oonres aia! TELANGANA : AZ 2933 | ogre ran ee “— 5 Hale hop GuLAt GHoUSE RHAN LaBoqve” STAMP VENDOR Lino: 17-03-001/2021 JOGIPET, Sangroddy Dist. 7.5 Poth FORM 26 (See rule 44) | Affidavit to be filed by the candidate along with nomination paper before the returning officer for election TO THE LEGISLATIVE ASSEMBLY OF TELANGANA (Name of the House) FROM 36-ANDOLE (SC) (Name of the Constituency). ' PART-A 1 ANIL KUMAR CHANTI, son of VITTAL CHANTI aged about 34 years, resident Gof H.No :- 1-28/3,Pothulaboguda , Vatpallev , Sangareddy , 502269. (Mention full postal address), a candidate at the above election, do hereby solemnly affirm and state on oath as under:- : (Pes u 4 ‘ i dD. BComLL 8. 4 i NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 98493765341) Tam a candidate set up by Alliance of Democratic Reforms Party ("name of the political party)/**am-contesting-as-an-Independent candidate, (**strike out whichever is not applicable) 2) My name is enrolled in 36 -Andole (SC) Assembly Constituency of Telangana State (Name of the constituency and the State), at Serial No :191 in Part No: 29 3) My contact telephone number(s}-is/are9182284938and my email id (if any) is CHANTIANIL773@gmail.com and my social media account(s) (if any) is/are (H)_https:// https://www. facebook, com/CHANTIANIL (i) What's Up - 9182284938, GiNTL 4) Details of Permanent Account Number (PAN) and status of filing of Income Tax return: The financial year for | Total income shown in Income- : Which the last | tax return (inRupees) for the last sia: |; Names ew Income-tax__| Five Years completed (as on 31st return has Mareh) been filed 202.23 | @ NIL 20-2 | di) NIL ‘Anil Kumar 1 | Gian (sen | COBPKASISA | 2020-21 | Gi) NIL 2019-20 | NIL 2018-19 NIL 2022-23 NIL Manatha 2021-22 NIL 2 Talari_ | HXPPM6S77M | _ 2020-21 NIL Spouse) 2019-20 NIL 2018-19 NIL 2022-23 Nit wor 2021-22 NL 3 HUF appnicapie [202021 NIL 2019-20 NIL 2018-19 Nit ' if grtesteo // 2 D. ISIMLU, B.comiL8. NOTARY ADVOCATE — SANGAREDDY (Town & Dist.) 18493765342022-23 @) NIL 2021-22 (ii) NIL 4 | Dependent pon 2020-21 | (iil) NIL | APPLICABLE 2019-20 | (iv) Nit 2018-19 ‘NIL 2022-23 NIL (2021-22 NIL Not 5 | Dependent? | sppricapie | 2020-21 NIL. 2019-20 ‘NIL 2018-19 NIL 2022-23 NIL | 2021-22 | (i) NIL Nor ai 6 Dependent-3. APPLICABLE |_ 2020-21 (iii) NIL 2019-20 | wy nit 2018-19 | NIL Note : It is mandatory for PAN holder to mention PAN and in case of no PAN it should be clearly stated "No PAN ALLOTED™ 5) Pending criminal cases i) 1 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 ling against me: criminal cases against the candidate then tick this Gi) The following criminal cases an (if there are pendi alternative and cases in the tabfe below). 4re off alternative (i) above , and give details of all pending ae // ATTESTED // 3 NOTARY, ADVOCATE SANGAREODY (Town & Dist.) Cell: 9849376534Table FIR No. With name ae Nor Nor Nor oo” jaa asarest Ce eal APPLICABLE, APPLICABLE APPLICABLE ty) _| Case No. with Name ofthe Nor Nor Nor © Court APPLICABLE | APPLICABLE | APPLICABLE Section(@) of concerned 1 Acts/Codes involved (give no. of Nor Nor Nor (© the Section, eg Section.of | APPLICABLE | APPLICABLE | APPLICABLE IG, ete). sti Nor Nor Nor (@)_| Brief description of offence APPLICABLE | APPLICARLE | APPLICABLE. Whether charges have been Nor Nor Nor (© framed (mention YES orNo) APPLICABLE. | APPLICABLE | APPLICABLE If answer against (c) above is Nor Nor (| YES, then give the date on NOT APPLICABLE es sieslete cases APPLICABLE. | APPLICABLE. ‘Whether any Appeal” - Application for revision has : Nor Nor (@) been filed against the NOT APPLICABLE ees nan ten YES er APPLICABLE. | APPLICABLE NO) L ! 6) Cases of conviction Mi I declare that I have not been convicted for any criminal offence. (Tick this altemative if the candidate has not been convicted and write NOT APPLICABLE against alternative (ii) below) OR Gi) Thave been convictgd for the offences mentioned below :NOT APPLICABLE (If the candidate has begh convicted , then tick this alternative and score off alternative (i) above , anf give details in the table below). IP AYTESTED // D. NARSIMLU, acomité. ‘ NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534Table a Nor | Nor NOT ©] Case No. arecicapue | arriveamte | apptiesnie xor Sor Nor (0) | Name of the Court APPLICABLE, APPLICABLE APPLICABLE (© _| Seetions(s) of Acts /Codes sor nor involved (give no. of the Section, | applicant | areticante — | APPLICABLE e.g. Section... n0f IPC, ee). (@ | Brief description of offence for | Nor Nor Nor which convicted arvticanue | arpniexnur | arpnieanur © ra Nor Nor © | Dates of orders of conviction arricuue | apenicanue ishment Nor Nor © | Punishment imposed americanus | aPPtteapie (| Whether any Appeal has been = Nor filed against conviction order APPLICABLE. APPLICABLE APPLICABLE, (Mention YES or No) | (h) | If answer to (g) above is YES, 5 nor xor nor give details and present status of | appricapLe APPLICABLE APPLICABLE appeal - 6A) have given full and up-do-date information to my political party about all pending criminal cases against me and about all cases of conviction as given in paragraphs (5) and ©). [Candidates to whom this Item is not applicable should clearly write NOT APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6 (i), above] Details should be entered clearly and legibly in BOLD letters Details to be given separately for each case under different columns against each item. Details should be given in reverse chronological order, ive, the latest case to be ‘mentioned first and backwards in the order of dates for the other cases. Additional sheet may be added if required, Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court's judgment in W.P (C) No. 536 of 2011. That I give herein below the details of the assets (movable and immovable etc) of ‘myself, my spouse and all dependents, I ATTESTED // D. NI IMLU, B.Com. 8. 5 NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534A. Details of movable asset 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 the Bank / Institution and Branch are to be given Note: 3. Value of Bonds / Share Debentures as per current market value in 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, sons), 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. | SLN | Descriptio | ANILKUMAR | MAMATHA | ype | Depen | Dependen | Dependen oes | QUANTI Sal) | UTALARL ten ae | es (Spans) ly [one @ hd 150,000.00 | 50,000.00 NIL NIL NIL TL er IV ATTESTED // DN ), B.ComLL 8. . NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534@ Deiails of deposit in Bank accounts (FDRs, Term Deposits and all other types of deposits including saving accounts), Deposits with Financial Institutions, ‘Nonbanking Financial Companies and Cooperative societies and the amount in each such deposit, SAVING ACCOUNT :- State Bank of India Alladurg Branch ‘Alc Number 30889537722 Rs : $000.00 SAVING ACCOUNT :- State Bank of India , Alladurg Branch , Alc Number 33337357625 Rs:~ 12,000/- NL [NL [NIL w Details of investment in Bonds, debentures/shares and units in ‘companies/Mutual funds and others and the amount. NIL NIL NIL. NIL | NIL ™ Details of investment in NSS, Postal Saving, Insurance policies and investment in any Financial instruments in Post office or Insurance ‘Company and the amount. NIL NIL NIL | NIL ae ATTESTED // Dd. IMLU, acomiie. NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534o Personal loans’ advance given to any person or entity including firm, company, Trust ete., and other receivables from debtors and the amount. NIL NIL NIL NIL | NIL (wi) | Motor Vehicles ‘Aircrafts/Yachts/Ships (Details of Make, registration number NIL NIL NIL etc. year of purchase | and amount) | (sil) |Tewellery, bullion “and Gold 3 Gm valuable ‘thing(s) (give and Silver -70 oS NIL gm Mkt nm | NIL | NIL value) Value :- 1,98,000.00 “Any other assets such as eI (iy | Sate oF lai interest NIL NIL nu | nm | Nx (ix) | Gross Total Value 1,55,000.002,60,000.00/ NIL] NIL) NIL | HT ATTESTED // 2 D. wat, B.Com... NOTARY ADVOCATE ‘SANGAREDDY (Town & Dist.) Cell: 9849376534B, Detai 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. ® ae ‘ANIL KUMAR | MAMATHA | epentnt- | Dependent | Deponden No a CHANTI (Self)_| TALARI (Spouse) | ! 2 3 POTHULABAGUDA Agricultural Land (VD. VATPALLY (3) Location(s) Survey NIL SANGAREDDY wi | wm | NL number(s) (ost) a SyN0 31992 pa NIL 1.00 Ac we | wn | NL atone NIL Yes ni | nm | NIL @ ee NIL NIL. wi | ni | NIL | | Cost of Land (in case of purchase) at the time of NIL NIL wi | nm | NL | | purchase ‘Any investment on the ee ee NIL NIL ni} nm | NL construction ee | See crest NIL 2,25,000.00 nie | NL | NIL Non- Agricultural Land Location(s) Survey NIL NIL wit | wm | NL number(s) Are (enim | aL NL wo | wt | Me Sy aaN) NIL NIL wi | wm | NL Date of purchase in case NIL NIL wi | wm | NIL (i) | of et acquired property Cost of Land (in ease of purchase) at the time of NIL NIL wi | wm | NL | | purchase ‘Any investment on the eee of NIL, NIL nit | on | NIL constuction et. Appreciate coat NIL NIL we | Nt) oN i TESTED // 9 D. SSIMLU, 8.comits. NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Celt: 9849376534~] oimmercia Bling Gncoding 1 apartments) -Locations) -Survey NIL NIL NIL | NIL) NIL en) ‘tea (total measurement in sqft) a be Na | NIL | NIL Bulle Ares ol mere ns) | NIL we lwal wn ‘Whether inherited (Yes or oS mmr Ta eases tise na Date of purchase in case of self ua a ee acquired propert} ‘Cost of property (in case of purchase} sibetinectpociase | NIL NIL | NIL) NIL arin aoe Teal Wy way OF Shem cmcion ae NIL NIL nit | wit | NL “Approximate curent market value aa a aa Residential Buildings Gncluding cations) aton(s) Survey number(s) Nu Nr NIL | NIL | NIL Are (otlmeossrenet in ogi) — = aaa Nee NIL NIL | Bui up area (Tol meanurement Ta me Toa Ti) i NIL] Nit NI Wists nalaoren OFeor ae) ww) ne Lo | Date of purchase in case of self- = NIL NIL wat | xt) NI sopra! peorety ‘Cost of property (in case of purchasc) | atthe time of purchase a | Att) a | "Any investment onthe land by way of development, construction ete | NIL a [eee ae “Approximate curent market value NIL NIL Nit | Nit | NIL 1G) Others Gach as interest in property) | yy, = wa | ] (vi) | Total of current market value of feta 00 | 22800000 | x | NIL) NIL HRYTESTED // 10 D. J, BcomLLB. NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534(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) ANIL Ss. KUMAR, MAMATHA | Dependent- | Dependent- | Dependent- Description CHANTI | TALARI (Spouse) 1 2 3 (Seif) Loan or dues 10 Bank’financial institution(s) ‘Name of the Bank or financial NIL NIL NIL NIL NIL Institution, ‘Amount outstanding, ‘Nature of Loan Loan or dues 10 (i | any other individuals/entity other than ‘mentioned above Name(s), Amount outstanding, nature of oan ‘Any other liability NIL NIL NIL NIL NIL NIL NIL NIL. NIL NIL NIL, NIL. NIL NIL NIL ae Wl ATTESTED ut Dp. 1 J, B.Com ALB. u NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534) "Government dues : Dues to Departments dealing with Government accommodation (A) Has the Deponent been in occupation of accommodation provided by the Government at any time during the last ten years before the date of notification of the current election? (B) Ifanswer to (A) above is YES, the following declaration ‘may be furnished namely: - (The address of the Government accommodation: , FLAT NO 908 MS-IIL, OLD MLA QUARTERS, KING KOTI ROAD HYDERGUDA .HYDERABD. (ii) There is no dues payable in rrespeet of above Government accommodation, towards- (a) rents (b) electricity charges; (©) water charges; and (a)telephone charges as on (date) [ the date should be the last date of the third month prior to the ‘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. YES? No(Pl. tick the appropriat e alternative )NO. Nor APPLICABLE we I ATTESTED // v D. Ni IMILU, a.comite. NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534ANILKUMAR | MAMATHA Dependent- CHANTI (Self) | TALART (Spouse) MUP 1 Dependent-2 Dues to department dealing cig [ibe a, | mm | om foe (including airerafs and helicopters) (iv) | Income tax dues nit nie nit | ni Nit (| Gst Dues NIL NIL NL [NIL NIL wo [ey we | Ne [om ma (vit) | Any other dues NIL NIL NIL NIL NIL ai | Gran toe of al NIL NIL NL | NIL NIL Whether any other liabilities are in dispute, if so, | Ge |menonthe NIL NIL me oad | and the authority before which itis pending. (9). Details of profession or occupation: (@) Self - Agriculture (b) Spouse ~ House Wife. (9A) Details of sources of income: (@) Self - Agriculture (6) Spouse : House Wife © Source of income, if any, of dependents ~ NOT APPLICABLE, er 1 BTFESTED // 3 D. NARSIMLU, 8.comus. NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell; 9849376534(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. ©) Details of contracts entered into by dependents NOT APPLICABLE 4) Details of contracts entered into by Hindu Undivided Family or trust in which the candidate or spouse or dependents have interest NOT APPLICABLE ©) Details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners NOT APPLICABLE Details of contracts entered into by private companies in which candidate or spouse or dependents have share Sub-contractor Agreement with - NOT APPLICABLE, (10) My educational qualification is as under:- 1) 10" ~(sse) ZPHS - SHANKARAMPET-MEDAK-1998 ( Give details of highest School / University education mentioning the full form of the cettificate/diploma/degree course, name of the School/College/University and the year in which the course was completed.) Ger I ATTESTED // o. jy BComLLB. NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Cell: 9849376534PARTB (11) ___ ABSTRACT OF THE DETAILES GIVEN IN (1) TO (10) OF PART A ShiSméaKum ~- ANIL KUMAR 1 Name of the candidate cane Tapes 1-28/3 ,Pothulaboguda , Vatpally : beers Sangareddy , 502269 3 ‘Number and name of the constituency and State 36-ANDOLE (SC) ‘Name of the politcal party which set up the candidate Grime Daqaoeratle 4 (otherwise write ‘Independent”) Refoi Party 5 Total number of pending eriminal cases NIL 6 ‘otal number of eases in which convicted NIL Year for which PANof last income Tax | Toll income return filed fe (a) Candidate GGBPK4SISA 2022-2023 | ppNOk are 7 (b) Spouse HXPPM6577M. 2022-2023 cen (6) Depends HUF Norareuicante | NOT APPLICABLE (4) depends NOT APPLICABLE NoraPeuicaste | NOT APPLICABLE 8 Details of Assets and Liabilities (Including offshore assets) in Rupees ANIL ‘pt KUMAR | MAMATHA Dependent- Description | CHANTI | TALARI Spouse) | D&eRdEREI | Dependenttt | P&PSTT (Self) Moveable A Assets 1,55,000.00 2,60,000.00| NIL NIL NIL (Total value) Be | nsvable NIL 2,25,000.00| NIL NIL NIL Assets T_| Purchase ries oF Sele |! a, NIL NIL NIL NIL acquired immovable Tf Development canstraction cost | ot immovable propery after NIL NIL NL | NIL NIL purchase (if | pliable) | - MH, | Approximate Current NIL 2,25,000.00 market price-(a) self-acquired | assets (Total NIL NIL NIL Value) (b) inherited : assets (Total NIL 2,25,000.00 Value) IATTESTED // 8 > D. SIMLU, @.comiLe NOTARY ADVOCATE SANGAREDDY (Town & Dist.) Celt: 9849376534[| Hiawities @ | Government dues(Total) ae (ii) | Loans from Bank, et NIL NIL a and others (Total) = Ha} Liabilities that are under dispute NIL NIL NIL @ | Government el duos Tidal) NIL NIL NIL. ‘NIL NIL Gf Loans from ‘Bank, Financial = Institutions NIL NIL NIL NL | NL and others (Total) i Highest educational qualification: | 1) 10" ~ZPHS ~ SHANKARAMPET-MEDAK-1998, (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; () I, my spouse, or my dependents do not have any asset or liability, other than those ‘mentioned in items 7 and 8 of Part A and items 8, 9 and 10 of Part B above. Verified at ANDOLE this the 10" day of November 023, ATTESTED ye poneNT 8. DN BComiLt NOTARY ADVOCATE ANGAREDDY (Town & Dist.) Cell: 9849376534 16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 column 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 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 deponent and the Affidavit should bear on each page the stamp of the Notary or Oath Commissioner Or Magistrate before Whom the affidavit is sworn, J ANTESTED // IMLU, e.comicé. NOTARY ADVOCATE ‘SANGAREDDY (Town & Dist.) Cell: 9849376534 uv