BSTRACT STATEMENT Of ELECTION EXPENSES

PART -I

ame of Stare/Union Territory

ature of Election(Please mention whether GeneralElection to State Assembly I LokSabha B e- election

v

Go ~~L £ L#ZLr/O If '["1I

$ /"'f.l-~ A S ~ETYl bDate of declaration of result

1~.-/6-~}--------'-------~__t-----___l

VII

Name and Address of the ElectionA ent

VI

Whether the party is a recognisedolitical artv

Yes/No

If candidate is set up bya politicalparty, Please mention the name of thepolitical ar

VIII

Date: Signature of the Candidate

Place:~

PART-II : ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE OF CANDIDATE

S. No. Particulars Amt. Amt. Amt. Total Election expenditureIncurred Incurred/ IncurredI Auth. by authorize I (3)+(4)+(5)Candidate d by Pol. authorizeI Election Party d byagent(in (in Rs.) othersRs.) (in Rs.)

1 2 3 4 5 6I I Expenses in public meeting, rally, procession

etc.:- ,Lt ~S-)..'1I. a: Expenses in public meeting, rally, ~ ?>S)..~,-V - -~ procession etc. (ieenth" than the ones with

Star Campaigners of the Political party I-t+Enclose as per Schedule-L]b: Expenditure in public meeting rally,

I I procession etc. with the Star Campaigner(s) (ie:'~SJ 86 I - )SS ,~~ I 0<1", than those foe genera party propaganda] --(Enclose as per Schedule-2) i -

Campaign materials other than those used in the cSl\~I -

public meeting, rally, procession etc. mentioned i/ --- .;- I443, _f ----

----.--,--" J- -ir:56)..

,../'"

S'~/~! --------~---------)...0-,..,$->

, 163'S) "/

~~o t~p~a~rt2ic~u~l~ar~s~ ~~~~~ __

r+ !mount of own fund used for the election campaignL Enclose as per Schedule - 7) ~f :3I Ti------t----'L~u--'m-p-'s-'-u-'-m-'-'-=-aLm-=-o'-u::...n~t.:.:r:...:ec:...:e:.:..iv::...e-ct.:....Lfr-o-m--th-e-p-a-r-ty--(i-e-s)-j-n-c-a-sh--o-r-c--he-q-u-e-e-t-c.-----------------''-------=---=-=--'"':

Enclose as er Schedule -8 N(L-

III

444

.mditure of Candidate

<1.1

--- --- --------- --

~uJe- 1

/;.';:.01 -, "; In plIbllr" meeting. rally. procession ere, lie: other than those with Citar Lamp.llgJ'ler'~ "I I" •...P"Ii{ i(.d p.u Iy J. 'U Nature of Expenditure Total Amount Source of Expenditure-'

in Rs.i\mt. incurred / Amt. Arnt. incurredAuth. by Candidate incurred / by others/ agent by Pol.

Party wlthname

: -1 2 3 4 r h

~-1 Vehicles for transporting visitors z» o 110 V·~t~ -'L Erprtine St;!ep, Pa nria] f!., Furniture. Fixtures. ]:'01.;>5 etc. .;1...1 (') trl ~3 Arches & Barricades etc. ".s-~It u

-- --- -4 Flowers/ garlands -..-5 Hiring Loud speakars, Microphone, amplifiers,

comparers etc.

6 Posters, hand bills, pamphlets, Banners, Cut-outs,hoardings

7 Beverages like tea. Water, cold drmk, JUice etc. -8 Digital TV -boards display, Projector display, tickers

boards, 3D display -9 Expenses on celebrities, payment to musicians, other

artists remuneration etc.

10 I Illumination items like serial lights, boards cte.•.....

~EAI-'t!II~t!:.VII II dll~I-'Vll, HelicojJLe,/ aircraft / vehi~:lp.s/I

11boats etc. clldl ge:. ( fVI self celebrity VI'any ut het ..-campaigner other than Star Campaigner)

12 Power consumption/ generator charges,

13 Rent for venue $6C'C y

14 Guards & security charges-?'

15 Boarding & lodging expenses of self, celebrity, party -functionary or any other campaigner including StarCampaigner

16 Others expenses---. ---- ..----- - -----.---

Total Lts >21.; LtS~.:2~~--

I

••Schedule, 2

Expenditure in public meeting rally, procession etc. with the Star Campaigner(s) as apportioned to candidate (ie: other than those Ifor general party propaganda)

447

;-;

3

procession dLapportioned 0 thegeneral party propaga

4

1

2

3

Schedule-3 ,/

Details of expenditure on campaign materials. like handbills. pamphlets. posters. hoardings. banners. cut-outs, £Id.- _Video and audio cassettes. CDsI DVDs. Loud speakers. amplifiers, digital TV I board display. 3 D display etc. for ea _election campaign ( le: other than those covered in Schedule- 1 & 2)

4

S. No. Nature of Expenses Total Amount in Sources of ExpenditureRs.

Amt. By Amt. By Pol.candidate I Partyagent

1 2 3 4 5

2

3

4

Total

7

Amt. By others

6

Schedule- 4

Details of expenditure on campaign through print and electronic media includirtg cable network. bulk SMS or Internet or soci:media ete. for candidate

1 4 5

S. No Nature of Name and address of Name and address of agency. Total Amount Sources of Expendituremedium media provider (print reporter. stringer. company or in Rs.(electronic I lelectronic Isms I any person to whom charges I Amt. By Amt. By Iprint) and voice] cable TV. social commission ete. paid/ payable. candidate/ Pol. Party E

duration media etc.) if any agentCol. (3) +(4)

62 3 7

1

2

3

4

448

Details of expenditure on campaign vehicle (s) and poll expenditure on vehicle(s) for candidate's election campaign

S. No Regn. No. of Hiring Charges of vehicle No. of Days Total amt. Source of ExpenditureVehicle & for which incurred/Type of

Rate for I Fuel charges IDriver's used auth. in Rs. Amt. By Amt. By Pol. AVehicleHiring of (If not covered charges candidate! Party mt,vehicle I under hiring) I (Ifnot agent Bymaintenanc covered othe under ers

hiring)

1 2 3a 3b 3c 4 5 6 7 8

1 H-f<./lts- 1963 l\ :..,-.2 ~')U 1I3 (J V<il 114 I'-I(,~ 11Total , L..-<'4k IJ~ S~(J I~.!!) Dd-f)J '}8 -Schedule- 6

Details of expenditure on Campaign workers I agentsS.No Date and Expenses on Campaign workers Total amt. Sources of Expenditure

VenueNature of Expenses Qty. No. Of workers ! incurred/ auth. Amt. By Amt. By Pol. Amt. ByIn Rs.

agents candidate/ Party othersagent

1 2 3a 3b 3c 6 7 8 9

1 Campaign workershonorarrurn/ salary /-etc. ~

2 Boarding Ad;/\' j r- 186t,fJ ~d

3 Lodging ~r- I, oTO-

4 Others ~ t~tnTJ ..

Total \ ..z b G t, '-:r-Schedule-7

Details of Amount of own fund used for the election campaign

S. No. , J Date Icash I DOl Cheque no. etc. with details of Total Amount in Rs. I Remarksi drawee bank I

~449 IIJt;tJ·~, 2.s~o1. :lbl}

'- b7~-~/~ ~fIS obtfd6 -

3 ~--Io- tJt6/~ ~tf

12 13 4 ~

f--_--_·-,-l-r·~ll_-;~O~-~_-_-_-'---_-~L-f_-_- _--=-c::::.:_-~-::-",--- .=-:~_--_-_-_-_-_-_-_-_-_-_-_-_-~========~_~-I-5_-,==le::f:-L.'1J,-,,~,-,6<..!(!)'L26_----':,__2

Total

3

4

" 7 \

Schedule- 8

! Details of Lump sum amount received from the parry (ies) in cash or cheque or DD or by Account Transfer-S. No. Name of the Political Party Date Cash DD/ Cheque no. etc. with Total Amount in Remark:

details of drawee bank Rs. any

1 2 3 4 5 6 17

1 ./

2 )/3 r-' I4

Total

Schedule- 9

ID etai so Lump sum amount received from any person/company/firm/associations/body of persons ete. as loan. gift or donaticete.

S. Name and address Date Cash DD/ Cheque no. Mention Total Amount In IRemarksNo. etc. with details whether loan, Rs.

of drawee bank gift or donationetc. I

.1 2 3 14 5 6 7 8

1 I2 I r/ i

3 '"i'--'4 I ,

Total

Note:1. In Schedule 5:-(a) copy of the order containing list of all vehicles for which permit issued by the Returning Officer to be enclosed.[b) If the vehicle is owned by the candidate/his relative/agent are used for election purpose, notional cost of hire ofall such vehicles, except one vehicle if owned and used by the candidate, notional costof fuel and drivers saiary forsuch vehicle, shall be included in total amount of expenditure in the above table.

450

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~s-~6b"'/.. ,3. <.... })66 0

7t,1SO--/.. ~ .J. (,16~al)

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fUTT HARYANA 35AA 130120Annexure - IV

FORM OF AFFIDAVITBefore the Distt. Electon officer (Karnal {District,Stat~/Union Territory.

Affiavit of Sh. Virender Singh Rathore son of Sh.::,;

Bhup'inder Singh Rathore aged 40 years resident of H .No.1087,,;Sector-13, Urban Estate, Karnal do hereby solemnlyand sincerely state and declare as under

,~

1."That I was contesting candidate at the General Election~to the House of the People/Legislative Assembly ofHaryana from 22-Gharaunda Parlimentary/Assembly~Constitutency, the result of which was declared on13.10.2014.

2. ,=,hatI/my election agent kept a separate and correctaccount of all expenditure incurred / authorised by me/ my election agent in connection with the aboveelection between'26.09.2014 (the date on which 1 was

result

3. That the said account was maintained In the Registerfurnished by the Returning Officer for the purpose andthe said Register itself is annexed hereto with thesupporting vouchers/bills mentioned in the saidaccount,

4. That the account of my election expendi ture as annexedhereto includes all itens of election expenditureincurred or authorised by me or by my election agent,the political party which sponsored me, otherassociations / body of persons and other individualssupporting me, ln connection with the election, andnothing has been concealed or withheld/suppressedtherefrom (other than the expense on travel of leaders'covered by Explanations 1 and 2 under section 77 (1) ofthe Representation of the People Act, 1951).

5. That the Abstract Statement of Election Expensesannexed as Annexure 11 to the said account alsoincludes all expenditure incurred or authorised by me,my election agent, the political party which sponsoredme, other associations / body of persons and otherindividuals supporting me,election.

in connection with the

6.That the statements in the foregoing paragraphs (1) to(5) are true to the best of my knowledge and belief,that nothing is false and nothing material hA'n~:e.:

~

thi~ay Of. /

D~

at

concealed.

Solemnly affirmed/ sworn by _be::ore e.

(Signature and seal of the Attesting authority, i. e.

Magistrate of the first Class or Oath Commission or Notary

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