\e been cotrecn) sp'rL od abole

nr ,:*"|;rl^ ln" ' c lrh( raneutser:

'r, ;;;{;*',

"' .' "' r'-'

',a beri'r' I

'n qu.'ined

'nd {t ar'o disqd'ined ror

''' ii'"c"i.*ii. n'r,'" ' ' ri'r ccilrari\ e A$'mbh orrhi'sra'e

I rfunte.decr,rc.r..r.1r ,.rr... orrrc __:! A. c6l. qiicl',s t*"a"r.i "l'i.i,r'" ii"i.l 'r'

r'R sh'|rr inrcrar'onro- d-4: rdrearol MI

I aGo decrat that I hrve "r hrLtr ird sr rl nor.be nonin1l"l:::T::"j:.::"i::

",",' '''*,'"i'"lT:,l.i '::., '.

. . ..i," r.rJ .i'",r'""."u\r). ,o 'r-e

Harra i\e A*embr'

:i;..;;;l;r,;,;i." ",,. , , .! ^\rrbD .onrruen""

A -4.4.,J

I Score ou1 rhe words nor applicrbl'N.B.: A 'Bognised polirical n'r' u'Jisrnnder lhc Elecrion Svnrboh (RcscrrL!r rnd Allohenr) Orde( 1963

'n

by $e Dlecrion conm'slon

PART IV(To be fiUed by rhe @ndidate)

(i) h6 b€d co.licred

(a) of any ofence(t uhdei slb-secrion (l) of section 24 of $e Jamnu and KashnirRepEentadon oflhc people Acr, 1957 i or

Yes4{<tz

(b) foi conlravenlion of any jrw sr.cified in pflie to $b-srion (2), of sclion 24 of theJmnu and K6hmir Rep€hlation of rhe people Acr, I 957 (lv of I 957) ed sentenced rotmprisonbed for not l6s lhm six nonrs I or

(ii) h6 ben convicred for dy olhq oll€.eG) for qbich he hs he.n s.nie.ced lo inpri$nmenlfor two yees or inor.

Irihedswer is Yes . rbe cmdida& shau funisn lhe fo0owing informlioh :

(i) c6e/Fnsi informalioh iepon No.No'policerdionrs,_ lrl Dhhcis,

^d sklel.':riL(it

(iii)

(iv)

('i)

(!ii)

(viii)

Gi)

seclionc) of the onccmed Act{s) bd bricf descriprion of rhe otrehsc) for which he h6b€e' convicred ir;l

c;unG) whicb coovided $e mdidac

Punishnen(s) i6posed Iiodicateli.(rl a/;,Dare(s) orcrede frcn prisoi Ni!

period or imprisonhen(s) and/or quanrum of

rtvision has,ha\e been dsposed oror rr/s€

NJ

w,twere ffy appelc)revhion(s) filed asoin$ .bo!e conviclioic)_,- ILODa.e a.d pdnnulaE ofappealrs, appti.dior(sJ tor rcvn'on nteJ

i.ill 'T;;",,,,. berore whch,he appear,.r ippr,c!rion,"' ro' 'e\ision

rriir lrrhesdappea(sy'apptrsrion(st

G) DareG) ofdispoel

(b) NaruEororde(t

Dac: lO-ll- Zorq.

lor evisiotr has/have ben disposd oa

ril

appeal(s)/rppUcation (s) lor

'{Autborizarioi orasent)a cardidatc aI tbe abole etcclion hseby

Add.*t toialaitiw;ti;. rDp.. (hane)

---

(Futl

phcelacxe lo et 6 sch &thoriad asftt.

(SieE,ure of $e Jat,onrcd ilenUs(drd||h5pin@phlfrc'3pp|lcabh

PART }'Ialo be filled by the Rehmins Om€€,

ssalNo. of nonimnon paper or f / ALa4U2^ - bt B^!,r"*,24,'"' J* ili:ff li:l)S *":li,f,.'

b me ar mr ome a'l'/ 54a1 r.., ^ ry+;ff^ w

D4e_ ll: ]]j:prg=.sc$.wdetapp|ic.bh

- PART VUD.cisior orRctu&ingOfiic.rAc..r,ring orRejecrins rh.Nonin*rion paD€r

- rhaveexdined rhk nohinarion prpfi inacsdtuce wirhRepRinta,ion oirhe p@prea(r. l;;i;; ;il:;?:iJ:ll"r'on17or'her@muad Kohmir

PARTVIIIRecipr forNonin ion I,apc. and Noti.cof Scrulin,

(To be handed over ro rhe peNn prcsenring rhc Noninarion raper;Serial No of nominarion pdper

The nomin ion luper ot

*_;;, ;--=aair ry rr.,";;.;;*i";#,;:i;il;"*, "r, ffi;il,iJ#:,":ll

e.,".urii;,.iiiifi'l,l a",ri*J. * ,. i",*f."".,fl erec,ion ,rch .hc

*ur;; :;;"r,i ",' "'"ril::illl,':ll:ffH ^,,,

omhaion pape,.i1l

,s."-.'1.*t-',ppI."ut.

An&{ 'o/iLnk

hy $c wdd& rqsIqddidb,&xl4ed!A*obb

\(ry.

y/t/

e4!l! |rlr ardd RrbDri Mr;

1,tu D,,i,icr Pd!@i r&R i d

(r) r @ a @die d q br 1L rdiu Nidod .o4F!s(:) Mr @E c -6rd i! R{jtsE asso

o) My cftd rr+be Nm!.r m e(troris Jir 3d4s Eidaqour(fay)aE l\ir

(1) DddL ortsm4n Aaomr Nunk (pag d n'tu or6ri4 orh&hc rq

, hq tuE kr 6nd by @ wdc)

t\vr'n;g!.=

'r ar 6rbr3 klt i6 Foes @hyde@nte6ftcgtudh6tired:

&ddqd4'de@

a\

iq\-&t@@4dlt:fub6d":dIrcoMd@,r,tudd@

?,reiqEbedbde|lsri,ldreuaDd.dnd

'I

!Ad&r4redodc*t&D'

I

FI^'g\s

uJ

'l

r]

5

fo'q'*

/

62

om!6nip win rerlr b b. ilrcded

Nore 2 E ch Lnd o blildiig or .ptud dNld be neodotred

ep6adyinlhjsfofu'

aT I r2lt 9

Ftt\1

I

F/1

I

7i*F-'!*

08

'tI

{'li

la; ffi-

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tT 112111

{ N* er.ar s@ llFe dtuL or un of bri! us1.id. ldrl u

f'{

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a ;frs+:"7

e) kdboisdsidoa$blt sdr-adYhrdiMb) sp.us. otu*nt!)

ro)My durr6 qurifieror isadd

Ar I12114

I O)TOOO)OFPART A,ffiVII-LAGE NOV"ORA PA\3ENCtsSIL LMER DISTfuCTPULWAMA P/O ACHAN

, rdd Dnhq ot Fdiis o!3vh.bg6bebde.ndby'|'.

sdl,trtqr&tutu

.u', l**.,1

at

I

i

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Nir

i'r '7\ a Nil

H4ktutuq!!fu@ a*. B

Ar 112117

r, rh! d@ent ee @!x4 do lEby t6t d d4h d ! oih6 of

pdditn|&,didhr4iMd

trid.atu eof @rtui6qFi

6wn.d'tdhilmT.id3olpdAd

tlll6d4P!*m!oid,'& r3o dj dtNolqer b 4

{,

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