Form 26

(See rule 4A) Please affix your

recent passport
size photograph
here

AFFADAVIT TO BE FILED BY THE CANDIDATE ALONGWITH NOMINATION PAPER

BEFORE THE RETURNING OFFICER FOR ELECTION TO BIHAR VIDHAN SABHA
(NAME OF THE HOUSE) FROM 64 KADWA CONSTITUENCY (NAME OF THE
CONSTITUENCY)

PART A

I RANJIT PRASAD DAS son/daughter/wife of MAHGU PRASAD DAS aged 59

years, resident of VILLAGE - MALIKPUR, POST – KURHELA BOBRA, PS – KADWA,
BLOCK – KADWA, DISTRICT – KATIHAR (BIHAR) (mention full postal address), a
candidate at the above election, do hereby solemnly affirm and state on oath as
under :-

1. I am a candidate set up by ************** (** Name of the political

party)/** am contesting as an independent candidate.

(** Strike out whichever is not applicable)

2. My name is enrolled in 64 KADWA, BIHAR (Name of the Constituency and the

state), at Serial No. 575 in Part No. 186

3. My contact telephone number(s) is/are 9931825945 and my e-mail id (if any)

is NIL and my social media account(s) (if any) is/are

(i) NIL
(ii) NIL
(iii) NIL
 (4) Details of Permanent Account Number (PAN) and status of filling of Income
Tax return :-
The Financial Year Total Income shown in income
Sl. for which the last tax return (in Rupees) for the
Name PAN Income tax return last five financial years
No
has been filed completed (as on 31st March)
(i) NOT APPLICABLE
NO PAN NOT (ii) NOT APPLICABLE
1 Self ALLOTTED APPLICABLE (iii) NOT APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NO PAN NOT (ii) NOT APPLICABLE
2 Spouse ALLOTTED APPLICABLE (iii) NOT APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NOT NOT (ii) NOT APPLICABLE
HUF (If candidate
3 is Karta/ APPLICABLE APPLICABLE (iii) NOT APPLICABLE
Coparcener) (iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NOT NOT (ii) NOT APPLICABLE
4 Dependent 1 APPLICABLE APPLICABLE (iii) NOT APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE
5 (i) NOT APPLICABLE
 (ii) NOT APPLICABLE
NOT NOT
(iii) NOT APPLICABLE
Dependent 2 APPLICABLE APPLICABLE
(iv) NOT APPLICABLE
(v) NOT APPLICABLE
(i) NOT APPLICABLE
NOT NOT (ii) NOT APPLICABLE
APPLICABLE APPLICABLE (iii) NOT APPLICABLE
6 Dependent 3
(iv) NOT APPLICABLE
(v) NOT APPLICABLE

Note :- It is mandatory for PAN holder to mention PAN and in case of no PAN, it
should be clearly stated “No PAN allotted”.

(5) Pending criminal cases

(i) 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
(ii) The following cases are pending against me : NOT APPLICABLE
(If there are pending 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
 FIR No. with name and
(a) address of Police NOT NOT NOT
Station concerned APPLICABLE APPLICABLE APPLICABLE

(b) Case No. with Name of NOT NOT NOT

the Court APPLICABLE APPLICABLE APPLICABLE

Section(s) of concerned
(c) Acts/Codes involved NOT NOT NOT
(give No. of the Section APPLICABLE APPLICABLE APPLICABLE
………………… of IPC, etc)

(d) Brief description of NOT NOT NOT

offence APPLICABLE APPLICABLE APPLICABLE

Whether charges have

(e) been framed (mention NOT NOT NOT
APPLICABLE APPLICABLE APPLICABLE
YES or NO)

If answer against (e)

above is YES, then give NOT NOT NOT
(f)
the date on which APPLICABLE APPLICABLE APPLICABLE
charges were framed

Whether any Appeal/

Application for revision
(g)
has been filed against NO NO NO
the proceedings
(Mention YES or NO)
(6) Case of conviction

(i) I declare that I have not been convicted for any criminal offence. (Tick this
alternative 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 of all pending cases in the Table below)
Table

(a) Case No. NOT NOT NOT

APPLICABLE APPLICABLE APPLICABLE

NOT NOT NOT

(b) Name of the Court
APPLICABLE APPLICABLE APPLICABLE

Sections of Acts/ Codes

involved (give No. of
(c) NOT NOT NOT
the Section. e.g. Section
………………… of IPC, etc) APPLICABLE APPLICABLE APPLICABLE

Brief description of NOT NOT NOT

(d) offence for which APPLICABLE APPLICABLE APPLICABLE
convicted

NOT NOT NOT

APPLICABLE APPLICABLE APPLICABLE
(e) Dates of orders of
conviction
(f) Punishment imposed NOT NOT NOT
APPLICABLE APPLICABLE APPLICABLE

Whether any Appeal

(g) has been filed against NOT NOT NOT
conviction order APPLICABLE APPLICABLE APPLICABLE
(Mention YES or NO)

If yes answer to (g)

above is YES, give NOT NOT NOT
(h) APPLICABLE APPLICABLE APPLICABLE
details and present
status of appeal

(6A) I have given full and up-to-date information to my political party about all
pending criminal cases against me and about all cases of conviction as given
in paragraph (5) and (6). NOT APPLICABLE

[Candidate to whom this item is not applicable should clearly write NOT
APPLICABLE IN VIEW OF ENTRIES IN 5 (i) and 6 (i), above]

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 item.

3. Details should be given in reverse chronological order i.e. the latest case to be
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 2011.

(7) That I give herein 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 of joint ownership will also have
to be given.

Note: 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.

Note: 3. Value of Bonds/Share Debentures as per the current market value Stock
Exchange in respect of listed companies and as per books in case of non-
listed companies should be given.

Note: 4. ‘Dependent’ means parents, son(s), daughter(s) of the candidate or

spouse and any other person related to the candidate whether by blood
or marriage, who have no separate means of income and who are
dependent on the candidate for their livelihood.

Note: 5. Details including amount is to be given separately in respect of each

investment.

Note: 6. Details should include the interest in or ownership of offshore assets.

Explanation:- For the purpose of this Form, the expression “offshore assets”
includes, details of all deposits or investments in Foreign banks and
 any other body or institution abroad, and details of all assets and
liabilities in foreign countries:
S. Spouse Dependen Dependen
Depen
No Description Self KANCHAN HUF t -1 t -2
dent -
DEVI 3

NOT
NOT NOT NOT
(i) Cash in Hand 20,000/- 5000/- APPLICABLE APPLICABLE APPLICABLE
APPLIC
ABLE

Details of
deposit in Bank
accounts (FDRs,
Term Deposits
and all other
types of deposits
including saving 20,000/- 100/-
accounts) A/C NO.- A/C NO.-
NOT
Deposits with 50200014932174 30638460390 NOT NOT NOT
(ii) Financial BANDHAN BANK STATE BANK APPLICABLE APPLICABLE APPLICABLE
APPLIC
ABLE
Institutions, Non BRANCH- OF INDIA
Banking KADWA BRANCH-
Financial
Companies and
Cooperative
societies and the
amount in each
such deposit
Details of
investment in
Bonds,
Debentures/Shar NOT
NOT NOT NOT
(iii) es and units in NIL NIL APPLICABLE APPLICABLE APPLICABLE
APPLIC
ABLE
companies/Mut
ual Funds and
others and the
amount
(iv) Details of
investment in
NOT
NSS, Postal NIL NIL
NOT NOT NOT
APPLIC
APPLICABLE APPLICABLE APPLICABLE
Savings, ABLE
Insurance
 Policies and
investment in
any Financial
Instruments in
Post Office or
Insurance
Company and
the amount
(v) Personal Loans/
advance given to
any person or
entity including
NOT
firm, company, NOT NOT NOT
NIL NIL APPLICABLE APPLICABLE APPLICABLE
APPLIC
Trust etc. and ABLE
other
receivables from
debtors and the
amount
(vi) Motor Vehicles/ HERO HONDA
Aircrafts/Yachts/ MOTORCYCLE
Ships (Details of REG NO.-
NOT
Make, BR 39 B/9748 NOT NOT NOT
NIL APPLIC
Registration YEAR OF APPLICABLE APPLICABLE APPLICABLE
ABLE
Number, etc, PURCHASE –
year of purchase 2011
and amount) AMT- 15000/-
Jewellery,
bullion and
NOT
valuable thing(s) NOT NOT NOT
NIL NIL APPLIC
(vii) (give details of APPLICABLE APPLICABLE APPLICABLE
ABLE
weight and
value)

Any other assets NOT

NOT NOT NOT
(viii) such as value of NIL NIL APPLICABLE APPLICABLE APPLICABLE
APPLIC
ABLE
claims/ interest

NOT
NOT NOT NOT
(ix) Gross Total RS. 55000/- RS. 5100/- APPLICABLE APPLICABLE APPLICABLE
APPLIC
Value 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 assets.

S. Spouse Dependen Depend

Depe
Description Self KANCHAN HUF t -1 ent -2
ndent
No DEVI -3
(i) Agricultural Land Mauza-Badheya
NOT NOT NOT
Location(s) Thana No.- 276 NOT
NIL APPLICAB
APPLICABLE
APPLICAB APPLIC
Survey number(s) Khata No.- 02 LE LE ABLE
Plot No.- 152
Area (total NOT NOT NOT
NOT
1.17 acres NIL APPLICAB APPLICAB APPLIC
measurement in acres) LE
APPLICABLE
LE ABLE
Whether inherited NOT NOT NOT
NOT
NO NIL APPLICAB APPLICAB APPLIC
property (Yes or No) LE
APPLICABLE
LE ABLE
Date of purchase in NOT NOT NOT
NOT
case of self acquired 13/09/1993 NIL APPLICAB
APPLICABLE
APPLICAB APPLIC
LE LE ABLE
property
Cost of land (in case of NOT NOT NOT
NOT
purchase) at the time 11000/- NIL APPLICAB APPLICAB APPLIC
APPLICABLE
LE LE ABLE
of purchase
Any investment on the
NIL NOT NOT NOT
land by way of NOT
NIL APPLICAB
APPLICABLE
APPLICAB APPLIC
development, LE LE ABLE
construction etc.
Approximate Current NOT NOT NOT
NOT
RS. 30,000,00/- NIL APPLICAB APPLICAB APPLIC
market value LE
APPLICABLE
LE ABLE

NIL NOT NOT NOT NOT

(ii) APPLICABLE APPLICAB APPLICAB APPLICA
LE LE BLE
Non Agricultural Land
Location(s)
Survey number(s) NIL
 NOT NOT NOT
Area (total NOT
NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
measurement in sq. ft.) LE LE BLE

NOT NOT NOT

Whether inherited NOT
NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
property (Yes or No) LE LE BLE

Date of purchase in NOT NOT NOT

NOT
case of self-acquired NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
property

Cost of land (in case of NOT NOT NOT

NOT
purchase) at the time NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
LE LE BLE
of purchase

Any investment on the

NIL NOT NOT NOT
land by way of NOT
NIL APPLICABLE
APPLICAB APPLICAB APPLICA
development, LE LE BLE
construction etc.
NOT NOT NOT
Approximate Current NOT
NIL NIL APPLICABLE
APPLICAB APPLICAB APPLICA
market value LE LE BLE

(iii)
Commercial Building
(Including NOT NOT NOT
NOT
apartments) NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
-Location(s)
-Survey number(s)

NIL NIL NOT NOT NOT NOT

 Area (total
measurement in sq. APPLICABLE
APPLICA APPLICA APPLICA
ft.) BLE BLE BLE

Built-up Area (Total NOT NOT NOT

NOT
measurement in sq. NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
mt.)

NOT NOT NOT

Whether inherited NOT
NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
property (Yes or No) BLE BLE BLE

Date of purchase in NOT NOT NOT

NOT
case of self-acquired NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
property

Cost of Property (in NOT NOT NOT

NOT
case of purchase) at NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
the time of purchase

Any investment on
NOT NOT NOT
the Property by way NOT
NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
of development, BLE BLE BLE
construction etc.

NOT NOT NOT

NOT
Approximate Current NIL NIL APPLICABLE
APPLICA APPLICA APPLICA
market value BLE BLE BLE

Residential Mauza - Malikpur NIL NOT NOT NOT NOT

Thana No.- 278 APPLICABLE APPLICA APPLICA APPLICA
Building BLE BLE BLE
(iv) (Including Khata No.- 113
apartments) Plot No.- 501,
502, 503, 504,
-Location(s)
505, 506, 507
-Survey number(s)
 Area (total NOT NOT NOT
NOT
measurement in sq. 22433 sq. ft. NIL APPLICABLE
APPLICA APPLICA APPLICA
ft.) BLE BLE BLE

Built-up Area (Total NOT NOT NOT

NOT
measurement in sq. 500 sq. ft. NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
mt.)

Whether inherited NOT NOT NOT

NOT
property (Yes or NO NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
No)

Date of purchase in NOT NOT NOT

NOT
case of self- 22/11/1974 NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
acquired property

Cost of Property (in

NOT NOT NOT
case of purchase) NOT
RS. 500/- NIL APPLICABLE
APPLICA APPLICA APPLICA
at the time of BLE BLE BLE
purchase

Any investment on
NOT NOT NOT
the land by way of NOT
RS. 5,00,000/- NIL APPLICABLE
APPLICA APPLICA APPLICA
development, BLE BLE BLE
construction etc.

Approximate NOT NOT NOT

NOT
Current market RS. 15,00,000/- NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
value

NOT NOT NOT

Others (such as NOT
NIL NIL APPLICA APPLICA APPLICA
(v) interest in property) APPLICABLE
BLE BLE BLE
 Total of current NOT NOT NOT
NOT
(vi) market value of (i) to RS. 45,00,000/- NIL APPLICABLE
APPLICA APPLICA APPLICA
BLE BLE BLE
(v) above

(8) I give herein below the details of liabilities/dues to public financial institutions
and Government:-

(Note: Please give separate details of name of bank, institution, entity or individual
and amount before each item)
S. No Description Self Spouse HUF Depend Depen Depen
ent -1 dent - dent -
2 3
(i) Loan or dues to
Bank/Financial
Institution(s) NOT NOT NOT
NOT
Name of the Bank or NIL NIL APPLICABLE
APPLICAB APPLIC APPLIC
LE ABLE ABLE
Financial Institution,
Amount outstanding,
Nature of Loan
Loan or dues to any other
individuals/ entity other
NOT NOT NOT
than mentioned above NOT
NIL NIL APPLICABLE
APPLICAB APPLIC APPLIC
Name (s), Amount LE ABLE ABLE
outstanding, nature of
loan
NOT NOT NOT
Any other liability NIL NIL
NOT
APPLICAB APPLIC APPLIC
APPLICABLE
LE ABLE ABLE

NOT NOT NOT

NOT
Grand Total of Liabilities NIL NIL APPLICABLE
APPLICAB APPLIC APPLIC
LE ABLE ABLE

(ii) Government Dues: YES/NO (Pl Tick

(A) Has the Deponent been in occupation of
Dues to the
departments accommodation provided by the Government at appropriate
dealing with alternative)
any time during the last ten years before the date
Government
of notification of the current election? NO
accommodation
(B) If answer to (A) is YES, the following declaration
 may be furnished namely:-
(i) The address of the Government
accommodation: NIL NOT
APPLICABLE
………………………………………………………………………………
………………………………………………………………………………
……………………………………………………………………………..
(ii) There is no dues payable in respect of above
Government accommodation, NOT
towards:- NOT APPLICABLE APPLICABLE
(a) Rent
(b) Electricity Charges
(c)Water charges and
(d) Telephone charges as on ……………………… (date)
[the date should be the last date of the third
month in which the election is notified or any date
thereafter].
Note- ‘No Dues Certificate’ from the agencies
concerned in respect of rent, electricity charges,
water charges and telephone charges for the
above Government accommodation should be
submitted.
Dues to
department
dealing with NIL
(iii) Government NIL
transport
(including aircrafts
and helicopters)

S. Description Self Spouse HUF Dependent Dependent Dependent

-1 -2 -3
No
Income Tax NOT NOT NOT NOT
(iv) dues
NIL NIL APPLICABLE APPLICABLE APPLICABLE APPLICABLE
 GST dues NOT NOT NOT NOT
(v) NIL NIL APPLICABLE APPLICABLE APPLICABLE APPLICABLE
Municipal/
NOT NOT NOT NOT
(vi) Property tax NIL NIL APPLICABLE APPLICABLE APPLICABLE APPLICABLE
dues
(vii) Any other dues NIL NIL
NOT NOT NOT NOT
APPLICABLE APPLICABLE APPLICABLE APPLICABLE
Grand total of
NOT NOT NOT NOT
(viii) all Government NIL NIL APPLICABLE APPLICABLE APPLICABLE APPLICABLE
dues
Whether any
other liabilities
are in dispute,
if so, mention
NOT NOT NOT NOT
(ix) the amount NIL NIL APPLICABLE APPLICABLE APPLICABLE APPLICABLE
involved and
the authority
before which it
is pending

(9) Details of profession or occupation:

(a) Self : AGRICULTURE & SOCIAL WORK

(b) Spouse : HOUSEWIFE

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

(a) Self : AGRICULTURE

(b) Spouse : NIL

(c) 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 into by the candidate : NIL

(b) details of contracts entered into by spouse : NIL

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

(d) details of contracts entered into by Hindu Undivided Family or trust in which
the candidate or spouse or dependents have interest : NIL

(10) My educational qualification is as under: 7 TH PASS FROM MIDDLE SCHOOL

KADWA, BLOCK – KADWA, DISTRICT – KATIHAR IN THE YEAR 1967

(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 in which the course was completed)

. PART – B

(11) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART – A:

1 Name of the Candidate RANJIT PRASAD DAS

VILLAGE – MALIKPUR, POST - KURHELA BOBRA,
2 Full postal address PS – KADWA, DISTRICT – KATIHAR
PIN CODE -
Number and name of
3 the constituency and 64 KADWA BIHAR
State
Name of the Political
Party which set up the
4 INDEPENDENT
candidate (otherwise
write ‘Independent’)

5 Total number of
NIL
pending criminal cases

6 Total number of cases

in NIL
which convicted
 PAN of Year for which last Total Income Shown
Income Tax Return
Filed
NO PAN
(a) Candidate NOT APPLICABLE NOT APPLICABLE
Allotted
7 NO PAN
(b) Spouse NOT APPLICABLE NOT APPLICABLE
Allotted
NOT
(c) HUF NOT APPLICABLE NOT APPLICABLE
APPLICABLE
(d) NOT
NOT APPLICABLE NOT APPLICABLE
Dependent APPLICABLE
8 Details of Assets and Liabilities (including offshore assets) in rupees
Depend Depen Depend
Description Self Spouse HUF ent-1 dent-2 ent-3
NOT NOT NOT NOT
Movable Assets
A (Total Value)
RS. 55,000/- RS. 5100/- APPLIC APPLICA APPLIC APPLICA
ABLE BLE ABLE BLE

B Immovable Assets
I Purchase Price of
NOT NOT NOT NOT
self-acquired
immovable
RS. 11,500/- NIL APPLIC APPLICA APPLIC APPLICA
ABLE BLE ABLE BLE
property
II Development/
Construction cost
NOT NOT NOT NOT
of immovable
property after
RS. 5,00,000/- NIL APPLIC APPLICA APPLIC APPLICA
ABLE BLE ABLE BLE
purchase (if
applicable)
III Approximate
current market
price
NOT NOT NOT NOT
(a) Self acquired
RS. 45,000,00/- NIL APPLIC APPLICA APPLIC APPLICA
assets (Total value) ABLE BLE ABLE BLE

(b) Inherited assets NIL NIL

(Total value)
9 Liabilities
I NIL NIL NOT NOT NOT NOT
Government dues APPLIC APPLICA APPLIC APPLICA
 (Total) ABLE BLE ABLE BLE

II
Loans from Bank,
NOT NOT NOT NOT
Financial
Institutions and
NIL NIL APPLIC APPLICA APPLIC APPLICA
ABLE BLE ABLE BLE
others (Total)

10 Liabilities that are under dispute

I NOT NOT NOT
Government NOT
dues (Total)
NIL NIL APPLICABLE
APPLIC APPLIC APPLIC
ABLE ABLE ABLE

II
Loans from
NOT NOT NOT
Bank, Financial NOT
Institutions and
NIL NIL APPLICABLE
APPLIC APPLIC APPLIC
ABLE ABLE ABLE
others (Total)

Highest educational qualification: 7TH PASS FROM MIDDLE SCHOOL KADWA,

BLOCK – KADWA, DISTRICT – KATIHAR IN THE YEAR 1967
11
(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 in which the course was completed)

VERIFICATION
I, the deponent 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 and no
part of it is false and nothing material has been 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 5 and 6 of Part A and B above,
(b) I, my spouse or my dependents do not have any asset or liability, other than
those mentioned in items 7 and 8 part A and items 8, 9 and 10 of Part B above.

Verified at …………………….…………… this the …………..………. Day of October 2020.

Deponent

Note: 1. Affidavit should be filed latest by 3:00 PM on the last day of filing
nominations.
Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of
the First Class or before a Notary Public.
Note: 3. All columns should be filled up and no columns to left blank. If there is no
information to furnish in respect of any item, either “NIL” or “NOT
APPLICABLE” as the case may be, should be mentioned.
Note: 4. The affidavit should be either typed or written legibly and neatly.
Note: 5. Each page of the affidavit should be signed by the dependent and the
affidavit should bear on each page the stamp of the Notary or Oath
Commissioner or Magistrate before whom the affidavit is sworn.