Tsec.gov.in

SCHEDULE― A GHMC ACT 1995
FORⅣ 18
Nonlination Paper
(SCC SCC 36)
As amendcd
Election to the Municipal Corporation of the City HYDERABAD .. 2016
l
.
Nalnc ofthc VVard
2
Nalnc ofthc Candidate
3
Father/Husband's Narne
H5-Balai Nagar Division
G.JYOTHI
G Dattu
4.
Age
.
5.
Address
¨
6.
If
the candidate is a member
Of the schedule castes or
Scheduled tribes or backward
7.
8.
7 tt,,{
The candidate in、 vad elctr01 roll
9.
Name of the proposer
10.
Part number and serial No.
H.No.15‐ 31-2L-94/4,LIG― HI Phase
KPHB,Hyderabad
classes..
Number and Name of the ward
Elechol rolls in which the name
of the candidate is incuded
y Lr
(,1.
Part Number & Serial No. of
.i \
39 years
〔
rl―
t>,*.&+
H4-Bttail Nagar D市 isf
12‐
64
I.Vijaya Lakshmi
Of the proposer in the ward
Electrol roll concemed
H
O.C.
P「
1,レ
譜
ttgnature of PЮ poser Fυ・
く
可αり静玖
DECLARATION BY CANDDAπ
Date:17-1_2つ ′
6
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「
12-105
I,hereby declare thatl agree to ujs nomnation.
.こ
G.:刃 0千 ′
1
Signature of Candidate
G' il
oTHi
t
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︰
TWENTY
１
RIUPEES
ル
鶏:椰P｀
職吉
蜘
21‐
To Whom:,で
「
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0艦
LiCENSCED STAMP VENDOR
Lic.NO.:15‐ 20031/2013
ン
Ren.No■
15‐ 20‐ 022/2016
H No:20135/5,R● llaguda Road,
Affidalit to be furnished by the candidate contesting
""
"?tf.Hff;Me$Effiflfl'R'R'oist'
Municipal Corporation along with nomination paper before the Returning Officer.
FoT
Tldtion of GREATER
From : 115
-
HYDERABAD MUNICIPAL CORPORATION
BAtAll NAGAR DlvlsloN
I G.JY$THI, 1ry7o G.Dattu, ageo so years, resident of H.No.15-31-21-96/11, LIG-lll
phase, KPHB, Hyderabad, a candidate at the above election, do hereby solemnly
on oath as under: .
. affirmhnd state
1) Iam a candidate set up byTELANGANA RASHTRASAMITHI PARTY'
2; I D"t.ir. of permanent Account Number (PAN) and status of filing of lncome Tax
‖
「
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￨
1賞摯性
12型
fttrtaX 1坦
ttT,Wll° 器
`return(in Rs.)
Gr'3{oruj
￨
鋼11醸話
檸
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i:2ti
ι
3)
The following Case (s) is/are pending against me in which cognizance has
been taken by the court.
(a)
(b)
Nil
N/A
@r
(C)
4\
Description
Offence
The details of cases where the court has taken cognizance
sections of the Act and description of the offence for which
cognizance taken:
t,tarne of tne court, case No. and date of order taking cognizance
revision (if any) filed
against the above order (s)
S.no.
Nil
cases in which I have been convicted bya court of law:
(a)
ffii6e
NI
Act and description of the offence for
which convicted
:
N‖
(b)
(C)
Nil
Punishment imposed
5)
That I have herein below the details of the assets (movable and immovable
etc., ) of myself, my spouse and all dependents :
A.
Details of movable assets:
Note:
1
Note:
2
Note:
3
Note:
4
Note:
5
Assets in joint name indicating the extent of joint ownership will also
have to be given .
ln case of deposit/ investment, the details including serial number,
amount, date of deposit, the scheme, name of the bank/institute and
branch are to be given.
Value of bonds/ share debentures as per current market value in stock
exchange in respect of listed companies and as per books in case of
non-listed companies should be given.
Deponent here has the same meaning as assigned in Explanation (v)
under sec. &5 A of the representation of the Pole Act, 1951'
Details including amount is to be given separately in respect of each
investment.
Ｓｍ
Description
Spouse
G Dattu
30,000
Cash in hand
11.
Se:f
G」 yothi
Depon
ent -1
20,000
NIL
N il
Nil
Depene
nt-2
Nil
Deposits in bank account
(FDRs, Term deposits, and all other
types of deposits including savings
oetaits
of
accounts) deposits with financial
institutions, non banking financial
companies and cooperative societies
and the amount in each such dePosit
savinds Bank Accounts:
State Bank of Hyderabad, KPHB
NcNo.62357 477 768
5,000
Andhra Bank, KPHB
A,zc No. 146710 7OO]-L37 45
０た鰯
C
`
N
500
匂・謝 0租
l
ヽ
Details of investment in bonds
debentures/ shares and units in
companies/ mutual funds and other
ヽ
Ni
Ni
Nil
and the amount
Details
IV
of investment in
NSS,
Posta
I
Savings, lnsurance Policies
and
Financial
lnstrument
investment in any
in Post office or lnsurance Company
Lrc- 601987705
Personal loans/ advance given to any
person or entity including firm,
company, trust etc., and other
receivables from debtors and the
amount.
Motor vehicles/ Air crafts/ Yachts/ ships
(details of make, Registration no. etc.
year of purchase and amount
V
VI
Nil
50,000
N‖
N‖
N il
Nil
Nil
■5,000
N‖
Nil
ＮＮ
NIL
TVS Victory No. AP28AJ3566
N‖
Date of Purchase: 2003
Vll
」
ewe‖ ry,bu‖ lon and valuable things
(giVe details of wg.And value)
Gold ornaments―
loo [email protected],500/―
30 gms@2,50o/―
2,50,000
75,000
Silver ornaments
l Kg《)35,000/―
Vl:l
Any other assets such as value
IX
claims/ interest
Gross total value
35,000
of
Nil
Ni
3,70,500
1,10,000
N il
NL
B. Details of immovable assets:
Note:1
Note:2
Ｓ．Ｍ
ハリ
ａ
窃︼
瑕
κ
Properties in joint ownership indicating the extent of joint ownership
will also have to be indicated.
Each land or building or apartment should be mentioned separately in
this format.
Se!f
Description
Spouse
G.」 YOTHl
NIL
NIL.
Agriculture land
Location (s)
Survey Number S)
Area (total measurement in
acres)
Whether inherited property
(Yes or No)
Date of purchase inc case
of self acquired property
絲
G,w♂
Nil
l
NIL
―
NA―
―
N洋
―
NA―
N苺
―
NA‐
NIL
Cost of land (in case of
purchase) at the time of
purchase.
Any investment on the land
by way of development,
construction etc.,
Approximate current
market value
Non - agriculture land :
Location(s)
Survey Number (s)
Area(tOtal measurementin
:
―
NA‐
―
NA‐
‐
NA―
―
NA―
―
NA―
―
NA―
NL
―
NA―
―
NA―
―
NA―
―
NA―
―
NA―
―
N洋
―
N洋
―
NA―
―
NA―
―
NA―
―
NA―
―
NA―
―
NA‐
―
NA―
‐
NA―
―
NA―
―
NA―
Builtup area (tota I
measurement in sq.ft)
Whether inherited property
(Yes or No)
Date of purchase in case of
self acquired property
Cost of property (in case
purchase) at the time of
purchase
―
NA―
―
N洋
―
NA―
―
NA―
―
Nん
―
NA―
―
NA―
―
NA―
Any investment on the property
by way of development,
―
NA―
―
NA―
Approximate current
market value
―
NA―
―
NA―
Residential Buildings:
N洋
N洋
―
NA―
―
NA―
―
NA―
―
NA―
No
No
‐
NA―
―
NA―
―
NA‐
―
NA‐
Sq.ft)
Whether inherited property
(Yes or No)
Date of purchase in case of
self-acquired property.
Cost of land (in case of
purchase) at the time of
purchase.
Any investment on the land
by way of development,
construction etc.,
Approximate current
market value
Commercial buildings
(including apartments)
Jocation(s)
-Survey No (s)
Area(tOtal measurementin
sq ft)
construction etc.,
lV
不
ア
(inCluding apartments)
―Location(s)
―Survey Nos
Area (tota I measurement in
sq.ft)
Builtup area (total
measurement in sq.ft)
Whether inherited property
(Yes or No)
Date of purchase in case of
self acquired property
Cost of property (in case
purchase) at the time of
purchase
G・謝 07Hi
V
V
(6)
Any investment on the
property by way of
development, construction
etc.,
Approximate current
market value
others (such as interest in
property)
Total of current market
value (i) to (v) above
―
NA―
‐
NA―
^N洋
―
NA―
―
NA―
―
NA―
―
NA―
―
NA―
i give herein below the details ofliab‖
ities/dues to public financial institution
and government:―
(Note: please give separate deta‖ s of name of bank,institution,entity or individual
and amount before each ltem)
Ｓ
＾
Ｖ
Ｎ
￨
Description
Loan or dues to bank/
Sef
Spouse
Depen―
dent― ■
Depen―
Depen―
dent2
dent‐ 3
―
N洋
―
NA―
―
NA―
―
NA―
―
NA―
―
N丼
―
Nん
―
NA―
―
NA―
financial lnstitution,
amount outstanding,
nature of loan
―
NA―
Loan or dues to any
other individuals/
entity other tha n
mentioned above
Name(s) amount
outstanding, nature of
loan
Any other liability
―
NA―
―
NA―
―
N洋
―
NA―
―
NA―
Grand total of
―
NA―
―
NA―
―
NA‐
―
N苺
‐
NA―
N洋
―
NA‐
―
NA―
―
NA―
―
NA‐
―
NA―
―
Nん
―
NA―
‐
NA―
―
NA―
―
Nた
―
NA‐
―
NA―
―
NA―
―
NA―
―
N丼
‐
N洋
―
NA―
―
N苺
―
Nん
―
NA―
―
NA―
―
N苺
―
N苺
―
NA―
liabilities
Government Dues:
Dues to departments
dealing with
government
accommodation
Dues to department
dealing with supply of
water
Dues to department
dealing with supply of
electricity
Dues to department
dealing with supply of
telephones/mobiles
Dues to department
dealing with
government transport
(including aircrafts
and helicopters)
)/
rovticrre \'1
lご
°
瑠プ
次
光
QЪκ
,I
Wt
ヽ謝。
NOTARY
“
る、
―
N鮮
―
NA―
―
NA―
Nil
―
NA―
―
N丼
―
NA―
Ni
Ni
―
NA―
―
NA―
―
NA‐
NI
Nil
―
NA―
―
N洋
―
NA―
Nil
―
NA―
―
NA‐
―
NA―
Nil
Nil
―
NA―
―
NA―
―
NA―
Nil
N‖
―
NA―
―
NA―
Nん
Nil
Grand total of a‖
︲
︲
一
Ｎ
「
Nil
lncome tax dues
Wealth tax dues
Service tax dues
Municipal/ property
tax dues
Sales tax dues
Any other dues
Ｉ
Ｉ
一
Ｎ
gOvernment dues
(7)
(8)
Details of profession or occupation:
o
Self:House wife/SOCial Service
o
Spouse:Pvt.Employee
My eduCational qualification is as under:
9th Standard― ZPHS SChOol,Manga:apa‖
i―
■999
(G市 e deta‖ s of Highest schoo1/uniVersity educajon menuoning the fu‖
form of the
certificate/dip10ma/degree course,name of the schoo1/cO!lege/un市 ersity and the
yearin which the course was completed)
9)
ABSTRACT OF THE DETAILS G!VEN:N(■ )TO(8)OF PART,A:
2
5
PAN of
7
■■5-BalaJi Nagar Division
TELANGANA RASHTRA SAMITI
PARTY
N il
Nil
Total income
shown
G」 yothi
NIL
G Dattu
Dependents
NIL
NA
NA
NIL
NA
NA
Details of Assets and ttabi1lies in Rupees
Self
Description
G」 yOthi
A
B
ほ
咆嘉θ
1瑾
Phase,KPHB,Hyderabad
Year of which
last income tax
return filed
NA
6
3
H.No.■ 5-3■ -2し 96/■ 1,LIGJ‖
Number of name of the constituency and state
Name of the political party which set up the
candidate (otherwise write "lndependent")
;tNumber of cases in which conviction order
passed
b) total number of pending cases where the
court (s) has taken cogniznance
3
4
1
2
G JYOTHI
Name of the candidates Sri/Smt/ Kum.
Full postal address
1
:i:i】
Movable Assets
(tota I value)
lm movable
Assets
3′
70,500
N‖
Gr'lloTtit
NA
DepOnent
Spouse
G. Dattu
DepOnent―
■
-2
1,10,000
.NA-
―
N丼
N‖
―
N丼
―
NA―
(
￨
ヽ
￨￨
8
Purchase price of
self- acquired
immova ble
property (tota I
value)
Approximate
current market
price of assets
(total value)
―
NA‐
―
NA―
―
NA―
―
NA―
NA
‐
NA‐
―
NA―
―
NA―
―
NA―
‐
NA―
Ni
Nl
―
Nん
―
NA‐
―
NA―
Nil
Nil
‐
NA―
―
NA―
―
NA―
Liab‖ ities
Government
dues (total)
Loans from
Bank,Financial
lnstitution and
others(totaり
9
9th Standard― ZPHS SChool,Mangabpa‖
Highest educational qualricatiOn:
i―
1999
(Give detalls of Highest schoo1/university educa■ on menJoning the full form of the
certificate/dip:Oma/degree cOurse,name of the schoo/college/university and the
yearin whth the course was completed)
VERIFICATION
l, the deponent, above named, do hereby veriry and declare that the contents of this
affidavit are true and correct to the best of my knowledge and belief and no part of it
is false and material has been concealed there from. I further declare that :
o
There is no case of conviction or pending case against me other than those
mentioned in items 3 and 4 above :
.
l, my spouse, or my dependents do not have any assets or liabilities, other
than those mentioned in items 5 and 6 of above.
Verified at Balajinagar this the
I+
day of January 2016.
G・洲
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FORII―
III
See Rule 4)
イ
I,
hereby declare that the code
of conduct prescribed by the
Commission has been read by me/ read over to me and
I will
State Election
abide by the conditions
stipulated therein.
Dtte: fマ
6.」 0■ イ
、
ーl― フ可も
￨
Signature of Candidatc
Nalne:G JYOTHI
signed before me on
this
la
day ofJanuary 2016
gnaniΨ鴫
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暇帥→
―
Cr'5Yofl-t'
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ON ACCOUNTS OF ELECT10N EXPENDITURE
I, GJYOTHI, w/o G.Dattu, aged 39 years, resident of H.No'15-31-2L-96/77,
LIG-lll Phase, KPHB, Hyderabad, Municipal corporation GHMC having filed the
nomination for the oflice of Member of 1 l5- Balaji Nagar Division hereby acknowledge
that I have been supplied with a copy of the State Election Commissioner's Order
no.392lTSEC-ULBs/2015 dt.21.07.2015 relating to maintenance of accounts of election
expenditure by the contesting candidates and also the Notification No. 409/TSEC-
ULBs/2015 dt.02.07.2015 prescribing maximum limit on expenditure which can be
incurred by the contesting candidates for the said offences.
I
hereby declare and undertake to keep my election expenditure within the limit
prescribed and also to maintain true and day to day accounts of the expenditure in the
manner prescribed.
I, further, declare that I am fully conversant with the legal provisions contained in
Greater Hyderabad Municipal Corporation Act, 1955 and rules issued there under dealing
with election expenses and I hereby undertake to act in accordance with these provisions
of Law and the mles made there under and in the true spirit of democracy while
contesting the election for the above mentioned office.
'
G SldtH;
Signature of Contesting Candidate
The above declaration is signed before me
RETURNING OFFICER
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DECLARAT10N
F‐
(lo be rlled bv cOntesting candidate along with nomination DaperSヽ
I,G.」 YOTHl,w/oG.Dattu,hercby
declarc that l am not disqualifled to the best of
m,kl10WiCdge and belief for being chosen Ward Member of l15-Bdai Nagar Division
of Greater Hyderabad Municipal Corporation tmder sec.21A,21B and 22 of Greater
Hyderabad Municipal Corporation Act,1955
Date:
dz
(+-(-)-o(5
JYorHi
Signaturc of Candidate
Narne:G JYOTHI
signed before me on
this
l?
day ofJanuary 2016
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GHル IC oRDINARY ELECT10NS,2016
Ward No. & Name
NEAR TEMPLE BUSSTOP
Electoral Roll Sl. No.
64
:G Dattu
Yrs., Gender:Female
Door No.
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EPIC No.
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Whether the candidate belongs to Scheduled Castesor Sched―
uled Tribes or Vimukhaathis or other socialy and educationa‖ y
backward ctasses specified in the Andhra Pradesh Educational
Rules oris he a convertirom the Scheduled Castes orthe Sched―
uled Tribes il so the paniculars there of
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Eligibility
For Abhaya Savings, Abhaya Savings Plus, Abhaya Gold, lnsured Cunent Deposit applicable to only
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Electoral Roll Sl. No.
105
Name
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Form一 IV
[See Fule 5]
This nomination paper for the Election to the Office of f'l' tt
Municipal corporation
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nou,) I ?1r ) lF,.
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from
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Strike off whichever is inapplicable.
11: t'
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GHMCE:ections‐ 2016
KUKATPALLY Circie‐ 14A′ Ward No.
,Iダ
Candidate's Profile
Si No
Particulars
4、 Oヽくてし主
Name of the Candidate who filed nominations
1
B蜀
Age
F
Sex (M/F)
4
MaritalStatus
ロ
5
No.of living children
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Present occupation
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whether contested in any elections previously, if so
particula rs thereon
14
一
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Elected positions previously held, if any
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Add:!nformation
No.of Nominations sets filed with serial Nos.
Name ofthe Candidate(To Spel‖ n both ianguages)
16
Telugu in clgar letters
,2却
脅
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English in Capita I Letters
一
ノ
specimen signature of the candidate for supply to the
Pr. Officer to compare the signature on polling Agents
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18
Name of the authorized persons to receive day to day
communications/letters from the Returning Officer
and his address:
Contact No MOb‖ e
19
Name of the authorized persons who will submit the
day to day expenditure detils to the RO & to the
His Contact No.
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Name of the Election agent, if willing to appoint
20
His address
Contact No.
Specimen signature of Election Agent
Date:-
.2016
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10
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Eductional Qualifications
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NOMINAT10N PROFORMA FOR ONLINE ENTRY
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CANDIDATE
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DETAILS:
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FATHER/MOTHER/HUSBAND'S
NAME
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4
AGE{IN YEARS)
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ADDRESS FOR CORRESPONDENCE
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SERIAL NUMBER OF THE
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10
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MARITAL STATUS
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EDUCAT10N QUALIFICAT10N
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DATE OF NOMINATION
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PARTY CATEGORY
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PROPOSER DETAILS
哺矧な星
SERIAL NUMBDR OF THE PROPOSER
IN THE ELECTORAL ROLL
磐°
洸慧
鶴ぽ
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