Affid~vit to be Furnished by the candidate along with Nomination Paper before theU Returning Officerfl For election to the West Bengal Legislative AssemblyB From 111 Panihati Assembly Constituency

I, Ahibh~san Chakraborty, son of Late Harendra Chakraborty aged 64 years, resident ofBasak B~an, R.N. Tagore Road, P.O.-Sodepur, P.S.- Khardah, Dist.- North 24 Parganas, KolI<ata-110, a candidate at the above Election, do hereby solemnly affirm and state on oath asunder:- g,(Strike out whichever is not applicable)(1) I arrtla candidate set up by Communist Party of India (Marxist).2 Details of PAN and status of filin of Income tax returnSI ~ Names Permanent The financial year for which

No. Account Number the last income tax return has(PAN) been filed

ACMPC 9195 I No IT filed at resentADNPB 5777 B I.T. return submitted for

the ear 2010-2011Not ApplicableNot ApplicableNot Applicable

S IfSlouse

D,ependent-l, pendent-2

Dependent -3 ....

Total income shown inIncome Tax Return (in

Rupees)N.A.

4,29,763/-

Not ApplicableNot ApplicableNot Applicable

Not ApplicableNot ApplicableNot Applicable

The following case (s) is lare pending against me in which cognizance has been taken bythe court:-SI

No.(a) The details of cases where the court has

taken cognizance, sections of the Act anddescription of the offence for whichcognizance taken:Name of the court, Case No. and Date oforder taking cognizance:

etails of Appeal (s)1 Application (s) forr is ion (if any) filed against the above

er (s):

The details of cases, Section of the Act anddescri tion of the offence for which convicted:

(b) Name of the Court (s), Case No and Date (s)of order (s):

(c) Punishment im osed:

(5) That I give herein below the details of the assets (movable and immovable etc) of myself, myspouse and all dependents:

A. Details of movable assets:(Note1. Assets in joint name indicating the extent of joint ownership will also have to be given2. In case of deposit/Investment, the details including Serial Number, Amount, Date of Deposit,

the Scheme Name of Bankllnstitution and Branch are to be given3. 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 person, substantially dependent on the income of the candidate.5. Details including amount is to be given separately in respect of each investment)

S. Description Self Spouse Dependent- Dependent- Dependent-3No. t 2

(i) Cash in hand Rs. 10,000/- Rs. Not Not Not

2,000/- Applicable Applicable Applicable

(ii) Details of deposits in Bank F D. account SB Not Not Not

accounts (FDRs, Term bearing A./C account Applicable Applicable Applicable

Deposits and all other types no.- bearingof Deposits including saving M 2023, no- 13561accounts), Deposits with F.D. 26 in with DCOFinancial Institution, Non numbers with Bank,Banking Financial E&NF PanihatiCompanies and Cooperative Railway Co- Br, Rs.societies and the amount in Opt. Bank, 6,04,611/-

_ -1 p.. PR 10 \ \

each such deposit SashibhusanDey St Br,Rs.13.90lakhs

(iii) Details of investment In Not Applicable Not Not Not NotBonds, Debentures/shares Applicable Applicable Applicable Applicableand units Incompanies/mutual fundsand others and the amount

(iv) Details of investment In Not Applicable LIC- Not Not Not

NSS, Postal Savings, Yearly Applicable Applicable Applicable

Insurance Policies and Premiuminvestment in any Financial Rs. -instrument in post office or 9,348/-,insurance company and the NSC- Rs.amount

65,000/-(v) Personal loans/advance Not Applicable Not Not Not Not

given to any person or entity Applicable Applicable Applicable Applicable

including firm, company,trust etc and otherreceivables from debtorsand the amount

(vi) Motor Not Not Not Not Not

veh icles/ai rcrafts/yachs / Applicable Applicable Applicable Applicable Applicable

ships (details of make,registration No. etc. Year ofpurchase and amount)

(vii) Jewelry, bullion and Not Applicable 58 gm gold Not Not Not

valuable thing (give details valued at Applicable Applicable Applicable

of weight and value) Rs.1,16,000/-

(viii) Any other assets such as Not Applicable Not Not Not Not

value of Claims/interest Applicable Applicable Applicable Applicable

(ix) Gross Total Value Not Applicable Not Not Not NotApplicable Applicable Applicable AIJplicable

B. Details of Immovable assets(Note I. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated

2. Each land or building or apartment should be mentioned separately in this format)S. Description Self Spouse Dependent-l Dependent-2 Dependent-3

No.(i) Agricultural Land Not Not Not Applicable Not Not

Location (s) Applicable Applicable Applicable Applicable

Survey number (s)Area (Total measurement in Not Not Not Applicable Not Not

acres) Applicable Applicable Applicable Applicable

Whether inherited property Not Not Not Applicable Not Not

(Yes or No) Applicable Applicable Applicable Applicable

Date of purchase in case of Not Not Not Applicable Not Not

self acquired property Applicable Applicable Applicable Applicable

_ 7 I\PR '/r

Cost of Land (in case of Not Not Not Applicable Not Not

purchase) at the time of Applicable Applicable Applicable Applicable

purchaseAny investment on the land Not Not Not Applicable Not Not

by way of development, Applicable Applicable Applicable Applicable

construction etc.Approximate current market Not Not Not Applicable Not Not

value Applicable Applicable Applicable Applicable

(ii) Non- Agricultural Land Not Not Not Applicable Not Not

Locations (s) Applicable Applicable Applicable Applicable

Survey Number (s)Area (Total measurement in Not Not Not Applicable Not Not

sq.ft) Applicable Applicable Applicable Applicable

Whether inherited property Not Not Not Applicable Not Not

(Yes or No) Applicable Applicable Applicable Applicable

Date of purchase in case of Not Not Not Applicable Not Not

self acquired property Applicable Applicable Applicable Applicable

Cost of land (in case of Not Not Not Applicable Not Not

purchase) at the time of Applicable Applicable Applicable Applicable

purchaseAny investment on the land Not Not Not Applicable Not Not

by way of development , Applicable Applicable Applicable Applicable

construction etc.Approximately value Not Not Not Applicable Not Not

Annlicable Annlicable Annlicable A nnlicable

(iii) Commercial Building Not Not Not Applicable Not Not

(Including apartments) Applicable Applicable Applicable Applicable

- Location (s)- Survey number (s)Built up area (Total Not Not Not Applicable Not Not

measurement in sq.ft) Applicable Applicable Applicable Applicable

Whether inherited property Not Not Not Applicable Not Not

(Yes or No) Applicable Applicable Applicable Applicable

Date of purchase in case of Not Not Not Applicable Not Not

self acquired property Applicable Applicable Applicable Applicable

Cost of property (in case Not Applicable Not Not Not Not

of purchase) at the time Applicable Applicable Applicable Applicable

of purchaseAny investment on the Not Applicable Not Not Not Not

property by way of Applicable Applicable Applicable Applicable

development,construction etc.Approximate current Not Applicable Not Not Not Not

market value Applicable Applicable Al)l)licable Applicable

(iv) Residential Building Not Applicable Not Not Not Not

(Including apartments) Applicable Applicable Applicable Apl)licable

- Location (s)- Survey number (s)

~ R Mljumcer

~

T nc1er ! oirrack-~ pcr ' sUL'~"V1SlOn

.(;) "ego' 0, 13/02o ,Llal.24 Pg" (N)

- 7 APR !!

Area (Total measurement One katha Eight Not Not Not Not

in sq.ft) Cittaks (1080 Sq. Applicable Applicable Applicable Applicable

fts. More or lessBuilt up Area (Total 2 storied building Not Not Not Not

measurement in sq.ft) admeasuring 1280 Applicable Applicable Applicable Applicable

SQ.fts.Whether inherited No Not Not Not Not

property (Yes or No) Applicable Applicable Applicable Applicable

Date of purchase in case 04-02-1983 Not Not Not Not

of self acquired property Applicable Applicable Applicable Applicable

Cost of property (in case Rs.5000/- Not Not Not Not

of purchase) at the time Applicable Applicable Applicable Applicable

of purchaseAny investment on the Investment for Not Not Not Not

land by way of construction of Applicable Applicable Applicable Applicable

development building Rs.construction etc. 2,00,000/-Approximate current Rs. 10.21 lakhs Not Not Not Not

market value Applicable Applicable Applicable Applicable

(v) Others (such as interest Not Applicable Not Not Not Not

in property) Applicable Applicable Applicable Applicable

(vi) Total of current market Rs. 1O.21Iakhs. Not Not Not Not

value of (i) to (v) above Applicable Applicable Applicable Applicable

(6) I give herein below the details of liabilities/dues to public financial institutions andgovernment: (Note: Please give separate details of name of Bank, institution, entity or individualand amount for each any) -Nil

s. DescriptionNo.(i) Loan or dues to Bank!

Financial Institution {s}Name of Bank or F IAmount outstandingNature of LoanLoan or dues to anyindividuals/ entity other thanmentioned in (i) above.Name (s)Amount outstandingNature of loanAny other liability

NotApplicable

NotApplicable

NotA licable

NotA Iicable

- 7 f\PR 20 \

NotApplicable

NotApplicable

NotA Iicable

NotA Iicable

NotApplicable

NotApplicable

NotA licable

NotA Iicable

(ii) Government Dues Nil Nil Not Not Not ApplicableDues to departments dealing Applicable Applicablewith governmentaccommodationDues to departments dealing Nil Nil Not Not Not Applicablewith supply of water Applicable ApplicableDues to departments dealing Nil Nil Not Not Not Applicablewith supply of electricity Applicable ApplicableDues to departments dealing Nil Nil Not Not Not Applicablewith supply of telephones/ Applicable ApplicablemobilesDues to departments dealing Nil Nil Not Not Not Applicablewith Government transport Applicable Applicable(including aircrafts andhel icopters)Income Tax Dues Nil Nil Not Not Not Applicable

Applicable ApplicableWealth Tax Dues Nil Nil Not Not Not Applicable

Applicable ApplicableService Tax Dues Nil Nil Not Not Not Applicable

Applicable ApplicableMunicipality/Property Tax Dues Nil Nil Not Not Not Applicable

Applicable ApplicableSales Tax Dues Nil Nil Not Not Not Applicable

Applicable ApplicableAny other dues Nil Nil Not Not Not Applicable

Applicable ApplicableGrand total of all Govt. dues Nil Nil Not Not Not Applicable

Applicable Applicable

(7) Details of profession or occupation:a. Self - Retired but employed as contractual service upto 15-04-11b. Spouse- Chhabi Chakraborty, at present retired Astt. Teacher 1\ t . ,.-

(hrf'l" :; l'\ 1;- ~ ,c::; """-t - I t) S-<6 tI"'-' ''<> k L..." t L. \Co-X Lwv;-;" ~j".: _ (p <:-L' t> ""; ...., .<...-<.• '-, - • I ~ b-O

(8) My educational qualification is as under: B.Com, Surendra Nath College, 1963(Give details of highest school/university education with full form of the certificate/ diploma/ degreecourse) (Name of the School/College/University and the year in which the course was completed).

1. Name of the candidate Ahibhusan Chakraborty2. Full postal address Basak Bagan, R.N. Tagore Road, P.O.-Sodepur, P.S.-

Khardah" Dist.- North 24 Parganas, Kolkata- 1103. Number and Name of the constituency 111 Panihati Assembly Constituency, West

and state Bengal4. Name of the political party which set up Communist Party of India (Marxist)

the candidate (otherwise write'Independent' )

5. a) Number of cases in which conviction Not Applicableorder passed (other than those referred toin Form 26)(b) Total number of Pending cases where Not Applicable

~

••.~ ~ 4 1/ J.

1/* ~ lI:ajumcter •. Un1Pr !-arrack-

( ( pera "Sub-;)ivision. ~. R&gd o. 13/02o List·2i r Q:l (N

- 7 ~PR 2 \ \

a) Candidateb) Spouse

Year for which lastIncome TaxReturn FiledNo I.T. file

I.T. return filedlas 2010-2011

Not A IicableDetails of Assets and Liabilities in ru ees

Self Spouse Dependent-l

No any incomeRetired from servj.ce in Feb'

11, Pension not startedNot A Iicable

6.s.

No.A. Moveable

Asset (Total value)ImmovableAssetPurchase price andDevelopment cost ofImmovable property

otal valueApproximate currentmarket price of AssetTotal Value)

Liabilities

Rs. Rs.14,00,000/- 79,6959/-

Rs. Nil2,05,000/-

Rs. Nil10,21,000/-

(i) Government dues Nil Nil Not Applicable Not Applicable

Total(ii) Loans from Bank, Nil Nil Not Applicable Not Applicable

Financial Institutionsand others (Total)

Highest educational qualification: B.Com, Surendra Nath College, 1963

Dependent-3

NotApplicable

NotApplicable

NotApplicable

NotApplicable

NotA licableNotApplicable

NotApplicable

(Give details of SchoollUniversity education with full form of the certificate/diploma/ degreecourse) (Name of the School/CollegelUniversity and the year in which the course wascom leted

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of this affidavit aretrue and correct to best of my knowledge and belief, no part of it is false and nothing material hasbeen concealed there from I further declare that:-

(a) There is no case of conviction or pending case against me other than those mentioned in items 3and 4 above;

(b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned initem 5 and 6 above.

Verified at Barrackpore this the 7tb day of April, 2011

*

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