n@) THPTS TAMIL NADU D-ltalucuer Pa g {pei pen FORM 26 (See Rule 4A of the conduct of Elections Rules, 1951) AFFIDAVIT TO BE FURNISHED BY THE CANDIDATE BEFORE THE RETURNING OFFICER ELECTION TO THE TAMIL NADU LEGISILATIVE ASSEMBLY i FROM No.16 EGMORE (RESERVED) CONSTITUENCY 620A a cares § |, D.KATHIRAVAN, son of G.Dheenadayalan, aged about 39 years, Perumal Koil Street, Thiruverkadu, Sunder Id No.109, New No,121, | candidate at the above election, do hereby solemnly affirm / BA2 1. am /.am not accused of any offence(s) punishable with imprisonment for two years or more in a pending case(s) in which a charges(s) has/have been framed by the Court(s) of competent jurisdiction I the deponent is accused of any such office(s) he shall furnish the following information: («ii) Case / First information report No./Nos. NOT APPLICABLE (xiv) Police Station(s) NOT APPLICABLE District(s) NOT APPLICABLE State(s) NOT APPLICABLE (xv) Section(s) of the concemed Act(s) end short description of the offence(s) for which the candidate has been charged NOT APPLICABLE (vi) Court(s) which framed the charge(s) NOT APPLICABLE (evil) Date(s) on which the charge(s) was/were framed NOT APPLICABLE (évii) Whether all or any of the proceedings(s) have been stayed by any Court(s) of competent jurisdiction NOT APPLICABLE 2. | have been/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 If the deponent is convicted and punished as aforesaid, he shall furnish the following information: Case/First information report No.(Nos NOT APPLICABLE Court(s) which punished NOT APPLICABLE Police Station(s) NOT APPLICABLE District{s) NOT APPLICABLE ‘Sate(s) NOT APPLICABLE MK3 (xii) Section(s) of the concerned Act(s) and short description of the offence(s) for which the candidate has ever been charged NOT APPLICABLE (xii) Date(s) on which the sentence(s) was/were pronounced NOT APPLICABLE (xiv) Whether the sentence(s) has/have been stayed by any Court(s) of competent jurisdiction NOT APPLICABLE. Place: CHENNAI di Date : 25-03-2001 Signature 6f deponent. VERIFICATION |, D.KATHIRAVAN, the deponent the above - named —deponent, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief, no part of itis false and nothing material has been concealed therein, Verified at Chennai this 25" day of March, 2014 Mh, Signature“of deponent R. JAYASHANKARAN, 5A, 8.., ADVOCATE & NOTARY MBAA, st Floor, HIGH COU() THerTs TAMIL NADU 624A 929370 ba DkKatiisevay \ 2e\ Bopsty THI rs area ig f PURASAWAL RAN CHCRNAL E2084 Affidavit of D.Kathiravan filed alongwith Nomination Paper before the Returning Officer For election to LEGISLATIVE ASSEMBLY (Name of the House} From No, 16, Egmore (Reserve) Constituency (Name of the Constituency) i |, D. KATHIRAVAN son of G, Dheenadayalan Aged 39 years, resident of Old No. 109, NewSNo. 121, Perumal Keil Street, Thiruverkadu, Chennai-77 (mention full postal address) 4 candidaig at the abwive Election, do hereby solemnly affirm and state on oath as undes:= (strike out whichever is not applicable)(1) Lam contesting as a Independent Candidate, (2) Details of PAN and status of filing of Income tax return : St | Names | Permanent ‘The financial year | Total income No. ‘Account Number | for whieh the last | shown In Income (PAN) Tncome-tax ceturn | Tax Return (in z = . - hhas been filed __| Rupees) 1, | Seif No No No 2_| Spouse: K. KOMALIE No No No (3) Phe following case(s) is/are pending ag 1 me in which cognizance has been taken by the court: SL Offence ‘Deseription No. = (a) | The details of eases where the court has taken NIL cognizanice, Sections of the Act and description of the offence for which cognizance taken : | {b) | Name of the court, Case No, and Date of order NI taking cognizance “1. [Details of Appeal (5) Application(s) for revision | NIL (ifany) filed against the above order(s) : 4, Cases in whieh I have been convicted by a court of law(other thase referred to in Form 26): | @ | The details of cases, Sections of the | NOT APPLICABLE Act and description of the offence for which convicted (&) | Name of the Coun(s), Case No. and | NOT APPLICABLE. Date(s) af order(s) T._| Punishment imposed NOT APPLICABLE (5) That I give herein below the details of the assets (movable and immovable ete.) of myself, my spouse and all dependents: A, Detai of movable assets : (Note: |. Assets in joint name indicating the extent of joint ownership will also have to be given2. In case of deposit!Investment, the details including Serial Number, Amount, Date of Deposit, the Scheme, Name of Bank! Institution and Branch are to be given 3. Value pf Rorids/Share/Debentures as per the current market value in Stock Exchange in respect of listed companies and as per books in ease 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 investunent) S| Deseripion Set | Spouse | Dep- | Dep- ] Dep- | No li fan [3 (i) | Cash inhand 1,00)000 | Nil Nil__NiL_[ Nil (ii) | Dols of Doposis in Bank | Nit Nil Nil Nil Nil aceoants (FDRs, Tem. Deposits and all ther types of Deposits including saving accounts}, Deposits vith Finacial Insitarions, ‘Non Banking Financial ‘Companies and Cooperative societies and the amouat in | ___| each such deposit (ib) | Details of investment in Nil Nil Nil | Nil | Nil Bonds, Debentures!shares and units in companies! Mutual Fords and fotversand the amount {| Meee I Delf ofinvesmentin | Nil Nil TNT | NID Nid NSS Postal Savings, Insurance Policies | snd investment in any Finacial Instrument in Post offer Insurance [Company and treat | (0) _ | Persone! loansfadvance Nil | ven any peeson or cntity including fier, Company, Trustee. and other receivables from shor and (vi) | Motor Vehick Nil Nil Nil | Nil) Nil ‘YachtsShips (letails of | Make, Registration No, ete, Yor of Purchase and _ [amet ) [Nil [Nit Nil(id) level, bullion and valuable thing (give details of weight and value) Nil Nil Nil [Na [Nil (wilt) | Any offer asets suck as value of Clim interest Nil Nil Nil Nu [Nil (x)_| Gross Total Value I 1,00,000 | B. Details of Immovable assets: (Note: 1. Properties in joint ownership indicating the extent of jaint ownership will also have to the indicated 2, Fach land or building or apartinent should be mentioned separately in this format.) [S| Description Now set Spouse 1G) Agrlewiaral Cand Locations) | ure nater()_ No Ne ‘Area (Tal measurement ia aces) No Ne ‘Whether inherited property (Yes or NO) No No No [No [No Date of purchase in ease of self acquired property No No [No | No Cost of Land (in ase 0 prohase) at the time of purchase No ‘Any Lavstment onthe and | by way of development, onstruction et No ‘No [No | No Approximate Curent inarket Value No No [No | No GH) | Non-Agricultural Land Loeation(s} Survey number(s) No No No [No [No ‘Area (Total mieasurernent in sa.ft) No No [No [No Whether inherited property ‘Yesot NO) No No [No | No Date of purchase in ase of self acquire proper No [No [No Cost of Land (in vse of puschase) athe time of | purchase ‘No No [No | No"Any [nvestment on the fand by way of development, construction ete No No Ne No | Approximate Current rmatke! value No No No No No ‘Commercial Buildings (including sparments) | Location(s) Sucvey number(s) No No No Ne Built up Area (Total measurement in sq fl.) No No No Wheter inherited prope (YesorNO) No No Ne No Date of purshase in eas of self voquired propery No No No No ‘Cost of property (in case of purchise) atthe time of purchase No No No No ‘Any Investment on the property by way of development, construction ate. No No No | Approximate Current ‘marke value No No No No div) Residential Buildings (including gpariments,) = Location(s) + Survey number(s) No No No No ‘Area (Total measurement in sq.ft) No No No No Built up Area (Total reasurement its.) No No No No ‘Whether inherited property. (YesorN0) No No No Ne Date of purchase in ease of self anid propery No No No No Costof property (in case of purchase) a the time of purchase No No ‘Any Tnvestment cn the [and by way of development, censtrution ete, No No Ne No Approsimate Curent unatke valve No No Ne No No(w) | Others (uc as interes in property) No (wi) | Total of Current Marker Value of () 0 6) above (No | government :- (6) | give herein below the details of liabilities / dues to public financial institutions S. Description | No Self Spouse 1 and (Notes Please give separate details of name of Bank, institution, entry or individwal and amount for each ite) (i) | Loan or dueste BankFinancial Institutions) Name of Bank or Fl Amount outstanding | Natue of loan No No Dep] Be No ‘Ne Loan or dues to any individualy/ Entity ther than mentioned in (i) hove. Namefs) Amunt outstanding | Nature of oan: No No HsThome Tae Dues Ko No - Wealth Tax Duss No | No, ~ [Service Tax Dues | No No. ‘Municipal Property Tax | Ne ‘No Dues | Sales Tax Dues Any oti No No No_/No [No Grand total ofaliGora. | No Ko No [No [No dacs (7) Details of profession or oecupation: a. Self Social Worker b, Spouse: Housewife (8) My educational qualification is as under: D.CT. Passed (Give details of highest School / University education with full form of the certificate! diploma/ degree course) (Name of the Schoo) ‘College’ University and the year in which the course was completed.) (9) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (8) ABOVE: 1, | Name of the candidate D. KATHIRAVAN Old No.109, New No, 121, Perumal Koil | By | ROL et Street, Thiruverkedu, Chennei-77 & Number and Name ofthe constituency | 16, EGMORE sand State 4 Name of the Political party which set | NDEPENDENT: vp the candidate (otherwise write Independent") (a) Number of cases in whieh NOT APPLICABLE. conviction order passed (other than those referred to in Form 26)| (@) Fotal number of Pending cases ‘where the court(s) have taken cognizance 5. | PANof Year forwhich last | ‘Total Income Shown. Income Tax Return filed (@) Cailidate (b) Spouse: 6. Details of Assets and Liabilities in rupees Description | Si Spouse | Dap | Dep] Dep A. Movable Asset (Total value) B. Immovable Asset (@ | Purchase Price and Development Cost of | Immovable Property | | (Total Value) (a) | Approximate Curent Market Price of Asset (otal Value) i Liabilities @) Government dues (Total) | (ii) Loans from | Bank, Financia) | Institutions and others (Total) 8, Highest educational qualification: D.C.T, Passed (Give deiails of School / University education with full form of the certificate / diplomat / degree course} (Name of the School / College / University and the year in which the course was completed.) MeVERIFICATION 1, D.KATHIRAVAN the depenent, above named, do hereby verify and declare that the contents of this affidavit are true and correct to the best of my knowledge and belief, no part of it is false and nothing material has been concealed there from. I further declare that: (@) there is no case of conviction oF pending case against me other than those mentioned in items 3 and 4 above; (b) L, my spouse, or my dependents do not have any asset or Viability, other than those mentioned in items $ and 6 above. Verified at Chennai this the 25" day of March 2011 Abe DEPONENT ‘Note: 1. Affidavit should be filed latest by 3.00 PM on the last date of filing nominations 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary Public. 3. All columns should be filled up and no column to be left blank. If there is no information to furnish in respect of any item, either “Nil” or “Not applicable”, as the ease may be, should be mentioned 4, The affidavit should be either typed or written legibly and neatly.