- -

For election to MUNICIPAL CORPORATION NORTH DELHI

From ... WARD N0.09N KAMAL PUR (No. and name of the ward)

I Pawan S/o of Late Sh. Bishamber Dayal aged about 33 Years Rio . .

H.No. B-1676, BLOCK-B, SHASTRI NAGAR, DELHI of candidate at

the above election, do her... '~; .;oiemnly affirm/state on the oath as ur. Jer:­

(mention full postal address) a candidate at the above election, do hereby·solemnly affirm

and state on oath as under:­

(Strike out whichever not appl icable)

' (I). l am a candidate set up by... BAHUJAN SAMAJ PARTY(name of the political

party/am contesting as independent candidate.

The financia l Petmanent Total incomeS.No. Name Account N umber year for which shows in income

tax ret :.1rn (in (PAN) the last income tax return has rupees been filed

PAWAN 2016-2017 4939I. AHFPG2655M

CIFPS3475N NIL NIL2. SARIKA

NIL NlL NIL\-\M{S\-\-r."\

4. NIL NILNIL1# 3.

N.A. N.A. N.A.5. -

(3). The following case (s) is/are pendir,g against me in which cognizance has been taken

by the court:­

S.No. Offence Descri~ -

(a) The details of cases where the court has taken cognizance, Sections No of the act and description of the offence for which cognizance

.;;._ -­ taken: ·­

' F{b) "'.."'--­·-.._ (,

Name of the Cout1, case no. anrl date of order taking cognizance: INo -

, (c) "'-. : ·? - \

Detai 1of Appeal(s)/application(s) for revision (if any) filed against ·.. \\

No

(4) Cases in which I have been convicted be a court of law (other than those referred to in

Form 'A')

(a) The details of cases Section of the Act and description of the No -

(b) offence for which convicted: Name of the Court (s). case no. and date (s) : N.A.

-

(c) Punishment imposed: No

(5) That I given herein below the details of the assets (movable and immovable etc.)

of myself, my spouse and dependents:

A. DETAILS OF MOVABLE ASSETS

(Note:

I. Assets in joint name indicating the extent of joint ownership wil l also have to be given.

2. in case of deposit/investment, the details including Serial Number, Amount, Date of Deposit, the Scheme, Name of Bank/ Institution and Branch are to be given.

3. Value of Bonds/Share/Debentures as per the current market value in Stock Exchange in respect of listed companies and as per books in case of non-listed companies should be given.

4. Dependent , here means a pe rson, substantially dependant on the mcome o the candidate.

5. Details including amount is to be given separately in respect of each investment.)

S.No Description Self

(i) Cash in hands Rs.

30,000/­

~~~ Detail o f Deposits in Bank account Savin<> ,.~f\J .""'~~. 0

. -'--~·· ) FDRs. Term deposits and all 01her ,., _ k/ '•. -. . I. J f!ll ~-.: · - ~ 't; pes. q f deposits including sa,in;;·''· ,·,,. ., ., °'· -· ­ Account no.

,. · ·; .._-::. ·:~..': 0i9~\!!l!s2. Deposits with Financial

Depend

ent-3

N.A.

N.A.

·­

Spouse

Rs.

10,000/­

Saving

Bank

Account

Dependent-

I

NIL

Dependent-2

NIL

NIL

institutions Non Banking Financial

Companies and Co-operative

societies and the amount in each

such deposit.

00 I 1921646 no. l 522 1 O

,KOT AK 031035,

MAHINDR DENA

A BANK, BANK

BRANCH BRANCH

KAM LA SANT

NAGAR NAGAR

sum of Rs. BURARI

3000/- sum of

approximate Rs.1300/­

( ii)Savi ng

Bank

Account

no. I 052553

14-12.

STATE

BANK OF

lNDIA

BRANCH

SANT

NIRANKA

Rl

COLONY

sum of Rs.

20001­

(iii) Saving

Bank

Account

No.5014760

1139

ALLAHAB

AD BANK

BRANCH

BURARl

institutions Non Banking f-inancial

Companies and Co-operative

societies and the amount in each

such deposit.

00 11921646

,KOTAK

MAHIN DR

A BANK,

BRANCH

KAM LA

1AGAR

sum of Rs.

30001­

approximate

(i i)Saving

Bank

Account

no. I 052553

1442,

STATE

BANK OF

INDIA

BRANCH

SANT

NIRANKA

RI

COLONY

sum of Rs.

2000/­

(iii) Saving

Bank

Account

No.5014760

1139

Al LAHAB

AD BANK

BRANCH

BURARI

no.1522 10

03 1035,

DENA

BANK

BRANCH

SANT

NAGAR

BURARI

sum of

Rs.1300/­

I Slllll of

I R~ 00/­

(iii) Dc1ail c>f im estment in Bonds Nil Nil Nil NIL N.A. Deben 1urcs/sharc and units in

companies/mulUal funds and olhcr

and the amount.

(iv) De1ails of investment in NSS. 11,403/­ Nil Nil NIL N.A. Postal Saving. Insurance Policies

and invl:!suncnt in any 1:inancinl

Institution in Post office or

Insurance Company and the

amount

(v) Personal loans/advance given 10 Nil NIL Nil NIL N.A. any person or cntit) including firm

company. Trust etc. and 01hcr

receivable from debtors and the

amount.

I

(vi) Motor Vehicles/ Aircrafts/ Yachts/ 43,000/­ Nil Nil NIL. N.A. Ships (detail of Mak Registration

No. etc. year of purchasing and

amount.)

(vi i) Jewelry. bullion and valuable Nil Gold Nil NIL N.A. th ings (given details of weight and

value) Rind

4.2 Rt.

Value

I 7,000/­ I i

-­I

Silver I~~.~--,-~

"< V­ ~.~· J - ._. J ' '

I

i

250 Gm

Value

Rs.

11,000/

-

(viii)

( ix).

Any other assets such as value of

claims/interest.

IGross Total value

I

Nil

Rs.

89,403/­

Nil

Rs.

31000/­

Nil

NIL

NIL

NIL

N.A.

N.A.

B. DETAILS OF IMMOVABLE ASSETS

(Note:

1. Prope111es in joint ownership indicating the extent ofjoint ownership will al ;,J

have to be indicated.

2. Each land or building or apartment should be mentioned separately in this format.)

Description Self Spouse Dependent- I Dependent-2

i::::-· .,_(Yes or No) ,. ~

: ·,:~..... ..-

Dependent-3S No.

(i) Nil Nil Nil Nil N.A. ­

Agricultural land

• Location(s)

· Survey

numbcr(s)

· ­Area (Total Nil Nil N.A.NilNil measurement in

acres}

-Whether inheri ted Nil N.A.Nil Nil Nil property

J__

Date or rurchasc Nil Nil Nil Nil N.A. in case or self

acquired property

Cost of land (i n Nil Nil Nil Nil N.A. case of purchase)

at the time of

purchase

A ny investment on Nil Nil Nil Nil N.A. the land by way of

development.

construct ion etc.

Approximate Nil Nil Nil Nil N.A. current Market

Value

(ii) Non-Agricu lt ural Nil Nil Nil Nil N.A. land

- Location(s)

- Survey numhcr(s)

--Arca (Total Nil Nil Nil Nil N.A. measurement in

acres)

Whether inherited Nil Nil Nil Nil N.A. property

( Yes or No) -Date or pu rchase Nil Nil Nil Nil N.A.

in case o r self

acquired property -

Cost or land (in Nil N il ·Nil Nil N.A. case of purchase)

at the time or

purchase -­

A ny investment on Nil N il Nil I Nil N.A. the land by way or

development.

construction etc.

Approximate

' Nil N il Nil Nil N-A.

--current iVlarkct

Value

-(i ii) Commercia l Nil Nil N il Nil N.A.

Building

(including

apanmcnts)

-Location(s)

• urvey numbers

Built up area (total Nil Nil Nil Nil N.A. measurement in sq.

ft .

Whether inherited Nil Nil Nil Nil N.A. propeny

(Yes or No l ---­ --

Date or purchase Nil Nil Nil Nil N.A. in case or self

acquired propeny

Cost or land (in Nil Nil Nil Nil N.A. case of purchase)

a t the time or

purchase -

Any investment on Nil Nil Nil Nil N.A. the land by way of

development.

construc tion etc.

Approximate Nil Nil Nil Nil N.A. current Market

Value -

(iv) Residen tia l Nil NIL Nil Nil N.A. Building

I ( including

apanments )

-Location(s)

-Survey numbers -

Arca (total Nil NIL Nil Nil N.A. measurement in sq.

n. -., Built up area (total Nil l' l L Nil Nil N.A.

measurement in sq.

Ii.

-­Whether inherited Yes NIL Nil Nil N.A. propeny

(Yes or 'o)

Date or purchase No. NIL Nil Nil N.A. in case or self

acquired propen) --

Cost or property

(in case or

No. NIL ? '

Nil Nil N.A.

purchase) at the

time of purchase

Any investment on Nil Nil Nil Nil N.A. the land by way of

development

constructio11 etc. -

Approximate Nil NIL Nil Nil N.A. current Market

Value

(v) Other (such as Nil Nil Nil Nil N.A. interest in

propeny) -

(vi) Total Current Nil NIL Nil. Nil N.A. Market Value or (i

to (v). --~

(6) I give herein below details of liabilities/dues to public financial insti tutions and

govenunent:­

(Note: Please g iven separate details of name of Bank. Institution, entity or lndi vidu:·' and

amount for each item)

SNo. Description Self Dependent- ISpouse Dependent-2 Depe;ident-3

Loan or dues to(i) Nil Nil Nil Nil N.A. Bank/Financial

lnstit ut ion(s)

Name of Bank or

Fl amount

Loan or dues to Nil Nil Nil Nil N.A. any

individual/Entity

other than

mentioned in (i)

above

Name(s)

Amount

outstand ing

Nature of loan --

Any other Nil Nil Nil Nil N.A. liability

-Grand Total of Nil Nil Nil Nil N.A. Liabilities

(ii) Governme nt dues Nil Nil Nil Nil N.A. Dues to

departments

dealing with

government

accommodation --

dues to Nil Nil Nil Nil N.A. depanments

dealings with

supply of water -

Dues to Nil Nil Nil Nil N.A. depanmcnt dealing

with supply or

electricity

dues to Nil Nil Nil Nil N.A. depanmcnts

dealing with

supply of

telephones/

mobiles

dues to Nil Nil Nil Nil N.A. depanments

dealing with

-~,\,;· ""::~·'Crnmcnt

-~~,~-~ ~~i~:~,..-­I" - .... . ··-

--

--

1ranspon

( including ~ircrafls

and helicopters)

Income Tax Dues Nil Nil Nil Nil N.A. -

Wealth Tax Dues Nil Nil Nil Nil N.A.

Service Tax Dues Nil Nil Nil Nil N.A.

Municipal/ Nil Nil Nil Nil N.A. propeny Thx dues

-Sales Tax dues Nil Nil N il N il N.A.

/\ny Olhcr dues Nil Nil Nil N il N.A.

Grand Total or all NilNIL Nil Nil IN.A. Govt. Dues

(7) Details of profession or occupation:

a. Self .....Business

b. Spouse .. . Tutor

(8). My educational qualification is as under: Left the school in the year of 1998 in

9th class but school leaving certi ficate has not been taken study up to 9th cLss in

Rajkiya Sarvodaya Bal Vidhyalaya (Given details of highest School/Univ rsity

education with full form of the certificate/diploma/degree course)

(name of School/College/University and the year in with the course was

completed).

(9) ABSTRACT OF THE DETAILS GIVEN IN (I) TO (8) ABOVE: -

/10,

I. Name of the Candidate Sh./Smt./Kum.

PAWAN

2. Full Postal address H.No. B-1676,

BLOCK-B, SHASTRI

NAGAR, DELHI I .;._, - -NuJI!ber and Name ofD.M.C. Ward Ward No.1.19N , !

.. ' _J\.' \

KAMALPUR

--

-- -

4. Name of the Political party which set up the BAHUjAN -

SAf.1AJ

5.

candidate (otherwise wri t 'independent'

(a) Number of cases in which conviction order

PARTY

No -

passed (other than those referred to in Form 'A '

No -

(b) Total Numbers of Pending cases where the

6.

Court(s) have taken cognizance.

PAN of Year for Total -­

Income

which last Shown

income tax

Return fi led

Candidate PAWAN PAN NO. AHFPG2655M 2016­ 4939.

2017

Spouse: SARIKA PAN NO.CIFPS3475N NIL NIL

Dependants HARSHIT Nil Nil - ­

7. Details of Assets and Liabilities in rupees

Spouse Dependant- Dependant- De ·endant-Description Self

I II III

Movable NIL NIL Nil N.A.A. NIL

Asset (total

value)

NILImmovable NIL NIL NIL N.~ -.~B.

Assets

(i). Purchase NIL NIL NIL NIL N.A.

price and

Development

cost of

...... /

9

immovabie

property

(Total

Value)

(ii). Approximate NILNIL NIL NIL N.. .

CwTent

Market price

of Assets

(total Value)

8. Liabilities NIL NIL N.,\.NIL NIL

Government Nil N., ..Nil Nil Nil

Dues (Total)

(Loans from Nil Nil Nil Nil N.r•.

Bank,

Finance

Institution

and other

(total).

Highest education qualification: Left the school in the year of 1998 in 9th c!ass but

school leaving certificate has not been taken study up to 9th class in Rajkiya Sarvodaya

Bal Vidhyalaya (Given details of School/University education with full forr of the

ce11ificate/diploma/degree course) (Name of the School/College/University and the year

in which the course was completed.)

~ OEPOl\iNT

VERIFICATION:

AFFIDVIT

I Pawan S/o of Late Sh. Bish.imber Dayal aged about 33 Years R/o.

H.No. B-1676, BLOCK-B, SHASTRI NAGAR, DELHI of candidate at

the above ekction, do hereby solemnly affirm/state on the oath as under:­

I. I am not accused of any offence(s) punishable with imprisonment fo r two years or

more in a pending case (s) in which a charges (s) has/have been framed by the Cou11(s) in

which a charge(s) has/have been framed by the Cou11(s) of competent jurisdiction.

If the Deponent is accused of any such offence(s) he shall furnish the follr ving

information:­

(i). Case/First information repo11 No./Nos ..... .NIL.... .............. .. .. ...... .

(ii) Police Station(s) ....... NIL...District(s) .... NIL.... (State(s) .. NIL.. .. .

(ii i). Section(s) of the concerned Act (s) and short Liescription of the offence(s) for' hich

the candidate has been charged ................ NIL. ..... .

(iv). Court(s) which framed the charge (s) ........... .. NIL. ...................... .............. .. .. . .

(v). Date(s) on which the charge(s) was/were framed ......... . NIL ........ ..... ............. .. .

(vi) Whether all or any of the proceedings(s) have been stayed by any court("s) of

competent jurisdiction ............. ............................. NIL .................................... .. ....... .

2. I have been/have not been convicted of an offence(s) [other than any offencc:s(s)

referred to in sub-section( I) or sub-section(2). or convicted in sub-section (3). of section

8 of the Representation of' th~ l'...dpk Act. 1951 (43 of 1951 )] and sentenc. d to

imprisonment for one year or more.

FORM 3 Notice ofNomination [See Rule 21] http://118.67.249.171 /MCD20 I7/(S(02yy4jc2ofonfhob Iprgojbj))/rpt...

o f3

Election to the *North Delhi/South Delhi/ East Delhi Municipa l Corporation from Ward No. and Name : 009-N KAMALPUR otice is h!feby given that the following nominations in respect ofthe above e_~tion have been received up to 3 P.M. today:

Serial r Name of Name of Address Particulars Electoral Name of I Electoral roll no. of Candidate *Father/ of roll Proposer nwnber of

Nomination Husband caste for number of proposer Paper Candidates candidate

belonging to Scheduled

Castes -----·--2-­+-----····-·--···-·­ ---4 ---· _ 5_ ____ --­6­ - --·­7 ­

~ARENDER ~!NOH rHAUHAN

8 URAT SINGH 144/G-14,

LOCK-A, BABA OLONY, SANT AGAR, BURARI,

DELHI

No LM1607282 PASHUPATI CRJ09~ AI'H DU 04/055

SHARMA 423427 HYAM LAL K2306025 JAY AZK0895250

AMRJTANAND~.K2024032 ' HRI RAM AZK0969766 BHARTI DEVI K0887950

AR SINGH RJ09864R9 ATYA K2203057

PRAKASH CRJ0968677 INGHSAVIR HANYUNUS

l--6--~AfSHRi · -- Al SINGH

RAlJTHAN .NO. 51, GALI 0-1,

UTTRANCHAL ENCL.,

BALKISHAN r------1-----1~

ALPUR, URARl, DELHI

No

HARENDRA JHA DIGAMBAR JHA- B-36, GALI N0.-7, OMAR

No

-.--1ru;SH --­· ~HARMA

I

OLONY, MAZRA KAMALPUR, DELHI-110084

.K.SHARMA°"-­ / 175, KAMAi-:-··----~

VIHAR, AMALPUR,

DELHI· 110084

- ··- --1-------'-·­ -------­ ·­ ···-­ --------·- ··---··­ ·-----­

SINGH.RAWAT

LTD0949164 RANI JHA AZK26630IO BRIJESH CRJ090203 I PRAJAPATI AZK24 15015 SUMAN 1AZK2301836 l'RNAP/\J'I ~K230 1 828

SHOK K1546738 KUMAR AZK1546753

OLDI r L/04/055DEVENDRI 351235 DEVI ASHOK K154539l KUMAR CRJ1638899 DEVAKI DURGESH KUMAR VERSHADEVI

. K149i7il DEVENDER ->-AZ~K-15~2-30_6_7,

AGAR K15237 11 VIKRANT Kl472554 OMVIR iAZKl539675 ---­ ____________.L__________

-- --­ -- ·- -·- --­- --··---­ - - ­----··---- ­------·-·--·­-·-·­--- ----- - --­ -- - --­ - ­---­·---­Place : DELHJ '--­ --­ ·- - ·--­ -- - -·---··--·­ - ­ - -Date : 03/04/20 17

• Strike offthe inappropriate alternative.. ~lReturningOfficer

Asstt. Returning Officer WardNo.•g M3/20li7 '/-49PM

NorthDelhi Municipal Corµonmo ·

___ _

FORM 3 Notice ofNomination [See Rule 2 1) http: //118.67.249. I7 1/ MCD2017/(S(02yy4jc2ofenthcb Iprgojbj))/rpt...

---·- ­ 9--KAlJSTUBA_____ LATE-iffi~··--- - ­ --·H.NQB-99, GALI ---N~----

AND BALODI PANDEY BALODI 0. 06, KAMAL

~SHYAMA D""

I APANKUMAR

I - HA

12 PRADEEP JBA

13 Al PRAKASH INGH

KAUSTUBA AND BALODI

DEV SARAN

VIHAR, KAMALPUR, BURARI, DELHl­I 10084

H.NO. - 69 1, KH. 0.-123113, GALI

NO. 15, LAL ORA, SANT AGAR, BURARI,

DELHI-II0084

ali No-13, Samia

No

No

No

K147 I366 SUNDER INGH RAWA:l'

INGH >U08'58« AMOT KUMAff"'°''°'

Kl827922 ~IL KUMAR iK091641 1 ·-­I SHRA

K2347243 Rohit Gupta Arvind Yadav Renu Pandey

nita Mishra Bharti Devi Rekha LaXIni

B, SHASTRI AGAR, DELHl­

110052 15 RA:rAN TYAGI

14-· i;A.WAN --AYAL

JTAR SING!:-! -II.NO -ff -- -·---- - No AKJYA CHOWK,

VlLLAGE-BURARl, DELHI

- --- - ------- ------·------'--­

lNGH Yihar, Mukandpur, Delhi -42

BIB>MMB,.--B-"''BWCi( - --No ­

SHARMA ic1uos47905 A:fUL ANHJ IAZ.K2825338

HYAM jAzK239 I 340 MOHIT l~K118650 1

HARMA ·,CRJ0847 I 37 UNIL IAZKl520527

KUMAR UPTA

1AURAV KUMAR

HARMA SATISH

HANDRA I DUTT

--;-Ki47i358 WASPA NAN- D AZKMG5905

AZKI464734

.

·

K 3130168 K 26537I4

AZK 0895342 K 1824754 K 2024032

AZK 0884627 MaJ ada Khatun AZK 259 1410 ~ JI Kumar ~K 2752888

Poonam AZK 2474045 AZK 2591492

nM0>6ill"~ - (Ko90To'4 BHAGWAN

AZK0\02780 lllTEND~iAZK3387460 POONAM !AZK2275675 DEVI filK8700341 SHAKEEL DL/04/055 AHMED 348I40 AIVIR SUNIL IDL/04/055

SARAFRAZ V,3483 14 SHIKHA RANI RJ1632587

1•·rn~c . DELHI~--· ------ ---··-------------i------------------·--- ­Date~..0~/04/2~~~-= . =-~----:=:~=-~-~-~~--------- ----· l3fl}~·1ke o!flhe mappropnate alternative, . ~//Returning Officer

Asstt.Returning Officnr of3 Ward f%3~0 l 7 7:49 PM

North Delhi Municipal Corporation