Annexure-E2 | ABSTRACT STATEMENT OF ELECTION EXPENSES, PART-I 1__[ Name of the Candidate Sh/Smilkm. (7. OL/7THAMAN. I | Number and name of Constituency 2S, VIkRAVAND| ASSEMBLY Tl | Name of State/Union Territory TAMIL. NADU IV__| Nature of Election (Please mention whether General BYE- ELECTION Election to State Assembly / Lok Sabha / Bye- election) ‘V__| Date of declaration of result a § /o- aD 3 VI_| Name and Address of the Election ™m RPGUNATH AM , YE2 - 1/20 KOU HI, | Agent Karrumanwre Post he Cumb10 ae 01) COFFS Vil_| If candidate is set up by a political party, Please mention the name of the /NDERPENDENT political part VIII | Whether the party is a recognised Yes/No U7 political part DN oe Date: 19: Me 0/9 Signatur of the Candidate Place: //KRAVA-ND| name: (/ Gow? HAMAN/ PART-II: ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE OF CANDIDATE S.No. | Particulars [Amt ‘Amt | Amt. | Toval Fleeion expenditure Incurred/ | Incurred/ | Incurred / | Auth. by | authorized | authorized | (3)+4)4(3) Candidate/ | by Pol. | by others Election | Pany | (in Rs) agent(in (in Rs.) oe — Rs) | i 3 a a 5 6 1 Expenses in public meeting, rally, procession ete.:- La: Expenses in public meeting, rally. procession ete. (ie: other than the ones with Star Campaigners || — — — of the Political pasty | (Enclose as per Schedule-1) a 1.b: Expenditure in public mesting rally, T procession ete. with the Star Campaigner(s) (ie | other than those for general party propaganda) —_— — —_— — (Enclose as per Schedule-2) a ‘Campaign materials other than those used in the public esting aly, prosesion et mentioned in |S] | — = |S \240 7 S.No. I above(Enclose as per Schedule-3)mt ‘Campaign, through print and electronic medi including ¢able network, bulk SMS or internet and Social media (Enclose as per Schedule-4) TV} Expenditure on campaign vehicle(s), used by a5 a candidate(Enelose as per schedule-5) 60155| — Oss Vv Expenses of campaign workers /agens = ay (Enclose as per Schedule -6) fen = Any other campaign expenditure 18,020 = = [0,020 = Expenses incurred on publishing of declaration regarding criminal cases (Enclose as per| —— | —— | — Schedule-10)* Grand Toial Tas = ~ AL YW S= PART III: ABSTRACT OF SOURCE OF FUNDS RAISED BY CANDIDATE SNo Particulars ‘Amount Gin Rs.) 2 “Amount of own fund used for the election campaign (Enclose as per Schedule - 7) “TRTGIS = 1 ‘Lump sum amount received from the party (ies) in eash or cheque ete. (Enclose as per Schedule -8) i ‘Lump sum amount received from any’ person/ company firm/ associations / body of persons etc. as loan, gift or donation etc. (Enclose as per Schedule -9) Total PayPART-IV FORM OF AFFIDAVIT Before the District Election Officer. (District, State/Union Territory) Affidavit of Shri/Smt/Ms cic, Woo, Di0).roeeses aaa eoncaneeraeeea : none Son/wife/daughter of prncmnnsenenne BE years, 1/0 do hereby solemnly and sincerely state and declare as under : (1) That I was a contesting candidate at the general election/bye election to the House of the People / Legislative from... Parliamentary! Assembly constituency, the result of which was declared on Assembly of .... (2) That Vimy election agent kept a separate and correct account of al expenditure incurred / authorised by me / ‘my election agent in connection with the above election between (the date on which I was nominsted) and the date of declaration of the result thereof, both days inclusive (3) That the said account was maintained in the Register furnished by the Returning Officer for the purpose and the said Register itself annexed hereto with the supporting vouchers/ills mentioned in the said account (4) That the account of my clection expenditure as annexed hereto includes all items of eleetion expenditure incurred or authorised by me or by my election agent, the political party which sponsored me, other associations / body of persons and other individuals supporting me, in connection with the election, and nothing has been concealed or withhel/suppressed thereffom (other than the expense on travel of leaders’ covered by Explanations 1 and 2 under section 77 (1) of the Representation ofthe People Act, 1951). (5) That the Abstract Statement of Election Expenses annexed as Annexure Ito the said account also includes all expenditure incurred or authorised by me, my election agent, the political party which sponsored me, other associations / body of persons and other individuals supporting me, in connection with the election. (©) That the statements in the foregoing paragraphs (1) to (5) are true to the best of my knowledge and belief, that nothing is false and nothing material has been concealed. Deponent Solemnly affirmed/sworn by ee oecees onsets day OF 201 «.,....before me (Signature and seal of the Attesting authority, ie. Magistrate of the first Class or Oath Commission or Notary Public) AdesACKNOWLEDGEMENT FORM. To ‘THE RETURNING OFFICER, Bn bLy VERAUBDDL,—___ iiipukan DISTT si, ae fs Gae- 1/2769 [208 ISMN, Tececlaseree ee ee ts Rb he Cisne aca with its enclosures containing, among other documents, a Register bearing serial No. 62/8, for maintaining of Cr econ of oslon pes nT ioe he eee ie br meno avs ain pecs wi ed true copy of that account with the District Election Officer / Returning Officer. x (Signature of Candidate with date) * Strike off whichever is inapplicable, ACKNOWLEDGEMENT (To be filed up by Office) The account of the election expenses in respect of . (Constituency) result of which was declared on (Date) has been filed by him /on his behalf on (Date) and has been received by me today —_—the (Date) of (Month). (Year) District. District Election Officer Office SealSchedules- 1 t0 9: Details of Elections Funds and Expenditure of Candidate Schedule- 1 [Expenses in public meeting, rally, procession etc. (ie: other than those with Star Campaigners ofthe Political party) S.No Nature of Expenditure Total Amount | Souree of Expenditure ins. ‘Amt incurred / | Amt ‘Amt. incurred by ‘Auth. by incurred / others Candidate / agent |by Pol Pacty with i iz 3 4 5 6 1__| Vehicles for transporting visitors = = = = 2 [Erecting Stage, Pandal & Furniture, Fixtures, poles as etc. = cage Arches & Barricades ee a = = = 4 [Flowers garlands — a = = 5 | Hiring Loud speakers, Microphone, amplifiers, ei comparers ete = Sr 6 | Posters, hand bills, pamphlets, Banners, Cut-outs, ae hoardings - oa = 7 | Beverages like tea, Water, cold drink, juice et. = = = —_— 8 [Digital TV -boards display, Projector display, tickers boards, 3D display _ — sa = ‘9 [Expenses on celebrities, payment to musicians, other aes artists remuneration ete. = oer 10 [Illumination items like serial lights, board et. = = = = 11 [Expenses on transport, Helicopter aircraft / vehicles! boats etc. charges (for self, celebrity or any other = aa ihre [campaigner other than Star Campaignet) 12__ [Power consumption’ generator charges = — fees 13 [Rent for venue — = — = 14 [Guards & security charges = et 15 [Boarding & lodging expenses of self, celebrity, party a functionary or eny other campaigner including Star 4 — eee Campaigner 16 _ [Others expenses = = = Total = — 5Schedule 2 [Expenditure in public meeting rally, procession etc. with the Star Campaigner(s) as apportioned to candidate (ie: other than those for general party propaganda) S.No [Date and [Name of the Star Campaigner(s) & [Amount of Expenditure on public meeting rally, Remarks, ifany Venue Name of Party procession etc. with the Star Campaigner(s) apportioned to the eandidate (As other than for general party propaganda) in Rs. 1 zi 3 4 5 Source of Expenditure Amount by [Amount by |Amount by [Candidate/Age | Political Party | Others at 1 — =< = — = = 2 — cae = = — as 3 — ae = aint ia = 4 ome — — —_ ea == Total Schedule-3 ae Details of expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners, cut-outs, gates & arches, video and audio cassettes, CDs/ DVDs, Loud speakers, amplifiers, digital TV/ board display , 3 D display etc. for candidate's election /campaign (ie: other than those covered in Schedule- 1 & 2) No, | Nar of Expenses a Rs. fam by » [An By Po [Amc By ola title) [aay ee Th 5 a 5 a 7 1 poplar x | St2¥0 | SL24o| — = 2 ee a = os a = ; == = = 7 = = = = To ae == oe 6 \ Dnaer|Schedule- 4 Details of expenditure on campaign through print and electronic media including cable network, bulk SMS or Intemet or social media, news items/TV/radio channel etc., including the paid news so decided by MCMC or voluntarily admitted by the candidate. ‘The details should include the expenditure incurred on all such news items appearing in privately owned newspapers/TV/radio channels etc, S. [Nature of [Name and address of [Name and address of agency, [Total Amount Sources of Expenditure Ne |(Geewnic/ [fecronc SMS" lanyperton toetom charges! ( fAmt.By [Ami By [Amt By print) and | voice/ cable TV, ‘commission etc. paid! payable, candidate! Pol. Party | others Guration | social mediate.) |ifany agent Col. 3) 4) ola 3 4 5 6 ui 8 1 = = — = = rt (ee 2 = — a nee = ea aes 3 a 4 = — aay — — = Total = | - : ‘| a Schedule-4A Details of expenditure on campaign through print and electronic media incl Juding cable network, bulk SMS or Internet or social media, news items/TV/radio channel ete., including the paid news so decided by MCMC or voluntarily admitted by the candidate. ‘The details should include the expenditure incurred on all such news items appearing in newspapersTV/radio channels, owned by the candidate or by the political party sponsoring the candidate. S.No [Nature of [Name and address of [Name and address of | Total Amount Sources of Expenditure medium |media provider (print | ageney, reporter, stringer, |in Rs. (electronic / |/electronic /SMS / voice’ | company or any person 10 ‘Amt By [Amt By [Amt By |print) and Jeable TV, social media | whom charges / candidate’ | Pol. Party [others duration etc.) commission etc. paid! agent payable, i Cot. (3) *¢4) 1 ie 3 4 5 6 7 8 1 | i —s = oe eer eee eee 2 os a 3, — — | a z ef | a4 ee, = Total = = ea[Schedule -S Details of expenditure on campaign vehicle (s) and poll expenditure on vehicle(s) for candidate's election campaign S. [Regn. No. of Hiring Charges of vehicle No.of — [Toralamt. Source of Expenditure No | Vehicle & Days for _| incurred/ auth. Vopicte —|Ratefor [Fuel charges Driver's | “Hishwsed ints Amt By Amt, By Pol. [Amt. Hiring of | Qf not covered | charges Jcandidate’ | Party by vehicle / funder hiring) | (If not agent other maintenanc covered s © ‘under hiring) i i 3a 3b 3e 4 5 6 7 8 1 STR 2955 | — = 29300 |27300 | — a mgaat | age | [ N29S| 32S | = a fas eh | Boo = Gono! Ga00] — [a S44 SS + Price] — |= | Pango reoge| 12280; — na bo/ss| boss} — Schedule- 6 Details of expenditure on Campaign workers / agents and on candidates” booths (kiosks) outside polling stations for distribution of voter’s slips 8. |Date and | Expenses on Campaign workers ‘Total amt. [Sources of Expenditure No] Vem” TyaureofBipenses [Rate [No.of wrtan/|MUTEH/ Sih Ta by [Amt By Pal. [Amt By agents No, of candidate’ |Party others Kiosks agent ia 3a ab fae 4 5 6 fa ian Candidates” booths rae =. |twanemirraee |=. =|! tee iste tee (na slips aloes eer | Seh ee | 5 —_ [Boarding oe = =e =| = =e 4 | —_ [Lodging a ee ee = oor ca ae eras Total a | =Schedule- 7 Details of Amount of own fund used for the election campaign S.No. [Date (Cast ‘DD/ Cheque no ec. with details of | Total Amount in Rs. [Remarks drawee bank 1 2 3 4 1S 6 1 An pes| Troro — — 16,020 = 2 (eel — May) S240 — = S),.240 4| = 3 Caldas) 60) |S S— — G0, 1S -| — 4 is ba) / bse a LA), GIs Hee Schedule 8 Details of Lump sum amount received from the party (ies) in cash or cheque or DD or by Account Transfer S| Name of the Political Party [Date Cash [PD/ Cheque no. ete. with | Total Amount in | Remarks, if No. details of drawee bank —_|Rs. any ip 3 4 5 6 a 1 = = a = ae = a = a = an — 3 = = = = = = 4 = aaa as —_— = Total a — oun ea eee Schedule- 9 a Details of Lump sum amount received from any person/company/fim/assoviations/body of persons etc a loan, gift or donation et S. ]Name and address [Date Cash) DD/ Cheque no. [Mention whether [Total Amount in | Remarks No. etc. with details Jloan, giftor | Rs. fof drawee bank [donation ee. | 1 ip 3 4 5 6 id 8 1 = — = = e ai — —_ ae 3 = = = 4 —_ —— See ~ | Total — —‘Sehedule- 10" Details of expenditure incurred on publishing eriminal antecedents, if any in newspaper and TV Channel Si. | Newspaper Tel Mode of payment No. (lectronic/cheque/DD! Cash) = (PL specify) Name of Date of | Expenses that | Name | Date & Time of | Expenses Newspaper | publishing | may have been | of insertion/telecast that may incurred (in| channel hhaye been Rs) _pineurred (in = Frs) 1 z 3 4 3 6 7 8 == — — ~— a — — a = — = = — — Total — = _— = Note 1. In Schedule 5:- (a) copy of the order containing lst ofall vehicles for which permit issued by the Retuming Officer to be enclosed. (b) Ifthe vehicle is owned by the candidatc/his relative/agent are used for clection purpose, notional cost of hire of all such vehicles, except one vehicle if owned and used by the candidate, notional cost of fuel and drivers salary for such vehicle, shall be included in total amount of expenditure in the above table 2. In all schedules if any expenditure on goods and services, provided by the Political Party; or provided by any person/ company! firm /associations/ body of persons etc. on behalf of the candidate, then the notional market value of such goods or services are to be indicated, in respective columns. 3. In Part—II, the Lump-sum amount of fund received from the political party or others or the candidate's own funds, should be mentioned date wise. In all such cases such amounts are required to be first deposited in the bank account of the candidate, opened for election expenses. 4, Each page of the Abstract Statement should be signed by the candidate * In pursuance of Hon’ble Supreme Court Judgment dated 25.09.2018 in WP(C) No. 536 of 2011 10TAMIL NADU 65AB 745174 FOS 13 SEP 2019 ws. Qemover a LAKSHMANAN ” a FORM OF AFFIDAVIT “STAMP VENOM oe Soe LC. Ne: ore ROAD 61, EV. Before the District Election Officer, Vilupuram District, Tamilnadu Ste ' : : AMINSIKARAL, CI HENNA: 4 Affidavit of Shri. V.Gowthaman(s/o, Vadamalai. 1 V.gowthaman, s/o. vadamalat aged about 47 years, residing at 9-2, Choolaimedu, Ward 110.108, N.G.O Colony 4" Street, Chennai-600094 do hereby solemnly and sincerely state and dectave as under:- (2) That was a contesting candidate atthe general election bye election to the House of the People Legislative Assembly of 75 Virkavandi Assembly constituency, the result of which was fel, 0n 24-10-2019, {2) that yimy election agent kepis separate and correct account of all expenditure incurred fauthorized by me/my election agent in connection with the above election betwrgen27/09/2019 (the dalv on which I was nominated) and the date of declaration ofthe result thereof, both days inclusive. (3) That the said account was ina‘ntained in the Register furnished by the Returning Offcer for the Purpose and the sald Repsteritselfs annexed here with the supporting vouchers/bils mentioned in the said account (4) That the account of my election expenditure as annexed hereto includes all tems of election curred or authorized by me or by my election agent, the political party which “uns body of persons and other individuals supporting me, in Oh with Phe’lection, vid nothing has been concesled or withheld/suppressed the exucnses on travel of leaders covered by Explanations a and 2 ter Harahan, sentation of People Act, 1951), Sets Rerceorras(5) That the Abstract Statement of Election Expenses annexed as Annexure Il to the said account also includes all expenciture incurred or authorized by me, my election agent, the politcal Party which sponsored me other associations/body of persons and other individuals supporting me, in connection with the election. (6) That the statements in the foregoing paragraphs (1) to (5) are true to the best of my Knowledge and belief, that nothing is false and nothing material has been cancelled, poren ee LOM tal f— Solemnly affirmed /sworn by V, Gowthaman at this day of November 2019 Before me. J.MANOHARAN AOL. ADVOcA Guduvanenory-603 203