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'FORM A

Communication with regard to Authorised Persons to intimate names of Candidates set up by recognised NATIONAL OR STATE Political party or REGISTERED UN-RECOGNISED political party.

(See paragraph 13(c) , (d) and (e) of the Election Symbols (Reservation and Allotment) Order, 1968.)

To

The Chief Electoral Officer, 2 ..(State/linion-Territory)

2 The Returning Officer for the 1/ . KAT/ //14/.2-„Constituency.

Sub, , t - General Elections to LogS Aefr 1 A from gm AA (State/Gaien-Tenitery) - Allotment of Symbols - Authorisation of persons to intimate names of candidates .

In pursuance of paragraph 13 (c), (d) and (e) of' the Election Symbols (Reservation and Allotment) Order, 1968, I hereby communicate that the following person (s) has/hpve been authorised by the party, which is National-Partyigtate-Partrirt-the-State-of /Registered Un:recognised Party to intimate the names of the candidates

prOposed to be set up by the party at the election cited above.

Name of person authorised to send notice

Name of office held in the party

District(s)/area (s) constituency/constituencies in respect of which he has been authorised.

1 2 3 1 -311YAM CHAN)3/4

301AUDHARy .

Seathotr fi;k4. Skil. cew044:, tte_

Cocumut.m.41- fls, g_

0,,,toueqptvol'st - LIDA,: v.,..:t t) • LA: b estaistA

AN

pi_

11; kv)...— .

Inserted by Notification No.56/97 Judi-III. dated 15.12.1997 ••

20

ilie I Nam I of Father's/ Postal ,.toc.titurac• ! the Mollie' '5/ address of approved Husband's I approved

candidate name of candidate

i

I

approved e.4nthdate

In putsuance of paragraphs I J (b), (c) and (e) and 13A of the Election.Symbols :Ku:me:vation and Allotment) Order. 196$ 1 heieby give police on behalf& -IP (part y 4.*-1..40,414LC04 lay;

6/-71,01-4.4 NtAtt;111--4.^.■,,-"zi •-tetain) ) 114:1 the

whose particulars ti -relinnished in columns (2) in (4) Itelmv is ill- appro‘td cat,,fidaic of the MI1V ab • i 1 me named, and

the Pelson whose paniculars ate mentioned in columns (5) to(7) below is the substitute candulate tol.the party, who wrii step-in on the approved candidate's nomination being

I ejected on scrutiny or on his 5vithdrawing limn the contest, il the substitute candidate is still a eel/nesting candidate.

•ttt.z ,..:stung general:bye election Cron this constituency •

.•: .1.

"iNtimeof the . substitute

candidate who will step-in on the approved candidate's -.noun:awn

being, rejecieti on set witty or on his withdrawing 110111 the

it substhute

: candidate is stilt a

I. contesting candidate

•

I Iather's7

Mother's/ Husband's name of substitute canditlaie

address of

substitute candidate.

--- •

Po s tal

'FORM B Notice as toname of condi late sec b the ethical tart Eire painratilis 13b

arid e and I3A of (he EleetSohnIt (Reservation andAllutinenalkiier 19681 I

'1 lie Kelton:rut Oilicei fro I is ti NA Q (.:ont,t it , Irr

Cameral/1)1c Iiieution tc LOK84.4.... from $r. pc4.1*- Constituency) in RAM—. .. (Stale/U.1140D itirtrY) candidats•

(Nanie of the setting up <4

7.:;; t's P 1 97

Check List of Documents in Connection with filing of nomination

Name of Constituency 1/ - kida•c- LISC:00 Name of the candidate ticcinairth AJcu'

0 4- it• . I tr Date and time of filing nomination paper ex:0

SI. No.

Documents .

Whether filed (write yesino (if there is any defectishor

coming in the documents, II same should be specified

Yet' • Y°34

0•••//4 Npos.

-

1 Affidavit in forrn 26 (a) Whether all columns ar filed up (b) If not, which are blank column (s) (Please specify). (c) Whether the affidavit is sworn before an oath

commissioner or Magistrate of First Class or before a notary Public.

2 Certified extract of electoral roll (when candidate is an elector of a different constituency)

rya '

3 Forms A and B (applicable in the case of candidates, set up by political parties.)

rt.

4 Copy of caste certificate from competent authority (if the candidate claims to belong to SC/ST)

N/A '

5 Security deposit (whether made) S"

6 Oath/affinnation (Whether taken) The Followina documents which have not been filed should be filed as indicated below :

(a) Should be filed latest by

(b) Above mentioned columns in the affidavit in form 26 have been left blank. You must submit a fresh affidavit with columns duly filled up before the commencement of scrutiny of nominations, failing which the nomination paper will be liable to be rejected.

(e)

(Signature) Date & Time : 06 • O .,at

Place k.4 • Len. • N.B. I. The Affidavit in Form 26 and Form MB have to be tiled latest by 3.00 P.M. on the last date of

filing nominations. 2. The nomination paper will be rejected if a candidate fails to fill the blanks in Form 26 even after

reminder by RO by the hour fixed for scrutiny of nomination paper.

3. Oath has to be taken after filing nomination paper and before the date fixed for scrutiny.

4. certified extract of electoral roll can be filed up to the time of scrutiny. 5. Security deposit should be made either before filing of nomination paper or at the time of filing of

nomination paper. Therefore, there is no question' of issuing notice for making the security

deposit. 6 If the columns in the affidavit are blank and incomplete the candidate should tile an affidavit

complete in alt respects instead of filing an affidavit In respect of only the blank column's and the second affidavit which be the complete one will be disseminated through the web site.

should be filed latest by

Received.

\ (M)1 •

(Signature of Candidate) Sigma

I -7617. R trrie,',44 f alai1st%

ARRRFVIATIONS

Coati 75 Sc .

Cloning II. fill

Imehlet It lit

Wan. is Rut sirTranske 19 PO

reproc 20. mc 'Mr

21. OEM

mission 22. OSC.

Exchange 23. Reid.

Dividend 29. BE

Warrant Debit Credo Standing Instructions

MLA

mew fee wit* tit

entft oft Nerve feta as

11 DW

12. Dr. 13. Cr. vs. SI.

Service Cnargan I Ivenli.111 •

I lanami pr.

PolUMed Pay order Inward Bala for Contotion Outward BOB for Collection Outstation Cheque for collection

Released Bill of exchange

A fr• 111•11•Sne..-

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W(1

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15 *11

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21. :41.4147

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ALLAHABAD BANK

wrm cifirqW WI7t1

Nature of Pass Book : Account No:

SAVING 50198939803

NT.1.1 7E1770 21 WI'

Name & Address of the Breneh(DIALTOLI IC 1334 ) VI LL P 0 GMALTOLI VIA BARSOI

7414 Rd Telephone No DIST XATIMAR 854105

447.417GIETPIN MSC 0

12113144134R ¶Z? MICR Code !LLLA0211334

SitaltIRW aA1 aN / Name of AccRAPREAW a.

MC. MAXIMS ALM C.

CIF No 4-4 r PAN

30102537n)-0

NA

rized Signatory

EIMPTRIF(M) TtetitiNDetall• of Account Holtioi(s)

7-4"7""(jun"V0190g3g803 RMIName(S) maim ALAN 17a/Address SO ABDUL HAKIM, VILL SHIVANANDAOUR

DIST KATIHAR-855102 BIHAR

IIFITITTIR iri1 AlFR/Mode of Operation • OPERATING r trKt.w

artwqr RRDRocurring Deposit

'..flint 11/44Ot *, let WI '% /Last Installment due on or before: e Int/Installment Amount Tratb/Pertod vim VtRate of Interest etswirif a9 fgfktmater of Maturity

ITITT2NRE TIMIMMaturhy Value

angtga *1 Pram/Nomination Details

;rsireil riltrra tiNominalion Registered : rfrAtTrol /Registration No. iso RTIT a=t fare, **We* MIPTIPF t isremstrs t1 EIFINAI SING. Name of Nominees 006 where nominee is a minor Relationship with Depositor

ltnn Aff4 4 tortkiDaw of Openiriii if Ail

,•TafrtrtfOccupalion : wra# Ti./Contact No. :

sexatzrs t Drifts) glVl wr4 ftgaa ateda wr am

Name of Person appointed to receive amount on behalf of minor

NO

17:7IT DATE

fadTBI PARTICULARS

N4 N. CHEQUE NO .

Ann 'UM AMOUNT

WITHDRAWN NM EtIN TOT

AMOUNT DEPOSITED

MR By

BALANCE

0401114 1160 1331 50190131803 02:01/16 1ser-14: 24400; Iteleared MO M: 0.00 02101/14 Iser-14: 1461S: BOO Balatce:

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