Yes/t*6 )~~c-)

PART-I-- ----~

- - - -- --- -_~ Name of llle Cd lid idrltf::' . ~h·Ls+~,..t.i~. J...//J,R.f:N De« S/ttJt,wI}NiI ! Number and name of Constituency I

I .l. 2. - (f I'Atf/l..At.J7'-'J>/JI 1I- I Nam~ St;HP /Union Territory 1III -/lAA. yt+N 4I r

: IV I Nature of ElectionI s TA'TG A,sGI"f/}}L.Y,I (Please mention whether General

I Election to State Assembly / LokI Sabha / Bye- election) ----IV Da te of d e cl ar a t io n of result / ~ - I'" ~I Iti

, VI Name and Address of the Election f)1f~~A-MPA(. ~~A+J /H)v

Agent .#- .3 S'I /~ 1<...M..I'I4'-

VII If candidate is set up by a political I",'-Dparty, Please mention the name of thepolitical party

VllI Whether the party is a recognised Yes/t*6political party

Date:)~~c-)<r~Si.gnature of the Candidate

Name NA~GNIJ€~ SIMJ~~Place: _ 1<~4'-<.PART·1l : ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE OF CANDIDATE

No. Particulars Amt. Amt. Amt. Total Election expenditureIncurred Incurred/ Incurredj Auth. by authorize j (3)+(4)+(5)Candidate d by Pol. authorizej Election Party d byagent(in (in Rs.) othersRs.) (in Rs.)

2 3 4 5 6j::"n", inpublic meeting, rally.precession -a: Expenses in public meeting, rally,

251"rO ~~.s~' ~ 77S(.procession etc. (ie: other than the ones withtar Campaigners of the Political party I__ Enclose as per Schedule-L)b: Expenditure in public meeting rally, -I procession etc. with the Star Campaigner(s) (Ie: - ~773' >~73'I other than those for general party propaganda) SDOO

I

-- (Enclose as per Schedule-2)

"," aSS" jI Campaign materials other than those used in the - L, t, 18 S!{public meeting, rally, procession etc. mentioned

443

1>"'"

PART III : ABSTRACT OF SOURCE OF FUNDS RAISED BY CANDIDATE

----

~"-1. ~ p"t:>II(' mcct ing. r al lv. p r- >,_·'O'551·:;>netc. (le: other than those with :'Ur l..'II",11,,"gl',<"'·-· ,.I 110" P"Ii[i,.oI p.u ty]_. -

: atureofExpenditure Total Amount Source of expenditureIn R~

IArnt. incurred / Arnt. Amt. incurredAuth by Candidate incurred I by others/ agent by PoJ.

/Party withname

.- --- -- -1 2 3 4 C; I)

1 Vehicles for transportmg visitors- ..

Z Erprtine Striep, Pa nrla] & Furniture Fixtures, poles ete. 8t1tH' 8~

3 Arches & Barricades etc. _.4 Flowers/ garlands

5 Hiring Loud xpeakars, Microphone, amplifiers, }~ I.~ ~comparers ete.

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

7 Beverages like tea. Water. cold drink. JUice etc. 'i~~o 19Ct<!

8 Digital TV -boards display, Projector display, tickersboards, 3D display

9 Expenses on celebrities, payment to musicians, other "70 6170artists remuneration etc.

-10 Illumination items like scrial Ilghts. boards etc.

11 Expenses VII II dll~PV! L,HdiL\!pL~('/ aircraft / vehit:!p.~;fboats etc. did! ~~~ ( fUI s elf, celelnity VI' auy othercampaigner other than Star Campaigner)

12 Power consumption/ generator charges,

13 Rent for venue

14 Guards & security charges

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

16 Others expenses (.4s~ ~s~?f"; R~eitk 2 2..$"& '" ],.25'&'

Total If 7 75'C 2-S 170 ~.S8' ~Schedule- 2 ' ' '

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

447

_ •••.•.•• '-= <1Il1t:"of lht:" Sldl Cdllll1digflt:"1 (~) s Aruo uut uf Expeuditu: to l'!J fJuuliL meeting I ally.Name of Party procession elL. wit h llle Sldl Cdlll{Jaigllt:"r(s)

apportioned to the candidate (As other than forgeneral party propaganda) in Rs.

1 2 3 4 5 ,~-~~1 .L.1 '9 - 10 - ).el, 'I I. - Jh!"/) is, StnlO /!- (Sf'" ~<f~-cr:--i./I;]

2 /1-to-H,'! f••Shi.. '1tll1.., .bt,7.,3'A (p~ (,,,-~,,~) .3

4

Total~~. ...."..=$ .~~ - . ..... '"-~ --"'"

Schedule-3

Details of expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners, cut-outs, gates & arches,video and audio cassettes, LDsI DVDs, Loud speakers, amphfiers. digital TVI board drsplay , .3 D display ete. for candidate'selection campaign ( le: other than those covered in Schedule- 1 & 2)

S.No. Nature of Expenses Total Amount in Sources of Expenditure Remarks, if anyRs.

Amt. By Amt. By Pol. Amt. By otherscandidate / Partyagent

1 2 3 4 5 6 7

1 ,4j .j. a-tfiftAJ2

3 ,

4

Total .Schedule- 4

Details of expenditure on campaign through print and electronic media including cable network, bulk SMS or internet or socialmedia ete. for candidate

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 / lelectronic Isms I any person to whom charges I Amt. By Amt. By Amt.

print) and voice] cable TV, social commission etc. paid/ payable, candidate/ Pol. Party Byduration media etc.) ifany Clgcnt others

I (01.(3}+(4)

. 2 3 4 5 6 7 8li. Ld;' ":f1ff.c.W

1-1,-

-448

---------'-------.l.- --L-- .-L..__:: hedule·5

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

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

I Type of Rilte..fur f-Euel..chal-ges ~;iVeI'Sused, auth. in Rs.

Amt. By Amt. By Pol AVehicle-Hiring 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 J.1j.f ,~ek...,/ .2

3

4

Total ,

Schedule- 6

Details of expenditure on Campaign workers I agents

S. No Date and Expenses on Campaign workers Total amt. Sources of ExpenditureVenue

Nature of Expenses Qty. No. Of workers I incurred/ auth. Amt. By Amt. By Pol. Amt. ByIn Rs.agents candidate/ Party others

agent

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

1 Campaign workers Vhonoranurn/ salary

~\V /'etc. t---2 Boarding ./V - _..

3 Lodging V t4 Others

Total ,

Schedule- 7

Details of Amount of own fund used for the election campaign..

S. No. IDate Icash ! DOl Cheque no. etc. with details of Total Amount in RS'I Remarksdrawee bank

449

---------------4

- ---------r------5

Date IcashII

S of Lump sum amount received from the party (ies) In cash or cheque or DD or by Account Transfer

~ o. Name of the Political Party

" I

4

00/ Cheque no. etc. withdetails of drawee bank

Total Amou nt In i'l:

Rs_ ;in,

1 2 3

1

2-

3

4

Total

Schedule- 9

5 6

/'1

r--;----------------7----------t---------+-----------------~---------·----\\¥

1

1Details of Lump SltJ11 amount received from any person/company /flrm/assoctatlonsybody of persons ete. as loan. gift or done~ ---- _.S. Name and address Date Cash •DD/ Cheque no. Mention ---- .IQtal AalOun.~-,n IRe.!!'~rNo. ete. with details whether loan, Rs. I

of drawee bank gift or donationetc.

1 2 3 4 15 6 7 8

1 I I2 I ~\./ I !

1

3 /'4 ,

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 cost of fuel and drivers saiary forsuch vehicle. shall be included in total amount of expenditure in the above table.

Schedule-3Details of expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners,cut-outs, gates & arches, video and audio cassettes, COs/DADs, Loud speaker, amplifiers, digital TV!board display, 3D display etc. for candidate's election campaign (ie: other than those covered inSchedule-1&2S. No. Nature of Total Sources of Expenditure Remarks, if

Expenses Amount in anyRs.

Amt. Amt. By Pol. Amt. ByAmount in Party othersRs.

1 2 3 4 5 6 71 Flag Cloth 29500 29500 11144r, ~t40

Printing2 Flag cloth, 28750 28750 fM-""'1 cJ.At~

stickers,3 Typing, 2500 2500 c.-..&J...

documents4 Security 10000 10000 ~

charges5 Tent and 21420 21400 UI'II4A ",~

chairsCA.JJ,.

6 Tea and 27645 27645 v It""" .' j«.c.aIwSnacks ~

7 Mukhota, 19950 19950 ~Pagri cloth

8 Loud 1(1,IM. G1~cJ,;speakers ~.(i)19.9.2014 250000 250000

To 1885 188513.10.2014(ii)30.9.2014 14000 14000 C,.M.J,..

To 115 11513.10.2014(iii)2-10- 12000 12000 ~

2014 1QO 100To IIlJ#I.M IP~~

13-10-2014 ~(iv)6.1..2014 24000 24000

Schedule-4Details of expenditure on campaign through print and electronic mediaincludi8ng cable network, bulk SMS or internet or social media etc. forcandidateS. Nature of Name Name and Total Sources ofNo. medium and address of Amount Expenditure

(electronic address agency, in Rs./ print) of media reporter,and provider stringer,duration (print/ company or

electronic any person/ sms/ to whomvoice / charges /cable TV, commission ~ c...J 1J.t4social etc. paid/ ~1~media payable, if Col. (3)etc.) any + (4)

1 2 3 4 5 6 7 81 4.-10-2014 Dainik Dainik 5460 5460

Jagran Jagran2 5-10-2014 Dainik Dainik 4692 4692

Jagran Jagran3 6-10-2014 Dainik Dainik 5460 5460

Jagran Jagran4 12.10.2014 Party Dainik 33749 33749

office, JagranBarsat

5 12.10.2014 Road Dainik 34420 34420show Jagran

6 12.10.2014 Party Dainik 92459show JagranNaglechowk -

7 12.10.2014 Dainik Dainik 9697 9697Jargan Jagran

8 12.10.2014 Dainik Dainik 9596 9596Jagran Jagran








16 15.10.2014 Dainik Dainik 10238 10238Jagran Jagran .



19 15.10.2014 Focus, Focus, 16000 16000Tehlka Tehlka

Total 435981 119315 316666

r,i q

Schedule-5Detailsofexpenditureon campaign vehicle(s)and pollexpenditureon vehicle(s)forcandidate'scampaignS. Regn. No. HiringCharges ofvehicle No. Totalamt. Source of ExpenditureN ofVehicle of incurred/auth.in0 & Type of Days Rs.

Vehicle forwhichused

Rate for Fuel Driver' Amt. By Amt Amt.Hiringof charge s candidat .By Byvehicle/ s (If charge e/ agent Pal. othermaintenan not s (If Part sce covere not y

d covereunder dhiring) under

hiring)1 2 3a 3b 3c 4 5 6 7 81 HR-45B- 1000 600 400 15 21000+9000=300 30000

days I i, • ,.! :~:I8488 002 HR-45B- 1000 600 400 15 21000+9000=300 30000

0543 days 003 HR-45B- 1000 600 400 15 21000+9000=300 30000

0381 days 004 HR-45B- 1000 600 400 15 21000+9000=300 30000

8735 days 005 HR5-1 1500 600 400 15 28500+9000=355 35500

days 006 HR-53- 1500 600 400 15 28500+9000=355 35500

0001 days 007 HR-45- 1000 6006 400 15 21000+9000=300 30000

1179 days 008 HR-75- 1000 600 400 15 21000+9000=300 30000

2240 days 009 HR-26- 1500 600 400 12 22800+7200=300 30000

8544 days 0010 HR-0545- 1500 600 400 12 22800+7200=300 30000

0029 days 0011 HR-45B- 600 600 400 8 8000+4800=1280 12800

6864 days 012 HR-45A- 600 600 400 5 5000+3000=8000 8000

4630 . days13 PB-05P- 1000 600 400 4 5600+2400=8000 8000

0009 days14 HR-45A- 1500 600 400 9 17100+5400=225 22500

0005 days 0015 HR-58A- 1000 600 400 9 12600+5400=180 18000

0803 days 0016 HR45A694 1000 600 400 9day 12600+5400=180 18000

2 s 0017 HR-45A- 1000 60Q 400 9 12600+5400=180 18000

8568 days 0018 HR-45B- 1000 600 400 10 14000+6000=200 20000

8488 days 0019 HR-45B- 1000 600 400 10 14000+6000=200 20000

0543 days 0020 HR-45B- 1000 600 400 10 14000+6000=200 20000

0381 days 0021 HR-45B- 1000 600 400 10 14000+6000=200 20000

8735 days 0022 HR5-5 1500 600 400 10 19000+6000=250 25000

dClYs 0023 HR-53- 1500 600 400 10 19000+6000=250 25000

0001 days 0024 HR-45- 1000 600 400 10 14000+6000=200 20000

1179 days 0025 HR-75- 1000 600 400 10 14000+6000=200 20000

2240 - days 0026 HR-26BZ- 1500 600 400 10 19000+6000=250 25000

8544 days 0027 HR-05S- 1500 600 400 10 19000+6000=250 25000

0029 days 0028 PB-02- 1000 600 400 10 14000+6000=200 20000

0009 days 0029 HR-45B- 600 600 400 10 10000+6000=160 16000

6864 days 0030 HR-45A- 600 600 400 10 10000+6000=160 16000

4630 days 0031 Rickshaw 400 300 9 2400+1800=4200 4200

daysTotal- 6,96,500 6,96,500

..V'~~

J 1.;\; I.

35AA 082814. I & Narender Sangwan S/o, Shri Sewa Ram aged .... years, t Ic: Vill.

Shekhpura Jager Distt Karnal now R/o H. No. 11~ sec.-6 Karnal. do herebysolemnr and sincerely state and declare as under:-

(1)Trat I was a contesting candidate at the general election to the House oft~e Legislative Assembly of Haryana from 22-Gharaunda as INLDCandidate Assembly constituency, the result of which was declared on19.10.2014

"(2)That I kept a separate and correct account of all expenditure incurred bynie in connection with the above election 'between 19.9.2014 to1~.10.2014 (the date on which I was nominated) and the date ofdeclaration of the result thereof, both days inclusive.

(3)That the said account was maintained in the Register furnished by theReturning Officer for the purpose and the said Register itself is annexedhereto with the supporting vouchers/bills mentioned in the said account.

r

(4)That the account of my election expenditure as annexed hereto includesap items of election expenditure incurred or authorized by me or by myerection agent, the political party which sponsored me, other associations

_ hbody of persons and other individuals supporting me, in connection.~,-1I

,»:~_ N~~ the election, and nothing has been concealed or1~ ~~ld / su ppressed therfrom (other than the expense on travel of

la- ("."~Y..0 \,. ,...~( ,~ •..~ -~t 1:::: r.,. ,<~J ...(..~.;1tIr~ 0'" '; \~;)~~ 1\ • ~\\i:.VP -, ,

\ f.>o (+.."If{Y'/~. -~~~

"

ers' covered by Explanations 1 and 2 under section 77 (1) of theRepresentation of the People Act. 1951).

-I That the Abstract Statement of Election Expenses annexed as AnnexureII to the said account also includes all expenditure incurred orauthorised by me, my election agent, the political party which sponsoredme, other associations/body of persons and other individuals supportingme, in connection with the election.

(6)That the statements in the foregoing paragraphs (1) to (5) are true to thebest of my knowledge and belief, that nothing is false and nothingmaterial has been concealed.

)'Q/Vv-J~ ~Deponent

f-I~tIM-

Solemnly affirmed/sworn by at.. this day of 201. before me.

/ cJJt--'~./ Deponent

rJM.J.,~~

ert;fie" :0 .ns, me f1Dovedo. 'I"~ ~ ,-/ c~~ {.; c'" Q' sotenum affirmed

betorc r 'k" i' -.:'\" ,,}b- .t~tI.~ Y

depon ~"; t; - . ... "" ~ ;1/.1" Ident' erf

SI1,,_ _" ! ••••- ..•

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