gf.u:aulI HARYANA Affidavit35AA 130542

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Affidavit of Parveen Kumar S/o Sh. Dharam Pal aged 32 years RIo VPO

JuJdla Distt. Karnal do hereby solemnly and sincerely state and declare as.

under:- )

':l. That I was a contesting candidate at the general election! bye

election to the House of the People/Legislative Assembly of ~~.

'. ---------------- from -~-'o.-------- Parliamentary/Assemblyit ' h I f hi h did ,0, --\0 r ~ I Y .,~ constituency, t e resu tow IC was ec are on L .

l That IIMy election agent kept a separate and correct account of all

~ expenditure incurred/ authorized by me/ my election agent in~1-4 ....\ l.t -t'-c> \ ~ -l 0 -\\.1 .

connection with the above election between -----------------( the date•-> on which I was nominated) and the date of declaration of the result

thereof, both days inclusive.

~9·~~tt1..~That the said account was maintained in the Register furnished by

ft;~~~~S\\:,,\:{.:the Returning Officer for the purpose and the said Register itself is1\ '.~ \~ "'~~,~ ~ ~ ...~: annexed hereto with the supporting vouchers/bills mentioned in the

. •........• .~

said account.

4. That the account of my election expenditure, as annexed hereto

includes all items of election expenditure incurred or authorised by

me or by my election agent, the political party which sponsored me,

other associations/ body of persons and other individuals supporting

me, in connection with the election, and nothing has been concealed

or withheld/suppressed there from ( pother than the expense on

travel of leaders' covered by Explanations 1 and 2 under section

77(1) of the Representation of the People Act, 1951).

5. That the Abstract Statement of Election Expenses annexed s

Annexure II to the said account also' includes all expenditure

incurred or authorized by me, my election agent, the political party

which sponsored me, other associations/ body of persons and other

individuals supporting me, in connection with the election.

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 has been concealed.

--~,JvvJA/L.--

Deponent

Verified that the above statement is true and correct to the best of my

knowledge and belief and nothing has been concealed therein.

~~~

Deponent

2.... '\10\ I '/0141 I IJ L.!,. .,

-------------------------------------_._------------_._ .._._-----_.-ABSTRACT STATEMENT OF ELECTION EXPENSES

PART -I

ame of the Cnlldid;;tember and name of Constituency

Yes/No

Da e: Signature of the Candidate

. Place: Name

PART·II : .';SS":"RACT OF STATDIEi\'T OF ELECTION EXPENDITURE OF CANDIDATE

S. No. Particulars Amt. Amt. Amt. Total Election expenditure IIncurred Incurred/ Incurred/ Auth. by authorize / (3)+(4)+(5)Candidate d by Pol. authorize/ Election Party d byagent(in (in Rs.) othersRs.} (in ks.)

1 2 3 4 5 6-- .-

I Expenses in public meeting, rally, processionetc.i-

N\~La: Expenses in public meeting, rally,

Iprocession etc. (ie: other than the ones withStar Campaigners of the Political partyr- (Enclose as per Schedule-L)L b : Expenditure in public meeting rally,

N\~procession etc. with the Star Campaigner(s) (ie:

I other than those for general party propaganda)(Enclose as per Schedule-2) 1 --u I:a algn mare ·a!s o:.':er than those used in the IO:-:::!:::!: c:'?t-;.;:. ,:~~ .. ~~c.-"""d!:l ere r.:"- -;0r"r .- -- -"'_ .. - ~----..- ..--.~-.---

III

~-,---------------------.'1 S. 0.' above(Encl£l..?~~2.per Schedule=---=.3.L)-,--_C.••m?a:gn. through print and electronic medianclu ing cable network. bulk SMS or internet

<1: d Social media (Enclose as per Schedule-41Expenditure on campaign vehicle(s), used bycandidate Enclose as er schedule-S

!V

v Expenses of campaign workers I agents(Enclose as per Schedule -6)

VI Any other campaign ~-=.e,-,n-=-d.:..:it:.::uc:..re=- -jGrand Total

PART III : ABSTRACT OF SOURCE OF FUNDS RAISED BY CANDIDATE

S No Particulars Amount (in Rs.)2 :>Amount of own fund used for the election campaignEnclose as per Schedule - 7)

Lump sum amount received from the party (ies) in cash or cheque ete.Enclose as er Schedule -8

I1

III Lump sum amount received from any person/ company/ firml associations I body ofpersons etc. as loan. gift or donation etc.(Enclose as per Schedule -9)

NIL-I Total

.~-".

Schedules- 1 to 9: Details of Elections Funds and Expenditure of Candidate

,."

,------Schedule- 1

F.xl',·n!;c·!; In pllbl'" mccring rallv. procession etc. [ie: other than those with Jt.Jr Llmp.l1gr"'"1 -, "I I he' !-'"Id i\ .il p.u ty J

I s. No--

Nature of Expenditure Total Amount Source of Lxpendrturein Rs.

Arnt. incurred / IAmt. Arnt, incurredAuth by Candidate incurred / bv orhers/ agent by PoL

I I Parry ,,1 n

Hname

1 2 13 le! ; ir=.1 Vehicles for transpnrting visitors I /L ErprtinE St"EP, P"n(bl 8- Furnitnre. Fixtures. poles etc. / I3 Arches & Barricades ete. /._--._-- -

4 Flowers/ garlands

5 Hiring Loud spp'"kPrs. Microphone, amplifiers, /comparers etc.

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

7 Beverages like tea. Water. cold drink. juice etc.

B Digital TV -boards display, Projector display. tickers ,0/boards. 3D display

9 IEx~enses on celebrities. payment to musicians. other~artists remuneration etc.

1.Q, !.l:''u.'JUil:1gan.ltems j c scr ia -ights, boards etc.

.. IE'_Vt:I!~t::' UII It dll:', "" HdiLul'ler/ aircraft / vehide~;f1 / Iboats etc. dldl gt:~ ( fUI s elf celebrity or allY uther

campaigner other than Star Campaigner)

12 Power consumption/ generator charges /13 Rent for venue /14 Guards & security charges /15 Boarding & lodging expenses-of self, celebrity, party /I functionary or any other campaigner including Star

ICampaigner

16 Others expenses

I---- . __ . ---- -_._-------- -----

Total I

,-

Schedule- 2

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

v,..;.

-'

447

I i dU.c uT [he Sl,j[ CmJ j1aigllel (~) & AiJluUllt uf EXY'=ildirlli e 011 /Jublie meeting rally, JName of Party pr ucessron eLL will. lh e Star CdllllJdlgller(s,

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

· :- 3 4/ 5·I : /z I \ /

13 ! \"" <;»:

4 I '\--'"Total

~Schedule-S

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

S.• o. Ii ature of Expenses !Total Amount in ISources of Expenditure Remarks, if anyRs.

IAmt. By Amt. By Pol. Arnt, By others:candidate I Partyagent

· !! 13 :4 IS 6 7

I I t Sl\VJA I '---90['0 y~ocoL..

z I I \ Lt ~61 \4~3 I ,

4 I I

Total 6~26-] .63.~1_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 Expendi uremedium media provider (print reporter, stringer, company or in Rs.(electronic / /electronic Isms I any person to whom charges I Amt, By Ar.l~B I"" --print) and voice] cable TV. social :commission ete. paid/ payable. cand'Q,.-e/ I?ol a IS}

duration media etc.) : ifany agcn- ,oU::t"rS

1 ~.(3) -(.!)

1 2 13 14 / 5 6 - ~.

1 I I ./ I I

2 I " \/ 13 ,~ \ I I4 ./' V I

. 448

J I I__ J_Schedule -5

,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 IFuel charges IDriver's used auth. in Rs.Arnt. By AmL By Pol. A,Vo •..•~ po-".,- •... Hiring ef candidate/ Parry(If not covered charges rnt, I

vehicle I under hiring) I (If not agent B"J

Imaintenanc covered othe under ers

hiring)

11 2 3a 3b 3c 4 5 6 7 8,

1 ~ ILf cravo ~767~ ~~<;<-OO \.••...

2 t

3 n4 •

Total , I07.t;&bSchedule- 6 tOlr-bbDetails of expenditure on Campaign workers I agentsS- o Da eand Expenses on Campaign workers jTotal amt. Sources of Expenditure

i\'er. eI~~a~re of Exoenses Qty. r' Of k I incurred/ auth. Amt. By Amt. By Pol. Amt. By'10. wor ers I In Rs.- .

agents candidate/ Party othersagent

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

1 Campaign workershouurarturn/ salaryete.

_.. _--2 Boarding

.-- ...

3 Lodging ----1- ------J4 Others l~jD() ;2~

~ D6yrc) \ tJrrD -Total ,

Schedule- 7 cS DtJ-O ~ _. -?~~.;vv'

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

S. No. IDate Icash I DOl Cheque no. et~at~r Total Amountfl RS.j Remarks ~ ~idrawee bank I..., ~ ~~d\V,~ IUli7t1

.;t~~~~ IL{C)6-to-\l.\

Ob - to ~.211Y-l.q~5:PO l)~~

-- ~- - -

• 1!3~-" -

15-------- ---

- 14 6- ------ ---I

.«

11 Ii' - 11

, f~ I

I;otali " I +I

II 1

IJISchedule- 8

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

S. No.1 Name of the Political Party Date !Cash IDOl Cheque no. etc. with Total Amount in . i Re~arks7j details of drawee bank Rs. anyI

1 12 3 14 ~5 6 17

L I , -: Ir ,,\ ~/ .•.. I

~\'i' I I0; I / 1 I

1- ::.a~ /' I I Ir ed le- 9

ezails of Lurnp sum amount received from any person/company/firm/associations/body of persons ete. as loan. gift or donationec.

IName and address,

in I RemarksS. Date Cash DOl Cheque no. Mention Total AmountNo. ete. with details whether loan. Rs.

of drawee bank gift or donation

!./ Ietc.I

1 2 3 4 15/ 6 7 Is I1 I I L,/

I J2 I -"""V l I3 I \~ I J

I / I 114 I ,

Total /j I I I:

'ate:L In Schedule 5:-(a) copy of the order containing list of all -ehicles for which permit issued by ie e ID --

(b) !fthe vehicle is owned by the candidate his relative/agent are used for elect" n _ .all such vehicles. except one vehicle if owned and used by the candidate, notiona cost of fuel ansuch vehicle, shall be included in total amount of expenditure in the above table.

450