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Ik!.: Ot NOV 2023,07:{5 PM I(UNIAR
E:
PErrh$.d ED STAMP VENIX}R
cxrxr,nnftoorr nrnnv No. l7l l029nm2
S/o CHEKURnIY VENKATA REDDY 1?11029
R-/o BOMM RAM- MASAIPET MADHAVA NAGAR,
wtoru
.. !
For
.. SELF

FORM 26
t (See rule 4A)

I
AFFIDAVIT TO BE FILLED BY THE CAND NG WITH
I NOMINATION PAPER BEFORE THE RETURNING OFFICER FOR
ELECTION TO TELANGANA LEGISLATIVE ASSEMBLY FROM
I NARSAPUR.3T CONSTITUENCY.

I PART-A

I, CHEKURTHI LAXMA REDDY, Son ofCHEKURTHI VENKATA

REDDY, aged43 years, R-/o.H.No.1, BOMMARAM VILLAGE, MASAIPET
I MANDAL, MEDAK District, T.S,a candidate at above election,
do hereby solemnly affrm and state on oath as under:
3

l. I am contesting as an INDEPENDENT.
E

2.My name is enrolled in 37-NARSAPUR Assembly Constituency, Telangana

'" State At SL No.03 in Part No.26

t'
F IIT. VIJAYA
MA, LtE

.D w/
-2,'- NOTARYAOVOCATE
Soo Dlst. Court SangareddY
' 'C!lt:8S0030437t

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3. My Contact Number is:9494981178.

My email id is : Nil
My social Media Account is : Nil

4. Details of the Permanent Account Number (PAN) Status of Filling of Income Tax Return

SI Name PAN The Financial Total Income Shows

No Year For Which In In-come-Tax
The Last Income- Return (In Rupees)
Tax Return Has for the last five
Been filed Financial Years
completed (as on 31't
March-2022-2023
I Self ARMPC6OTSC NA NA
2 Spouse- REKHA EFTWPR3I23N NA NA
3 Dependent -l NA NA NA
(KEERTHI REDDY)
4 Dependent -2 NA NA NA
(VENKATA RAMANA
REDDY)
5 Dependent -3 NA NA NA

Note : lt 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 ,". ( \,/ )
(Tick this alternative if there is no criminal case pending afuinst the Candidate and write NOT
APPLICABLE against altemative (ii) below)
(ii) The following criminal cases are pending against me : NOT APPLICABLE
(If there are pending criminnl 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)

FIR No. with name and Nil Nil Nit

(a) Address of police station
Concerned
(b) Case No. with Name of Nit Nil Nil
the Court
(c) Section (s) of concerned Nit Nil Nit
Acts/Codes involved
(give no.of the section,
e.g. section......of IPC'
etc.
(d) Brief description of Nil Nit Nit
offence
(e) Whether charges have Nir Nil Nil
been

3.t
!I. VIJAYA
Cotk NOTARYADVOCATE
MA, LL8

i)op: Dist. Court $ar,gare.Jdy

Coll: 95003(ir"37 {
 Framed(mentioned YES or
No)
(f) lf answer against (e) above is Nir Nit Nil
YES, then give the date of
which chare were framed
(g) Whether any Nit Nit Nir
AppeaUApplication for
revision has been filed against
the proceedings (Mention
YES or No)

(6) Cases of Conviction

(i) I declare that I have not been convicted for any c .,rr,."L;/r*2 . eick thisatternative, if the
candidate has not been convicted
and write NOT APPLICABLE against alternative (ii) below)

(ii) I have been convicted for the offences mentioned below: NOT APPLICABLE
Qf the candidate has been cowicted, then tick this alternotive

and score offalternative (i) above, and give details in the Table below)

(a) Case No. Nit Nil Nil

(b) Name of the Court Nit Nit Nil
( c,) Section(s) of Nit Nit Nit
Acts/Codes Involved
(give no.of the section,
e.g. Section ..... of IPC,
etc.
(d) Brief description of Nil Nit Nil
offence for which
convicted
(e) Dates of orders of Nit Nil Nit
conviction
(f) Punishment imposed Nil Nil Nil
(g) Whether any Appeal Nil Nil Nir
has been filed against
conviction order
(Mention YES or No)
(h) If answer to (g) above Nil Nil Nit
is YES

(6A) I have given full and up-to-date information to my political party about all pending
criminal crru. against me and about all cases of conviction as given in paragraphs (5) and
(6).

fcandtdates to whom thk item k not applicabte should clearly write NOT APPLICABLE IN
VIEW OF ENTRIES IN 50 and 6 (i), above J
Note:
1. Details should be entered clearly and legibly in BoLD letters.

to be given separately for each case under different columns agoinst each item'
.,errLsirEo
I}T. VTJAYA
MA, LLB

Qr,'nlw-' NOTARYADVOCATE
3op: Dist. Court Sangareddv
Cell ?{i003o43:r
 in reverse chronologicol order, Le, the lalest case to be
3. Delails should be given
mentioned ftrst and backwards in the order of dates for the olher cases

4. Additional sheet may be added d required.

5. Candidate is responsible for supplying oll information in compliance of Hon'ble

Supreme Court's judgment in llt.P (C) No. 536 of 2011.

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-l: Assets in joint name indicating the extents of joint ownership will also have to be
given.
Note-2: ln case of the deposit/investment, the details including serial Number, amount, date
of deposit, the Scheme, Name of the Banlc/institution and branch are to be given.
Note-3: Value Of the 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, 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 in-come and who are dependent on the candidate on the candidate for their

livelihood
Note-S: Details including Amount ls 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.

Sl No Description Self Spouse Dependent-l Dependent-

2

(i) Cash in Hand 50 000/- Nil Nil Nit

o .'ATTESTED
t- a
il. VIJAYA
MA, LLB
NOTARYADVOCATE

v{t /v--.- ?gp: Dist. Court Sangareddy

0 Cell: 85OO30a:17,
 5

(ii) Details Of INDIAN BRANCH NiI Nil Nit

Deposit in Bank :SANGAREDDY,
Accounts (FD ACC.NO:649792479
Rs. Term 4,
Deposited
including AMOUNT
Saving Account) :500004
Deposits With
Financial
institutions on-
Banking
Financial
Companies and
Co-operative
societies And
the amount each
such De it.
(iii) Details Of Nir Nil Nit Nir
investment ln
NSS, Portal
Saving Bank
insurance
Policies And
investment ln
Any Financial
instruments ln
post oflice or
Insurance
Companies
and the
Amount
(iv) Details 0f NA Nil Nit Nit
investment ln
NSS, Portal
Saving Bank
insurance
Policies And
investment ln
Any Financial
instruments in
post Oflice or
Insurance
Companies and
the Amount
jtA
.,ATTESTED
t-
!T. VIJAYA

Sanq
r) \l-- NOTARYADVOCATE
MA. LLB

1op: Dist. Court Sangaredoy

\,\"Ll'
U Cel{: 85003O437{
 6

(v) Personal Loans/ Nil NiI Nil Nit

Advance given
to any Person or
entity including
Firm, Company,
Trust Etc., and
other
receivables from
debtors and the
amount
(vi) Motor JEEP NiI NiI Nil
Vehicles/Aircrat COMPASS
/Yachts/ships LIMITED
(Details of 2018
Make, TSO9GH8O55
Registration 26,00,000i-
numbers etc..,
Years of YAMAHA
purchase and YBR.
amount) 20tl
AP234138,
45,000/-

(vii) Jeweler, Bullion 10TULA Nir Nil

and valuable, GOLD
thing (Give Nil
details of Rs.3,50,000/-
weights and
Value)

(viii) Any Other Nil NiI NiI Nil

Assets such as

Values of N;I Ntil

Nil Nil
claims/Interest
(ix) Gross Total Rs.27,45,000/- Rs.3,50,000/ Nit Nil
Value

MA.
..ATTESTED

OI. VIJAYA
MA, LLB
NOTARYADVOCATE
lpp: Dist. Court Sangarecldv

u,ItI-- Celt:850030187r
 7

B) Details of immovable Assets.

Note-l: Properties in joint ownership indicating the extent ofjoint ownership will also
have to be indicated.
Note-2: Each land or building or aparhnent should be mentioned separated in this
format.
Note-3: Details should include the interest in or ownership of offshore assets.

st. Description Self Spouse D-1 D-2

No

Asriculture Land RAMNATHGUDIPAL GOLLAPALLE Nit Nir

: LY VILLAGE, \rILLAGE,CHEGUNT
Location MOMINPET A MAIYDAL., Sy.35
MANDAL., Sy.82,
Survey Number
AC.1-26GTS.,
Area (Total
AC.11-12GTS.,
measurement in
acres)
Rs.2,50,000/-
Whether inherited
property (Yes or MASAIPET VILLAGE
No) Y"s & MANDAL,
Date of Purchase Sy.87l lg
in case ofself-
acquired property t tl*
AC.03 Acres,
Cost of land (in
case of purchase
at the time of
purchase
N/e
Any investment on
the land by way of
development,
ru
/n
construction etc., @Per AC Rs. @Per AC Rs.
Approximate Rs.2,25,000/- Rs.2,25,000/-
current Market Total : 25,36,875/- Total :10046,2501-
value
II Non-Agriculture Nil Nil Nil
Land: Nil
Location
Survey Number
Area (Total
measurement in
acres)

\,i4., .,AT-TESTED
*
Y
( ._o
i5
I}T. VIJAYA IiUIIAN
NOTARYAD'O'PLL'
)opl' Dist. Court Sangaredoy
.14;
ufi Cell: 8500304ii7r
 I

Whether inherited
Property (Yes or
No) No NO No A/o
Date of purchase in
case ofself-acquired
property NtL fVt r- Ntu Nru
Cost of land (in case
of purchase at the
time of purchase
Any investment on
the land by way of
development,
construction etc.,
Approximate
current Market
value
III Commercial Nil TOOPRAN OLD Nil Nit
Buildinqs : MUNCIPALITY
Including OFFICE BACK SIDE,
aoartments) TOOPRAN
Location
MUNCTPALITY
Survev Number
Area (fotal HNo.12-48/2/4
measurement in 193 SQ YDS.,
acres)
Built-up area(Total
Measurement in t737
sq.ft.) +.Fv
Whether inherited
Property (Yes or
No)
Yng
Date of purchase in
case of self-acquired N/a
property
Cost of land (in case
of purchase at the v/*
time of purchase
Any investment on
the land by way of
development,
Nla
construction etc.,
Approximate
current Market
Rs.24,00,000/-
value
IV Residential
Buildines: NiI
Nir Nit Nit
Location
Survey Number
Area (Total
11A.
* rl
( Y
v,
o I}T. VIJAYA

0 u["lF
tvtA LLB
* NOTARYADVOCATE
f,.-r: Dist. Court Sangareddy
Gell:85003043'.
 9

Measurement in
acres)
Built-up area(Total
Measurement in sq.ft.)

Whether inherited
N'1 Nil Nil Nfl
Propefi (Yes or No)

Date of purchase in case

of self-acquired property
Cost of land (in case of
purchase at the time of
purchase
Any investment on the
land by way of
development,
construction etc.,
Approximate current
Market value
v Others (such as NiI Nir Nil NiI
interest in property

VI Total of current Rs.29,95,000/- Rs.37,50,000/- Nit Nit

Market value of (i) to
(v)above

8. I give herein below the details of liabilities /dues to public financial institutions and
Government:
(Note: Please given separate details of the banks, institution, entity or individual and
amount before each items).

,,A-IT
).iA., ESTED
OI. VIJAYA
NOTARYADVOCHUE
--"
cop:Dist. i
Court .,,r",
;;i;ii6iiJ*i{W,
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 l0
Sl no Description Self Spouse Dependent -1 Dependent -2
(i) Loans or Dues to NIL SBI NIL NIL
Banking /Financial SANGAREDDY
Institutions, Name BRANCH:
of CROP LOAII
the Bank or 1,00,000/-
Financial
lnstitution, CANARA
Amount MASAIPET
0utstanding, BRANCH:
Nature CROP LOAN
of Loan. 1,00,000/-
Loans or Dues to NIL NIL NIL NIL
Any others
Banking
/Financial
Institutions,
Name Amount
Outstanding,
Nature
of Loan.

Any Other NIL NTL NIL NIL

Liability
Grand Total of NIL Rs.2,00,000/- NIL NIL
Liabilities

II Governments (A) Has the Deponent been in occupation Nit

Dues: of
;\.
(
* i6
OT. VIJAYA
MA, LLB

'!d r
u; NOTARYADVOCATE
3op: Dist. Court Sangareddy
Cell:8500304?"
 Dues to the accommodation provided by the
Departments Government at
dealing any time during the last ten years before
with Governments the date
accommodation. of notification of the current election?
(B) lf answer to (A) above is YES, the
following
declaration may be furnished namely :'
(i) The address of the Government
rv/*
accommodation:

(ii)There is no dues payable in respect of

above
Government accommodation, towards -

(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 prior to the month in which
Nla
the election is notified or any date
thereafterl.
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.
ul Dues to Not applicable
j.X Department
,,ATTESTED

OI. VIJAYA
+
)oh/-,^ NOTARYADVOCATE
3p.,': Dist. Court Sangarerldv
Ccl'l: 8F.00?-' .' -"
MA, LLB

-r
 dealing with
Government
transport
(including
aircrafts and
helicopters)
IITI lncome Tax Dues Nit
Self Spouse Dependent -l Dependent -2

(v) GST Dues Nit Nil Nit Nit

(vi) Municipal Nit Nir NiI Nit
/Property Tax
Dues
vii Any other dues Nit Nil Nil Nil
Vril Grand total of all Nir Nir Nit Nit
Government Dues
lx Whether Any NiI Nil Nit Nil
Other
liabilities are in
Dispute,
if so
mention the
amount
involved and the
authority before
which it is pending

9. Details of profession or occupation:

(a) Self - AGRICULTURE
(b) Spouse - HOUSE WIFE.
(9A) Details of sources of income:
(a) Self - AG ILTURE CROP
(b)Spouse - .........Ni1 .....
(c) Source of income, if any, of dependents, ......NIL............
(98) Contracts with appropriate Government and any pubtic company or companies
(a) details of contracts entered by the candidate Not applicable.
(b) details of contracts entered into by spouse Not applicable

MA.
details of contracts entered into by dependents Not applicable
rl
D

ITI. VIJAYA
MA LL8

C NOTARYADVOCATE
3pp: Dist. Court SangaredoY
Gell:850030(17' ' .
(d) details of contracts entered into by Hindu Undivided Family or trust in which the
candidate or spouse or dependents have interest &!3ppbU!g
e) details of contracts, entered into by Partnership Firms in which candidate
or spouse or dependents are partners $!3pp!!g[!9
(f) Details of contracts entered into by private companies in which
candidate or spouse or dependents have share \q!3pp[gg[!g
10. My Education qualification is under:-
e" $fssno rN Govr scHooI, GANGARAIT, llE
(Given details of highest School/University education Mentioning the Full Form of the
certificate/diploma/degree course, Name of the schooVcollege/university and the year in
which the course was completed).

'.ATTESTED
e"/g^\
il. VIJAYA TroIIIR
a. MA, LLB
NOTARYADVOCATE
3oo: Dist. Ccurt SangarGddy
Uett. 85003.!43!q

C,'E
 PART-B
11. ABSTRACT OF THE DETAILS GMN IN (l) To (10) Of Part -A:

I Name of the Candidate CHEKURTHI LAXMA REDDY

2 Full Postal address H.No.l, Bommaram Village Masaipet Mandal'
Medak District.502334
3 Number and name of the 37. NARSAPUR AIID TELANGANA STATE
constituency and state
4 Name of the political party which set INDEPENDENT
up the candidate (Otherwise write '
independent )
! Total number of pending criminal Nit
CASES

6. Total number of cases In which Nit

convicted
7 PAN of Year for which last Total income shown
income tax return
files
(a) candidate ARMPC6OT5C NIL NIL
(b) Spouse EHWPR3I23N NII, NIL
ODependent -l NIL NIL NIL
(d) Dependent -2 Nil Nil Nil
8 Details of Assets and Liabilities in Rupees
Description Self Spouse Dependent -l Dependent -2

A Moveable Assets 1,00,000/- Nil Nit Nit

(Total Value )
B Immovable Asset Rs.29,95,0001 Rs.37,50,0001 Nit Nir

I Purchase Nit Nil Nit Nit

price ofself-
acquired
immovable
property
u Development/ NIL NIL NIL NIL
Construction
cost of
MA.
[\ immovable

Ill. VIJAYA
,0
( MA. LLB

C V NOTARYADVOCATE
1op: Dist. Court Sangareddl
Cell:850030437r
 property after
urchase
lll Approximate Nil Nit Nit Nit
current
market price
of
(a) Self -
acquired
assets (Total
Value)
(b) inherited
assets
Value
9. Liabilities Nit Rs.2,00,000/- Nit Nit

IV Government Nil Nil Nit Nil

dues (Total)

v Loans From Nil Nir Nit Nit

Bank,
Financial
institutions
and others

10. Liabilities that Nil Nit Nit Nil

are under
d
vi Government Nit Nit Nit Nit
dues otal
vu Loans From Nit Nit Nit Nit
Bank,
Financial
institutions
and others
otal
1l Highest educational qualification:
-1E\
clqr, lr.t t.4PPs Qtnleran, kroH^pudcM)
rlrrr, g^tr/\ ,ne1
(Give details of highest School/University education mentioning the full form of the
certificate/diploma/degree course, name of the Schoot/College/University and the
year in which the course was completed.)

MA..
,,AfiESTED
t
<o
t--
OT. VIJAYA
MA, LLE
NOTARYADVOCATE
rl ?op: Dist Court Sang;rrect<ly
Cet;: $$003043?'l

olf-L
 1

a i.
 VERIFICATION

I, the deponent, above named, do hereby verifu and declare that the contents ofthis
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 ofPart A and B above;

(b)1, my spouse or my dependents do not have any asset or liabiliry, other than those
mentioned in items 7 and 8 of Part A and items 8,9 and l0 ofPart B above.

Verified at t \q.fr^V.,r this the duy of

(
Swom and signed before me on this

f'h day of November,2023 at SANGAREDDY.

C (>t>-a
DEPONENT

Note: 1. Affrdavit should be frled latest by 3.00 PM on the last day of filing nominations.
Note: 2. Affidavit should be swom before an Oath Commissioner or Magistrate of the Fhst Class
or before a Notary Public.
Note: 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
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 swom.

..ATTESTED

il. VIJAYA
MA. LL8
NOTARYADVOCATE
Cop: Dist. Court Ssngaraddy
Ce,i. liJ0030t13?l