FORM 26(See Rule 4A of the Conduct of Election Rules, 1961))

Affidavit to be filed by the candidate along with Nomination PaperBefore the Returning Officer

for eJection tn !.-e.Q.K.~A.~.H.A.l~!.m).~.o.f..t~.~.Ro.~~~>'From 23 Karur Constituency. (Name afthe Constituency)

~~I ..ft..k•• laraj,IIA t'

• "_\o'OCATf &. ••••OT\IO

If !o;ULJ;-f>J'l""l

m

R. Valaiyapathi, son of A. Ramanathan, Aged about 61 Years, resident of 18/92,Rajaji Street, Karur 639 001,.lm~Dli(m ..fUl1.P9.sta1.".<!c1.r~ssLacandidate at the aboveelection, do hereby solemnly affirm and state on oath as under

(2) My name is enrolled in 135-Karur Assembly of Tamil Nadu State (Nameof the Constituency and the State), at Serial No. 387in Part No. 139. (IDCard o. TN/26/152/0270250).

(3) My contact telephone number is 9843727466 ..and 9597509152My e-mail LD is Lvalayapathy@gmail.com and my social media account isNone.

(4) Details of Permanent Account Number (PAN) and status of filling of IncomeTax return.

PAN The financialyear

for which thelast

Income-lax

returnHas been filed

AAFPVI179E 2011-2012

AEZPN5851M

APWPV6974P

Total income

Shown in In-Come-lax

return(in Rupees)

10,46,958

Nil

Nil

j)!i-\'''N'j)E.NT-~9.;3 NIl--

(5) 1 am not accused of any offence(s) punishable with imprisonment for twoyears or more in a pending case(s) in which a charge(s) has 1 have beenframed by the court(s) of competent jurisdiction.

If the deponent is accused of any such offence(s) he shall furnish the followinginformation:-

(i) The following case(s) is 1are pending against me in which charges havebeen framed by the court for an offence punishable with imprisonmentfor two years or more

O~~IL-\T.lt.lI(..-nr.lj,:& ".1 L.

AttVO(AH 1. "<OT,\IO •••..\!lL!t.-ld~ 11061.

(a) Case I First Information Repon No. I NilNos.Together with complete details ofconcernedPolice Station / District / State.

(b) Section(s) of the concerned Act(s) Niland shon description of theoffence(s) for which charged.

(c) Name of the Coun, Case No. anddate of order taking cognizance: Nil

(d) Court!s) which framed the chargers) NOT APPLICABLE(e) Date(s) on which the chargers) was I

were framed. NOT APPLICABLE(f) Whether all or any of the

proceedings(s) have been stayed by NOT APPLICABLEany Court(s) of competent.urisdiction.

(ii)The following case(s) is lare pending against me in which cognizance hasbeen taken by the coun [other than the cases mentioned in item (i)above]:-

(a) Name of the Court, Case No. and dateof order taking cognizance: NOT APPLICABLE

(b) The details of cases where the counhas taken cognizance, section(s) of the NOT APPLICABLEAct(s) and description of theoffence(s) for which cognizancetaken.

(c) Details of Appeal(s) I Application(s)for revision (if any) filed against the NOT APPLICABLEabove order!~)

(6) I have not been convicted of an offence(s) [other than any offence(s)referred to in sub-section (1) or sub-section (2), or covered in sub-section(3), of section 8 of the Representation of the People Act, 1951 (43 of 1951)and sentenced to imprisonment for one year or more.

Ifthe deponent is convicted and punished as aforesaid, he shall furnish thefollowing information:

(7)That I give herein below the details of the assets (movable and immovableetc.) of myself, my spouse and aJl dependents:

Note: I. Assets in joint name indicating the extent of joint ownership wiJlalso have to be given.

Note: 2 In case of deposit/investment, the details including serial number,Amount, date of deposit, the scheme. Name of the BankfInstitutionand branch are to be given.

Note: 3 Value of bonds/share debentures as per current market value inStock exchange in respect of listed companies and as per books inCase of non-listed companies should be given.

Note: 4 Dependent here has the same meaning as assigned in explanation (v)Under Sec.75A of the Representation of the People Act 1951.

Note: 5 Details including amount is to be given se8ara~el~ in respect of eachInvestment. ~

SJ Description Applicant Spouse Dependent- Depe DepenNo.

V. tv"pP J ndent denl-3~.V''-AI1AP1lT I

\ \J"'~ I". V\.S.H'" -2

(i) Cash in handRs.3,500/- Rs.41,000/- Rs 1,500/ Nil Nil

~»l-\

T.R.J(~ar-1j,I.A.,.J.L...ADVOCAl(!. .••or A~Y,

"\RL'K - f,~" nlll.

(ii) Details of deposit in Bankaccounts (FD Rs. Tenn depositsand all other types of depositsincluding saving accounts),Deposits with FinancialInstitutions, Non-BankingFinancial Companies and Co-operative societies and theamount in each such deposit.

Details of investment in Bonds,debentures! shares and units incompanieslMutual funds and

others and the amountDetails of investment in NSS,

Postal Saving, Insurancepolicies and investment in any

Financial instrument in PostOffice or Insurance Company

and the amount.

T.RJiftlar,lj,JI ..•..I.l.,.••1I\OC ..••lf.so I\OIARY,

~\"LJI j>l"~il.

I. LYB KarurMainNc no.

0362301000037282Goint account

with spousappinnai)

Rs.I,13,279/-

2. AXIS BankKarur Alc no.

123010 I 0006982 7

Rs.27,118l-

3.1ndian BankKarur Car Street

Ncno. 734 793084

Rs.3,419/-

LIC'S NEWJEEVAN

OHARA. PolicyNo.752928414date-26/3/2003

Rs. I 0,000/-LIC'S NEW

JEEVANSURAKSHA

PLAN-I PolicyNo.700855670date-28/312002

Rs. I 0,500/·

FixedDeposits in

LVB@Karur Main:·

I.DepositAc.No.0362I1100000635

211,Rs. I 0,00,000

I·DepositDate·

4111120132.Deposit

Ac.No.0362I1100000636

011Rs.

11,00,000/Date·

5/11120133.Deposit

Ac. 0.036211100000659

611 Rs.5,00,000/-

Date-9/112014.

LIC's BIMABACHATPolicy No.756218177

Date-19/3/2012Rs.25,000

S.B. inaccount:LVB KarurMain Aleno.0362309000002197

Rs.4,500/-

LIC'SNEW

JEEVANKISHORE.

Polic)'No.753285972 date·20/3/2004

Rs.101,000/-

LIC'SNEW

JEEVANKISHORE.

PolicyNo.752350973 date-281312000Rs.25,000/-

LIC'SNEWBIMA

GOLD.Policy

No.756214519 date-

28/8/2011Rs.50,OOO/-

(v) Personal Loans/advance givento entity including finn, com-

pany, Trust etc, and otherreceivables from debtors and the Nil Nil Nil Nil Nil

amount.

(vi) Motor Vehicles/ HONDA ActivaAircraftNachts/Ships (Details Scooter TN 47 Pof Make, registration number 1410YEAR Nil Nil Nil Nil

etc., year of purchase and 2006@amount).

Rs.48,0001-

(vii) Jewellery, bullion and valuable Gold Goldthing(s) (give details of weight 30 gram@Rs 750grams@

and value) 2750 per gram Rs.27501- per Nil Nil NilRs 82,5001 gram

Rs.20,62,000I and Silver

5KgsRs.2,35,0001

(viii Any other assets such as values') of clairnslinterest. Nil Nil Nil Nil Nil(ix) Gross Total Value Rs. Rs Rs.

2,98,316/- 49,63,5001- 1,82,000 Nil Nil

Note: 1. Properties in joint ownership indicating the extent of joint ownershipNote: 2. Each land or building or apartment should be mentioned~parately in thisformat.Sl Description R. VALAIY APATHI V.NAP INNAI V. VISHNUNo SE •...F C;j'D'-'->>:' J)P'''-NJo'''''T [(i)

Nil Nil Nil

Not Applicable Not Applicable NotA licable

Not Applicable Not Applicable NotA licable

Not Applicable NotNot Applicable Applicable

NotNot Applicable Not Applicable Applicable

Not Applicable Not Applicable NotApplicable

r.R.Ka nl a r,lj) l(.A ,1l.L,

i\D\OCAlf $. r.OfAII.Y,)(ARUK __hI'! (tUl.

Approximate current Not Applicable Not Applicable NotMarket value. Applicable

(ii) Non-AgriculturalLand; Location(s) Nil Nil NilSurvey number(s)

Area (total Not Applicable Not Applicable Notmeasurement in Sq. ft.) AoolicableWhether inherited Not Applicable Not Applicable Not

I property (Yes or No). AoolicableDate of purchase in Not Applicable Not Applicable Notcase of self-acquired Applicable

propertyCost of Land (in case Not Applicable Not Applicable Notof purchase at the time Applicableof purchase)Any investment on the Not Applicable Not Applicable Notland by way of Applicabledevelopmentconstruction etc.Approximate current Not Applicable Not Applicable Notmarket value Aoolicable

(iii) Commercial Building(including Apartments) Nil Nil NilLocation(s) SurveyNumber!;)Area (total Not Applicable Not Applicable Notmeasurement in sq.ft) Applicable

Built-up Area (total Not Applicable Not Applicable Notmeasurement in sq.ft) Applicable

Whether inherited Not Applicable Not Applicable Notproperty (Yes or No). Applicable

Date of purchase in Not Applicable Not Applicable Notcase of self-acquired Applicableproperty.

Cost of Property (in Not Applicable Not Applicable Notcase of purchase) at Applicablethe time of purchase.

~~\~qL-Y' qlL-\

T.?t.Kamaraj,I,A.J.L.,\DliOCAIE ,., NOTARY,

",\l~l.,'1( ~ 6.l~ /JUl.

Any Investment on the Not Applicable Not Applicable Notland by way of Applicabledevelopmentconstruction etc.Approximate current Not Applicable Not Applicable Notmarket value Applicable

(iv) Residential Buildings No: 43/21, Rajaji No: 18/92, Rajaji(including Apartments) Street, Karur 639 001 Street, Karur 639-Location(s) Survey No: Karur 00 I (joint property NILsurvey number(s) survey Ward 11 in the name of R.

valayapathy and V.Nappiniai) SurveyNo: Kamf survey

Ward 11Area (total 2516 2483 Notmeasurement in Sq.ft) ApplicableBuild-up Area (total 2516 2483 Notmeasurement in Sq.ft) AoplicableWhether inherited Notpropertv (Yes or No). No No ApPlicableDate of purchase in 16/09/1990 31/10/2008 Notcase of self-acquired Applicableproperty.Cost of Property (in 1,90,000 37,50,000 Notcase of purchase at the Applicabletime of purchase)Any investment on the Nil Nil Nilland by way ofdevelopmentconstruction etc.Approximate current 32,64,400 42,34,700 Notmarket value. Applicable

(v) Others (such as interest Nil Nil Nilin propertv)

(vi) Total of current market 32,64,400 42,34,700 Notvalue of (i) to (v) Applicableabove

(8) I give herein below the details· of liabilities/dues to public financialinstitutions and government:-

V. NAPPINNAJ.s. rDU>~

to.) 1'--

~~04\~\L\

T R K.lrnaraJ,1 A II,\UVOCU( S.NotAn,

1\ ~ ::', R - I, I') '{J I

(i) Loan or dues toBank! FinancialInsti tutions( s)Name of the Bank Nil

Nil Nilor FinancialInstitution, amountoutstanding, NatureofLoan.

Loan or dues to anyotherindividuals/entityother than men- Nil Nil Niltioned aboveName(s) Amountoutstandings,nature of loan.Any other liability Nil NIL NIL

Grand total of Nil NIL NILJ liabilities

(ii) Government dues: Nil NIL NIL

Dues to departmentdealing withgovernmentaccommodation.Dues to department Nil NIL NIL

dealing with supplyof water.Dues to department Nil Nil Nildealing with supplyof electricity.Dues to department Nil NIL NILdealing with supplyof telephones/mobiles.Dues of department Nil NIL NILdealing withgovernmenttransport (includingaircraft andhelicopters).Income Tax Dues Nil NIL NILWealth Tax dues. Nil Nil NilService Tax dues. Nil Nil NilMunicipal/property Nil Nil NilTax dues.

~~'~\~

c)LA. "-.U

T.It.Kama raj ,11<\ . .1\,1..,

AI)VOO,1f &. NOTAlIY,

K"IlUIt-1>3'J ~-tn,

Sales Tax Dues Nil Nil NilAny other dues. Nil Nil Nil

(iii) Grand total of all Nil Nil NilGovernment dues.

(iv) Whether any other Nil Nil Nilliabilities are in dis-pute, if so, mentionthe amountinvolved and theauthority beforewhich it is pending.

T.1t.jl.l1l1;lI".j,. " ./5J.".\'OCATE& ...•01-\11:\.

Iv'RLk ~ f,)·'.UI.

I Name of the candidate R. VALAIYAPATHI2 FuIl postal address 18/92, Raiaii Street, Karur 639 0013 Number and name of the constituency 23, Karur Constituency, Tamil Nadu

and State4 Name of the political party which set up AAM AADMI PARTY

the candidate (otherwise write'Independent')

5. (i) Total number of pending cases where Nilcharges have been framed by the Courtfor offences punishable withimprisonment for two years or more.(ii)Total number of pending cases where Nilthe court(s) have taken cognizance(other than the cases mentioned in itemii) above)

6 Total Number of cases in which Nilconvicted and sentenced toimprisonment for one year or more(except for offences referred to in sub-section (I ),(2) or (3) or section 8 ofRepresentation of the peo Ie Act, 1951.

7. Year for which last TotalPAN Income Tax return income

filed shownj( a)R. VALAIYAPATHI AAFPV1179E 2011-2012 10,46,958

",-/."'J>IMTIO

-'"' ~ b) V. NAPPINNAI AEZPN5851M Nil Nilc..~O<.D£..

c?vVE.¥~1LNT_ \ APWPV6974P Nil Nil

8. Details of Assets and Li abilities in Ruoees ""v~L 'M: DE-NbE.'"Description I R. ALAIYAPATHI I V. NAPPINNAI I V. VISHNU

A. Movable AssetsI

Rs.2,98,316/-I

Rs 49,63,500/- I Rs(Total Value) 1,82,000/-

J)S.~~Nj)c."" -">-~3.

~

B. ImmovableAsset

I. Purchase price 1,90,000 37,50,000 NILof self acquiredimmovable

I propertyII. Development! NIL NIL NIL

construction costof immovableproperty afterpurchase (ifapplicable)

III. Approximate 32,64,400 42,34,700 NILcurrent marketprice of-(a) Self acquired 32,64,400 42,34,700 NILassets (TotalValue)

(b) Inherited NIL NIL NILassets (TotalValue)

9 Liabilities NIL NIL NIL(i) Government NIL NIL NIL

dues (Total)(ii) Loans from NIL NIL NIL

Bank, FinancialInstitutions andothers (Total)

(i) Government dues NIL NIL NIL(Totals)

(ii) Loans from Bank, NIle NIL NILFinancialInstitutions andothers (Total)

T.R.l(~ftlaraj,l .•.._i>! .Alt\OCAIE t.. f'.OHI!'.

"AIU,,1l: -(,$"lJ:.tl.

I, the deponent, above named, do hereby verify and declare that the contents of thisaffidavit are true and correct to the best of my knowledge and belief and no part ofit is false and nothing materials has been concealed there from. I further declarethat:-

Ca)There is no case of conviction or pending case against me other than thosementioned in item 5 and 6 of Part A and B above;

Cb) My spouse, my dependents, or I do not have any assets or liability, other:~~~:hose mentioned in items 7 and 8 of part And item~ a~ ~fPart B

Verified at Karur this the ..?th ...day of Ap,il ..fQH ••. ~PONENT

Book No : ViIIPage No : eGSerl,l No : .4 \nate : 5""-4-~1'"lnate of Expiry: 24.05.Z017

Solerno1y affirmed ond 'I~ _&;:,\ L,baore me 0\ K"mlf on ":::> ~ /

~99493355ST R KAMARAJ, B.A_.B.L.,

• 'ADVOCATE I ,'OTARY,Alca: Kap~;r Di~td('t,Govt of ·L:r~J1D::.du.

Reg.No.G.O. Ms. No: 6~~12~1282 Rani Mat\g:uD.m~t Sl~<;c.,

, KARGR ~ c39 vOl.