INDIA NON JUDICIAL

Government of National CaPital Territory of DelhE

e-Stamp

SU 181

sdqt{ GtqtCertificate No.

Certificate lssued Date

Acccunt Heference

Unique Doc. Reference

Purchased by

Description of Document

Property Description

Consideration Price (Rs.)

First Party

Second Party

Stamp Duty Paid By

Stamp Duty Amount(Rs.)

C

CHAMAN LAL

Not Applicable

CHAMAN LAL

10(Ten only)

otN

0(Zero)

+k

.Please write or type below this line- - " - - - - -. -

tA

t-

I

20-Jan-2A20 03:37 PM

TMPACC (lvy d1921 3031 DELHI/

\ri

T

Form 26(See rule {A)

AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINATION

PAPER BEFORE THE RETURNING OFFICER FOR ELECTION TOLEGISLATIVE ASSEMBLY OF NCT OF 2020- (NAME OF THE HOUSE)

FROM 52 _ TUGHLAKABAD ASSEMBLY CONSTITUENCY (NAME THECONSTITUENCY)

PART-A

I, CHAMAN LAL, **sonldatrghte#vrifu of LATE SHRI CHHAJURAM' aged 65 years,resident of B-75, BLOCK -8, HARKESH NAGAR, OKHLA INDUSTRIAL ESTATE,DELHI-110020 (mention full postal address), a candidate at the above election, do herebysolemnly affirm and state on oath as under: -

(1) I am a candidate set up by I'}EoPLES PARTY oF INDIA (DEMOCRATIC)

(**name of the political party)/**anreentesting:asanJ+rdepe+rtlent+a*didate.

(**strike out whichever is not applicable)

(2) My name is enrolled in 52 - TUGHLAKABAD ASSEMBLY CONSTITUENCY,STATEruT OF NCT OF DELHI Q'{ame of the Constituency and the State), at SerialNo. 490 in Part No. 3.

(3) My contact telephone number(s)islare: Mobile No.+91-9210141013 and my e-mail id (ifany) is NA and my social media accournt(s) (if any) t*larc

(i)

(ii)

(iii)

NIL

NIL

NIL

-

(1) Details of Permanent .\cCount \untber (P\\) and Status of filing of lnc..,nt. Irt

return:

Gtal income shown

Tax Return (in RuPees) for the

last ltve Financial Years

completed (as on 31't March)

in Income

,vear for which

the last income

tax has been

fi1ed

The tlnancial

F.Y.2018-i9 NIL(i)F.Y.2017-18 NIL(ii)

F.Y.2016-17 NIL111 )

t .v. zols-to NIL)p.v. zot+-t s NIL(v )

ADXPL34O3Ai Self

(CHAMAN

LAL)

F.Y. 2018-19 NIL(i)

F.Y. 2017-18 NIL(i i)

F.Y.2016-17 NIL

F.Y. 2015-16 NIL(iu)

F.v. zot+-ts NIL)(

Spouse

(KAUSHALIYA)

NOT APPLICABLE(i)

NOT APPLICAB LE(i i)

NOT APPLICAB LE(iii)

NOT APPLICABLE(ir)

NOT APPLICAB LE(v)

NOT

APPLICABLE

NOT

APPLICABLE

HUF (lf

Candidate is

Kartal

Coparcener)

1J

NOT APPLICAB LE,(i)

(ii ) NOT APPLICABLE

NOT APPLICAB LE(iii)

NOT APPLICABLE(iv)

NOT APPLICABLE,)(

NOT

APPLICABLE

NOT

APPLICABLE

4 Dependent 1

NOT APPLICABLE(i)3tu

NOT APPLICABLE)

111) NOT APPLICABLE

NOT APPLICAB LE(iv)

NOT

APPLICABLE

NO'I

APPLICABLE

2

1.q)o

(1)NOT

APPLICABLE

NOT

APPLiCABt-E( ii) .\OT APPLIC \B L-

NOT APPLICAB LE

Note:ItismandatoryforPANholdertomentionPANandincaseofnoPANIt should be

clearly stated'No PAN allotted"'

(5) Pending criminal cases': -

fi/ I declare that there is no pending criminal case against me' (Tick this alternative

if

there is no criminal -case pending against the candidate and write NOT APPLICABLE

against alternative (ii) below)OR

(il)Thefollowingcriminalcasesarependingagainstme:NoTAPPLICABLE

(If there are pending criminal cases against the candidate' then tick this alternative and

score off alternative (i) above, and give details of all pending cases in the Table below)

Table

rS)itr"I'. Js-\

\l.o .11

NOTAPPLICABLE

, NOTAPPLICABLE

NOTAPPLICABLE

FIR No. with nameaddress of Police Stationconcerned

and(a)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Case No. with Name(b)

NOTAPPLICABLB

NOTAPPLICABLE

NOTAPPLICABLE

Section(s) of concernActs/ Codes involved

(give No' of the Section'e.g. Section....... of IPC,

ed of

etc.).

(c)

NOT

APPLICABLBNOT

APPLICABLENOT

APPLICABLEd)( Brief descriPtion of offence

NOT

APPLICABLENOT

APPLICABLENOT

APPLICABLEWhether charges

framed (mentionor NO)

have

been

(e)

NOT

APPLICABLENOT

APPLICABLENOT

APPLICABLEthen give the dateer against (e) above

111( )

NOT APPLICAR LE,(iv)

NOT EPPT-ICAB I,E,v)(

Dependent-36

J

--'AYl0 c t(

$

on nhich charges \rereframed

\OTAPPLICABLE

\OTAPPLICABLE

(e) Whether any AppeaUApplication for revisionhas been filed against theproceedings (Mention YESorNo)

NOTAPPLICABLE

(6) Cases of conviction

fi\,/ I declare that I have not been convicted for any criminal offence. (Tick thisYa-lternative, if the candidate has not been convicted and write NOT APPLICABLE against

alternative (ii) below)

OR

(ii) I have been convicted for the offences mentioned below: NOT APPLICABLE(If the candidate has been convicted, then tick this alternative and score off alternative (i)

above, and give details in the Table below)

Table

NOTAPPLICABLE

4

NOTAPPLICABLE

NOTAPPLICABLE

a( ) Case No. NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLB

(b) Name of the Court

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

c( ) Sections of Acts / Codesinvolved (give no. of theSection, e.g. Section.......of IPC, etc.).

NOTAPPLICABLE

NOTAPPLICABLE

Briefoffence

description offor which

convicted

NOTAPPLICABLE

NOTAPPLICABLE

Dates of orders ofconviction

NOTAPPLICABLE

NOTAPPLICABLE

(e)

NOTAPPLICABLE

NOTAPPLICABLE

(0 Punishment imposed NOTAPPLICABLE

('g)".fr,'::n

,r%,

NOTAPPLICABLE

-Whether any Appeal has

*F" filed against\flryli.tion order, (N\6ition Yns

NOTAPPLICABLE

(d)

(6A) I have given lull and Llp-to-date information to mr political partv about all pendingcrirninal cases against me and abor-rt all cases of conviction as given in paragraphs (5)

and (6)- Nor API'}LICAIILE lN vIEw oF ENTRIES IN S(i)and 6(i), above.

[Candidates to whom this item is not applicable should clearly write NOTAPPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), abovel

Note:

1. Details should be entered clearly and legibly in BOLD letters.2. Details to be given separately for each case under different columns against

each

3. Details should be given in reverse chronological order, i.e., the latest case tobe mentioned first and backwards in the order of dates for the other cases.

4. Additional sheet may be added if required.5. Candidate is responsible for supplying all information in compliance of

Hon'ble supreme court's judgment in w. p (c) No. 536 of 201r.(7) That I give herein below the details of the assets (movable and immovable etc.) of myself,

my spouse and all dependents:

A. Details of movable assets:Note:1. Assets in joint name indicating the extent ofjoint ownership will also have

Note:2

to be given

In case of deposit/lnvestment. the details including Serial Nurnber,Amount, date of deposit, the scheme, Name of Bank/rnstitution andIlranch are to be given.

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

'Dependent' means parents, son(s)" daughter(s) of the candidate or spouse

and any other person related to the candidate whether by blood ormarriage" who have no separate means of income and wlio are dependent

Note:3

on the candidate for their livelihood

lf ansn'er to (g) abovc isYES, give details andpresent status of appeal

Note:4

NOTAPPLICABLE

NOTAPPLICABLE

\UT.\PPLIC \BLE

hr)

h( )

5

,Aas rf

I

Note:5

Note:6

Explanation-

Detailsincludingamountistobegirenseparateirir':es:-'"=-'-

investment.

Details should include the interest in or or,vnersirip of offlhore assets.

For the purpose of this Form, the expression 'ooffshore assets"

includes,detailsofall

NOTAPPLICABLE,

\r, l.

-tPPr.t.{ BLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NIL NIL(iii) Details ofinvestrnent in

(Bonds.

Dcbentures

/Shares andunits in thecornpanies/

MutLral

FLrnds andothers andthe arrount.

NOTAPPLICABL,E

NOI-APPLIC

ABLE

NIL NOTAPPLICABI-E

NOTAPPi-ICABLE

(iv) Details ofinvestment in

NSS. PostalSaving.

I nslrlance

Policies andinvestment in

any Financial

instrurnents

in Post officeor lnsuranceCornpany

and thealrount

NIL

NOTAPPLIC

ABLE

NIL NIL NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(v) Personal

loans /advance

given to anyperson or

entity

inclLrding

f'lnr.company.

Trust etc.

and

other

receivables

tiom debtorsand the

alnount.

.J:'l-

ffie':i_ /

7aYr+fr

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABLE

Motor

Vehicles/'dirciafts/

YachtslShips

(Detaiis bf

NIL NIL NOTAPPLICABLE

/) tr

7

,4

Make.

registration

number.

etc. year ofpurchase and

amount)

(vii) Jewellery,bullion andvalr-rable

thing(s)(give

details ofrveight and

val ue)

l0 GramsSilver{ 400/-

5 Grams

Gold,

< 1 8000/-30 Grarns

Silver

t 1200/-

NOTAPPLICABLE,

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABI-E

(viii) Any otlterassets sr-rcl.t

AS

value olclaims/

i nterest

NIL NIL NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABLE

(ix) Gross Totalvalue

< 13400/- < s4200^ NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABLE

B. Details of Immovable assets:

Note:1. Properties in joint ownership indicating the extent of joint ownership will also

have to be indicated -

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

Note:3. Details should include the interest in or ownership of offshore assetsDependent-3HUF Dependent-

IDependent-2Spouse

(Kaushaliya)S.

No

Description Self(Chaman Lal)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLTCA

BLE

NIL NOTAPPLICA

BLE

AgriculturalLandLocation(s)

Survey

number(s)

NIL(i)

*

NOTAPPLICA

BLE

NOT

APPLICABLE

NOTAPPLICABLE

NO'fAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Area (TotallreasLlrelrent

\acres)NOTAPPLICABLE

NO'IAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE$#:;p'tr,{v

NOTAPPLICABLIl

NOTAPPLTCABLE

4'k- a A ^Al/

!

7

(Yes or No) NOTAPPLICABLE

NOTAPPLlCABLE

NOTAPPLICABLE

\OTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

Date ofpurchase in

case of self -

acquiredNOTAPPLICABLE.

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE,

Cost of Land(in case ofpurchase) at

the time ofpr-rt'chase NOT

APPLICABLT]

NOTAPPLICABLE

NOTAPPLICABLE

NOT

APPLICABLE

NO'fAPPLICABLE

NOTAPPLICABLE,

An1'

lnvesttnent

on the land

by lvay" ofdeveloPment,

construction

etc. NOTAPPLICABLE,

NOTAPPLICABLE

NOTAPPLICABLE

NOT

APPLICABLE,

NOTAPPLICABLE

NOTAPPLICABLE

Approxirnate

Current

rnarket value NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE,

NOT

APPLICABLE

NILNon-AgriculturalLand

l-ocation(s)

Survey

nLrmber(s) NOTAPPLICABLE

NOTAPPLICABLE,

NOTAPPLICABLE

NOT

APPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Area (total

lneasLlrement

in sq. ft.) NOTAPPI-ICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOT

APPLICABLE,

NOTAPPLICABLE

NOTAPPLICABLE

Whether

inlierited

propefiy

(Yes or No) NOTAPPLICABLE

NOTAPPLICABLE,

NO'fAPPLICABLE

NOT

APPLICABLE,

NOTAPPLICABLE

NOTAPPLICABLE,

Date ofpr-rrchase in

case of self -

acquired

property NOl'APPLICABLE

NOTAPPLICABLE,

NOTAPPLICABLE

NOT

APPLICABLE,

NOTAPPI,ICABLE

NOTAPPLICABLE

Cost of Land

1in case ofpurchase) at

the time ofpLrrchase

(ii)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOT

APPI-ICABLE

NOTAPPLICABLE,

NOTAPPLICABLE

Any

the land

way ol

n on) (

L

NIL

(iii)

developrnent.

constructior.t

etc.

Approxintate

c urrent

rnarket value

NO'.r-

APPLICABLENOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOT

APPLICABLE

CommercialBuildines(includingapartments)

-Location(s)

-Survey

number(s)

NIL NIL NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABI-E

Area (totalrleasuretnent

in sq. ft.)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

BLrilt-Lrp

Area (totalrxeasUrerrent

in sq.fi.)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Whether

inherited

property

(Yes or No)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOT

APPLICABLE

Date ofpurchase in

CASC

ofself-acq Lrired

property

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NO'IAPPLICABI,E

Cost olpropenv (in

CASC

of purchase)at the time ofpurchase

NOTAPPLICABI,E

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

An,v

Investrnent

on the

property by\\ aY oldeveloprnent,

construction

etc.

NO'fAPPLICABI,F,

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOl'APPLICABLE

Approxirnate

c Llrrent

rrarket value

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

^1r

-

ResidentialBuildinss(including

aparlments):

-Location (s)-Survey

numbers)

B-75, block -8,Harkesh Nagar,Okhla IndustrialEstate, Delhi-I 10020

H.No. 36. GaliNo. 2. \ikhilVihar.lsmailpur.

Faridabad.

Harl'ana

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

Area (Total

measLlrelllent

in sq. ft)

223 Sq. ft. 890 Sq.ft. NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

BLrilt up

Area (T'otal

measLlrelnent

in sq. fi.)

890 Sq.ft. NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Whether

in herited

property:

(Yes or No)

YES NO NAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Date ofpurchase in

CASC

of self -acq Lr i red

propefiy

NOTAPPLICABLE

NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABt,E

Cost ofproperty (in

case ofpurchase) at

the tinte olpurchase

NOTAPPLICABLE

Year 2014 NO'TAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPt-ICA

BLE

AnyInvestment

on the land

by way ofdevelopment,

construction

etc.

< 2s000/- { 1000000/- NOTAPPLICA

Bt,E

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(iv)

A pproxirnate

cLlrrent

rnarket value

{ r300000/- T 3000000/- NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(r') Others (such

as interest in

propeny)

NIL NIL NOTAPPLICA

BLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(i)

nt

otal of < 1300000/- { 3000000/- NOTAPPLICA

BL,E

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

*tr - A ^A\

NOTAPPLICABLE

223 Sq" ft.

{ 8o00oo/-

[[

,i

J

rLIr

(8) I give herein below the details of iiabilities dues to public l-rnancial instrtLttions andgovernment: -

(Note: Please give separate details of nan.ie of bank. institution, entity or individual and

amount before each item)

Dependent1

Dependent-2

Depen

dent

-3

S. No Description Self(Chaman

Lal)

Spouse

(Kaushaliya

)

HUF

NOTAPPI,ICABLE

Loan or duestoRank/Financi:tlInstitution(s)Narne ol BankofFinanc ial

Institution.

ArlountoLrtstanding.

Nature of loan

NIL NIL NOTAPPLICAB

LE

NOTAPPLICABLE

NOTAPPI,ICABLE

Loan or duesto any otherindividuals/entity otherthanmentionedabove.

Name(s),

Amount

outstanding,

nature ofloan

NIL NIL NOTAPPLICAB

LE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

Any otherliabilitv

NIL NIL NOTAPPLICAB

LE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(i)

Grand total ofliabilities

NIL NIL NOTAPPLICAB

LE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABLE

(ii)

\./.

GovernmentDues;

Dr-res todepartrnents

Dealing u,itlr

(A) Has the Deponent been in occupation of accommodationprovided by the Government at any time during the last tenyears before the date ofnotification ofthe current election?

(B) If ansiver to (A) above is YES, the fbllowing declaration rnaybe firrnished namely: -

(i) The address of the Government accommodation:

,/YESn\IO

(Pl. tick theappropriate

NOTAPPLICABLENOT

,,APPLICABLE

JI n/)

t

I

lII

l

"Gov'ernment

#ornmodation(B-\

APPLICABLENILNILNILNIL

(ii)

(a) rent:

sr-rbrr,itted.

oi .lc"i:in respecttowards-

iLL:sl, L) ;'3" able1SThereea c rrl'llnl Lrdation 'Governulent

(c

(d)

thereafterl.

charges:,le ctric itre)(bandcharges;water) date91 ,)20 (.031JonASchargestelePhone monththirdtheofdatelasttl-rebeslror"rlddate orIthe notifiedISelectionthehwlricrnmonththetoprior

dateanv the agenciesfrotr-tCertificate'Dueso'NNote- watercharges.electricitYrent,ofin resPectconcerned abovetheforchargesand rclePhonecharges beshor-rldaccommodationGovernmentNOTAPPLICABLE,

NOTAPPLICABLE

NOTAPPLICABLT,

NOT

APPLICABLE

NILDltesdepaftment

dealing

Government

transPort

(including

aircrafts andhelicoPters )

to

with

( iii)

DependentJHUFSpouseSelf

NOTAPPLICABI-E

NOTAPPLICABLE,

NOTAPPL-ICABLE,

NOT

APPL,ICABLL,

NILNILlncome Tax

dues

tv( )

NOT

APPLICABLENOTAPPLICABLE,

NOTAPPLICABLE,

NOT

APPLICABLE,

NILGST dr'res(v)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPT-IC

ABLE]

NOT

APPLICABLE

NILNIL

ProPertY tax

dues

(vi)

NOTAPPLICABLI

NOTAPPLlCABLE,

NOTAPPLICABLE

NOT

APPLICABLE,

NILNILAnY other dues(vii)

NOTAPPLICABLE

NOTAPPLICABLE,

NOTAPPLICABLE

NOI-

APPLlCABLE,

NILNILGrand total of

all Government

dues

(viii)

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLICABI-E,

NOT

APPLICABLE

NILNILWhether an}other liabilitiesare in disPute, ilso. mention the

alnount

lved and the

is

before

,N 6l ct/o/,

NIL

i

NIL

i9) Details of profession or occupation:

(a) Self :Pensioner

(b) Spouse: House Wife

(9A) Details of source(s) of income:

(a)

(b)

(c)

Self: Pension

Spouse: NIL

Source of income, if any, of dependents NOT APPLICABLE

(9B) Contracts with appropriate Government and any public company or companies

(a) details of contracts entered by the candidate NOT APPLICABLE

(b) details of contracts entered into by spouse NOT APPLICABLE

(c) details of contracts entered into by dependents NOT APPLICABLE

(d) details of contracts entered into by Hindu Undivided Family or trust in which thecandidate or spouse or dependents have interest NOT APPLICABLE

(e) details of contracts, entered into by Partnership Firms in which candidate or

spouse or dependents are partners NOT APPLICABLE

(0 details of contracts, entered into by private companies in which candidate or

spouse or dependents have share NOT APPLICABLE

(10) My educational qualification is as under:

Class 7th pass from Govt. School, Kalkaji in the year 1966.

(Give details of highest School/University education mentioning the full fbrm of the certificate/

diploma/ degree course, name of the School /College/ University and the year in which the course

was cornpleted.)

a {t t

F

(1 1).

PART-B

ABSTRACToFTIIEDETAILSGIVENIN(1)To(10)oFPART-A:

LALcandidateName of the

1

110020

ATE,

GAR,ANB,15,B. ELIIIDESTSTRIALINDUOKIILAaddressFull postal

DELIII

ATE/UTTU52 FoCTNFoSTSTITUBNCYCON

and Statethe constitrrencYol

Number and name

(DEMOcRATIC)

INDIAOFPARTY

candidate

uP thewhich setpafiypoliticalName of the

CASESof pendingnumberotalT)whichtnCASESofnumberotalT Total

income shorvn6

lastwhichforYfiledreturnTaxincomePAN of NIL"t

NILAADxpt-:+o:(a) Cand idate NILNIL

eol\prt 065F CABLE,NOT APPLI'(b) SPouse ICABLE,NOT APPLABLECNOT APPLI CABLE,NOT APPLI(c) HUF NOT

LE,LICABNOT APP(d) DePendent ln RuPees)assetsoffshoreLiabilitiesandAssetsofDetails8

DePende

nt No.3DePendent

-2DePendent

-1HUF

YA)

Spouse

(KAUSHALI

LAL)

Sell(CHAMAN

NOTAPPLIC

ABLE,

NOTAPPLICABLE,

NOTAPPLICABLE,

NOTAPPLI

CABLE,

purchase (ifapplicable)

Iil ApproxirnateCurrent marketprice-(a) self-

acquired assets

(Total Value)

(b) inheritedassets (Total

Value)

{ 1300000/-

NIL < 3000000/-

NIL

NOTAPPLI

CABLE

NOTAPPLI

CABLE

NOTAPPI-ICABLE

NOTAPPLICABLE

NOl'APPLICABLE

NOTAPPLICABLE

NOTAPPL,IC

ABLE

NOTAPPLiCABt,E

9 Liabilities

(i) GovernrnentdLres (-fotal)

NIL NIL NOTAPPLI

CABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABLE

(ii) Loans fromBank,

Financial

lnstitutions andothers (Total)

NIL NIL NOTAPPLI

CABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABLE

l0 Liabilities that are under dispute

(i) Governrnentdues (Total)

NOTAPPLICABLE

NOTAPPLIC

ABLE

NIL NIL NOTAPPLI

CABLE

NOTAPPLICABI-E

(ii) Loans fl'orrBank.

Financ ial

Institutions and

others (Total)

NIL NIL NOTAPPLI

CABLE

NOTAPPLICABLE

NOTAPPLICABLE

NOTAPPLIC

ABLE

ll Highest educational qualifi cation:

Class 7th pass from Govt. School, Kalkaji in the year 1966.

(Give details of highest School/University education mentioning the full form of the

certificate/diploma/degree course, name of the School/College/ University and the year

jryhlaq course was comrleted.)

F

A c4 /

(b) I. my spouse. or

Jrt rqpr{tioned in rtems 7{ trRP

e

VERIFIC.{TION

my dependents do not have any assetand 8 of part A and items g, 9 and l0 of

or liability, other than thosePart B above.

I' the deponent' above named. do herebr. verify and declare that the contents of thisaflldavit are true and correct to the best of rly knowledge and berief and no part of it is falseand .othi,g ,rateriar has been conceared there from. I fr,utrrer decrare that: _(a) there is no case of co,viction or pending case against me other than those mentioned initems 5 and 6 of part A ancl B above;

I

II

IT

afinG

+

ew Delhi rhis rhe 20 y of January,2020J. A l- ST"

r{

Affidavit should beNore: 2. Affidavit should be

First Class or before a Notary public

YA0 t(

latesr by 3.00 pM on the last dav of

JAN 2020 ir?l"ta,ilEPONE

6lStfNT6 L3q

OY

PUBTIC 0

nomrnationsswom before an Oath Commissioner or Magistrate of the

i.\1

Note: 3

Note:4

Note: 5.

filing

All corumns should be fired up and no corumn to be reft brank. If there is r.roi,fbrmation to furnisrr in respect of any item. either ,,Nir,, or ,,Not appricabre,,, asthe case rnay be. should be mentioned.The affidavit shourcr be either typed or written regibry and neatry.Each page of the Affrdavit should be signed by the deponent and the Affidavitshould bear on each page the stamp of the Notary or oath Commissioner orMagistrate befbre whom the Affidavit is sworn.

\

>f

I

(}

iirf

ffi