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NOMINAT10N PAPER
Election to the Legislative Assembly ofTELANGA A siate.

d a'
STRIKE OFF PARTIOR PART I BELOW WHICHEVERIS NOT APPLIC___

PART I
(To be used by candidate set up by recognized political partltl

I nominate as a candidate for Election to the Legislative Assembly from the 46-

KUKATPATIY( ASSEMBLY CONSITruENCY) .

Candidate's name ]{ANDAMURT VEI{KATA suHAsrNt Fathe/s Name

NANDAMURI HARI XRTSHNA ,Her Postal Address' H.No.10'3'3LOl Al2 Humayun

Nagar, l{ear NMDC,Masab Tank Hyderaba4 TETANGANA. Pln' 500028. Her name

is entered at S.No. ..710.. ln Part No 48 of the electoral roll for 63' AMPALLY

Assembly constituency.

My name is SRIDHAR lASn,Sio VENKATESWAR MO IASTI and it is entered at Sl.No

215 in Part No 334 of the electoral roll for the 45- Kukatpally Assembly
Constltuency.

Date:‐ 1711.2018
b+:,
Signature of Proposer

1s+<rt sttounQ)
 PARr-r
/
(To be used by candldate NOT iet up by recognized polltic.l party) /
We hereby nominate as candidate for eledion to the Legislative Assgrhbly from
Constituency.
the........................................... Assembly
/
Candidate's Name........................... ...........tathe/s/Mof e/s/husbandt
name...............-.----.. W Postal
Address....................... ..........1i/ name entered at
S1.No............................. in Part no........... of /tfre electoral roll for
.......... Assembly Constituency. ,/
/
We declare that we a.e electors of this Assembly ConstitueD(y and our names are entered
/
in the electoral roll for this Assembly Constituency a)ir{dicated below and we append our

signatures below in token of subscribinS to t ns noy/natlon.

Partlculars ofthe propf and thelr signatures

Electoral Roll No.Of ProDor6r

SI No Part of Part Full Name Signature Date
Eledoral Roll
＾

ｔ●
２

1 /2. 4 6.
■ ２ ３ ４
，
６ ７ ３ ９．１
０

Note: There should be ten electors of constituency as proposers,

 PART III
l, the candidate mentioned in Part I assent to this nomination and hereby declare that-
(a) lam a citizen of lndia and have not acquired the citizenship ofany foreign state.

(b) That I have completed 43 Years ofAge.

ISTRIKE OUT c(i)OR c(ii) BEI,OW WHICHEVER lS NOTAPPLICABLEI

(c) (i) I am set up at this election by the TEIU6UOESAM PARW which is reco8nized State Party

in this state and that the symbolreserved forthe above party be allotted to me.

OR
(ii) I am set up at this election by the....../.................... Party, which is a registered

unreco8nized Political Pao/that I am ing this election as an independent candidate.

(strike out which is not app )and that the symbols I have chosen, in order of

prefetence, are:-

(d) My name and my fathe/s/mothe/s/husband's name have been correctly spelt out above ln

E GUSH (name oflanguage); and

(e) That to the best of my knowledge and belief, lam qualified and not also disqualified for

b€ing chosen to fillthe seat in the Legislative Assembly ofthis State.

*lfunherdeclare that lam a memberofthe

-,,,,,,....* Gste which is a scheduled
r$caste ofthe state of,,,..,-,...in relation t0,,,...,.,...,(area) ln that state.

I also declare that I have not been, and shall not be nominated as a candldate at the present General
Election/the bye-€lections b€iry held slmultaneously, to the Letislative Aisembly of TELAt{GAt{A
State from more than two Assembly C.nstituencies.

Date:17.11.201E Sitnature of the Gndi

* Score out this paragraph, ifnot applicable

irscore out the Words not applicable
N.B. A Recognized PoliticalParty means
a politicalpady recognized by the Election Commission Under
The Election Symbols(Reservation and Allotment) Order, 1958 in the State concerned.
 PART IIIA
(To be filled bY the Candidate)
whether the Candidate-
(1) has been convicted-
(a) Of anyoffence(s) under sub-s€ction(1)or
(b) For contGvention of any law specified in sub-sedion(2),
Ofsection 8 ofthe Representation ofthe People Act,1951
(43 of 1951)or
(i)
been sentenced lo imprisonment for two years or more.
t the onswer is "yes" the condidote sholl lunish the following inlormotioni
(i) case/Fi6t lnfomation Report No./Nos.......,.1{ ...............................

(ii) Police station(s)...... Nil.....District(s)... Nll....State(s)...... Ni1.....

(iiD S€ction(s) of the concemed Act(s) and brief description of the offence(s) for which he

has b€en convicted................................ .. ....... 11 ... ... .. . ... . .. . . . . . . . . ................ .........

(iv) Oate(r) of conviction(s)....................................... Ni1..........................................

(vl Court(s) which convicted the candidate...,..............,,, Ni1........., .,..............,,..'..." '

{vi) Punishment{s) lmposed llndicate period of imprlsonment(s) and/or quantum of

,lne(s)1.................................................................. Nll ................ ......'...

(vii) oate(s) of releas€ from prison..................... Nil...

(viii) war/were any app€al{s}/revi5ion{s) fi led against above convict,on(s) ...... l{i|....

(ix) Date and pa rticulars of the appeal(s)/applications{slfor revision fi|ed,,,......t{11.......

(x) Name of the coun(s) before which the appeal(s)/application5(s) for revlslon

fi|ed.........................................................N11............

(xi) whether the said appeal(s)/applications(t) for revision has/have b€en disposed of or

islare pendin9.....................,,,,,,.,,....................,...Ni1..........................................................

(xii) lfthe said appeal(s)/applications(s)fo. revision has/have been disposed of-

(a) Date(s) of disposa1.........Ni1..............

(b) Nature of order(s) passed......l{11......

(2) Wheth$ the candidate is holding any office under the Government of lndia or Stat€
Government?..,..... l{o-"'
-lf yes, details ofthe offfce he1d........................... OT APPUC,48tE....................

(3) whether the aandldat€ has been dedared insolvent byanycoun?.... .. O...,..
 -lfyes, has he been dlscharged from insolvency............I{OT APPUCABU.............

(4) Whetherthe aandidate is under allegiance or adher€nceto any foreign country...... O.........

-tf yes, give detai|s....................................... 1{oT AppUcABu ....................................

Whetherthe candidate has been dlsqualifled under section 8A ot the said act by an order of

president?......lto.....

-if yes, the period for which dlsqualiffed......... l{Ot APPUCAALE .................

(6) Whether the candidate was dismiii€d for corruption or for disloyalty while holdinS office under

the Government oflndla orthe Govemment ofany state?.,.. O......,

-if yes, the date ot such dismissa|..................... I{OT APPIICAB|,E ......................

(フ ) Whether the c.ndldate has any subsisting contract(s) with thecovernment elther ln lndivldual

(apacity or by t.ust or partnership in which the candidate has a share for supply of any goods to

that Governmeht of tor executlon of wo*s undertaken by that Government?....., Ito,....

-if yes, with which Government and details of subsistint contract(s) OT APPUCABLE

(8) Whether the aandidate is an manaSlngagent, or manageror S€cretary of any company or

Corporation (other than a aooperative society) ln the Gpitalof which the Centrel Government or

State Govehment has not less than twenty-five percent share? .......t{O.,...

lf yes, with which Government and the details thereof.................. IOT AppUCASt E .............

0) Whether the candldate has been dlsquallfled bytheCommlssion undersection lOAofthesatd

4ct......1{O......
-ifyei, the date ofdisqualifi@tion............... OT AppucAglt .....,.....,,

PlaceiXukatpally

Date:17.11.2018 sitnature of the Candi

 PART IV
(To b€ filled by the RetuminS Officer)

Serial No. of Nomination Paper.........,...........---,-,

This nomination was delivered to me at my ofllce at.................................................,,...(hour)

On................................(date) by th€r candidate/proposer{Name).

Dater. (Returning Officer)

+Score out the word not

applicable

PART V

Decision of Returnint Officer Acc€pting or Rejecting the Nomlnatlon Paper

I have examined this nomination paper in accordance with section 36 of the Representation oI the

People Act, 1951and decide as followsi-----

0ate:.............,,................................

Returning Ofti€er
 PART VI

R€c€ipt ,or Nomin.tion P.pe. and l{otlce of Scrutiny

Oo be handed over to the person presentingthe Nomination Paper,,

Serial No. of nomination Paper.....................

The nomination paper of .........,................................................,a candidate for election from the

Date:..., Returning Officer

'score out the word not applicable

11′ 16′ 2018 ceotsems2.l€langana.gov.in/ghmc-S€a.ch/PonlForml asPx

● ′

Officc of thc ChielElectoral Officer

Telangana District : l6-Medchal Malkajgiri I Assembly: 46-Kukatpally
ヽbtcr

Sl.No. in part: 215

ID Card (EPIC) No: RDV3778281

SRll)HARJASTI

R€lation Namc : VENKATESSヽ R RAO JASTl

House No: 16-2‐ DEl1/G2

Age: 39

G€nder: Malc

Polling Station No & Namc: 334-ST MARY HIGH SCH00L

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t'Cit6■ 7001′ 2013,Ren‖
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Ph No.984983806●
︰
    １

FORM‐ 26
    １

(See rule 4Al

    １
   １

AFFIDAVTTTO BE FILED BY CANDIDATE ALONG WITH NOMINATION PAPER

n-rruirune oFFrcER FoR ELEcrroN ro rHE MEMBER
it'ririi ixi oF
(ASSEMBLY
tEciiArrva AssEMBLY, TEIANGANA FRoM, 46-KUKATPALLY
cbNsrruENCY)
PART A
1

lが ANDAMURI VENKATA SuHASINI′ Dノ O NANDAMURI HARI KRISHNAI Age:43

′
Ytaに Resdent oF H.No.■ 0‐ 3-310/A/2 Humavun,lagar7 Near NMDC′ Masab Tank
dO hereby
derabad′ TELANGANA,日 n‐ 500028a Canddate at the above dediOn′
町
afnrm and state on oath as under:-

嶋
′
●
1
 ０   助

I am a candidate set up by TELUGUDESAM PARTY'

in
My Name is enrolled in 63 NAMPALLY aSSEMBLY CONSTITUENCY
No 48'
TELANGANA STATE at seriat No'710 in Part

9848975278 and my E-mail I'D is N'A and my

3) My Contact Telephone Number is

social media account is

(i) Facebook account: SUHASINI NANDAMURI

ng lncOme Tax Return
4)DetalS of Permanent AccOuntNumber(PAN)and status of n‖

The Financial Tota‖ ncome

SI No

year fOr whiCh shOwn in incOme

the ncOme tax Tax return ln

retum has been Rupees)

lled

Nandamuri Venkata

Rs 12′ 00,000/‐
Chundru Venkata Sn
Harsha(Student
Dependent &!

(5) Pending criminal cas€s

against me'
(i) I declarc that there is no pending criminal case
rn"i Pending agpinn
iri iit"-ran if there is no criminat @seatternative 'the '
(ii) betow)
';;2;;;;;;;;;i; ior neeuceeu "suinst
oR
(ii) The following criminal ca
ff,;ffaes
pending
,;E ":;g,! ;t##:fliiffff"#:gr;r' "'r*'"
in the Table below)

α 塑ヽ゛
カ
ヽ ;tr
￨ン
_ル
1ラ
 FIR No.With name NOT APPLICABLE
and address Of
PoliCe Statlon
concerned
NOT APPLICABLE
Case No. with
Name of the Coud
NOT APPLECABLE
NOT APPLICABLE
Section(s) 。f
@ncerned
Acis/Codes
inuolY€d (give no,
of the Secnion, e.g'
Section......"of IPC
etc.).

or lppuclsLr NOT APPLECABLE

ipuon of
… or applrclsLr
E-hether charges
have b€en
traff.il€di(men$onYE
NOT APPLICA3LE

響1選I(1.if讐縄
charges Were
u6i aPPLrclalr noi aFPLrcABLe

器 醐 辟 報
been ■led against
the
proceedlngs( rlrerti
面 PHCABLE
=f ansWer
above tO(9)
is YES, give
details and
present status of

(6)Cases of Conviction
for any criminal offenccs'
(i)I declare ttrat I have been convicted
writo NOT
if the Gandidate has not been Gonvicted and
(flck this altsrnative,
against atternatlve (ii) b€low)

%
OR
 nViCted fbr the ofFences ment10ned be10W:
(11) l have been∞
●onViCted′ then tlCk thiS aiternatlVe and
(lf the candidate has been
S in the detal:sin the table be:oW)
scOreofr a:temauve(1)abOVer and giVe deta‖

NOT
Case No. NOT APpLECABLE NOT APPLICABLE
(a) APPLICABLE

NOT
Name of the NOT APPLICABLE NOT APPLECABLE
(b) ApPLECABLE
Court

NOT NOT
sections of fr-orlppLrclgLe AP'LECABLE
(Cl APPHCABLE
ACお ノCOdes
lnvolved(giVe
no.of the
sdion′ e.9,
s“ ion,¨ ,..Of
IPc,etCニ NOT ‖OT
oiiE-'retd.sctiPtion
NOT APPL■ CA● LE APPLECABLE
(d) AppLECABLE
of offence for
which convicted

NOT AP「 直 CABLE NOT NOT

(e) DateS Of OrderS APPECABLE APPUCABLE
of conviCuon

NOT
Punishment NOT APPLICABLE NOT
▲ppLICABLE ApP口 cABLE
(う
imDosed- NOT NOT
any NOT APPLユ LA● LE APPLICABLE
(9) APPLICABLE
App€als has been
-Whether
tiled against
conviction
order(Mention
I Yes or No)- NOT APruLADLE ‖OT NOT
APPLECABLE APPLECABLE
口“５

癬
蘊 嘲
(6A) have given full and up-to-date information
t to my political party about all

pending criminal cases against me and about all cas€s

of convictions as given in

paragraPhs (5) and (5).

b whom this item is not aPPlicabte should clearly

wiE NoT
[Candidates

APPUC.ABLE IN WEW OF ENIRIES I 5 (i) and 6 (i) abovel

Notel
enfutd clarry aod legibry in EoLD letats
7, oetails should be
cas€ under differcnt @lumns
2, Debits tu b giYen seryrably for each

against ead, item'

3,Detasshoutdbegi4enlnreve$echrcnologicalotder'l'e'thelah'tase
dabs for the other
b E mentiond first and bckwads in the otdet of
ag.
4, Additional shfr,t may & addd if tquired'
alt information in @mPliance of
5, @ndidab is ,esPonsibte for supplying
tlon'bte Su4eme Coa'ts iudgnent in w'P(
C)No' 536 of 20"'

immo\rable etc") of
(7)That I give herein below fie details of the asseB (Movable and

myself, My Spouse and all dePendents'

A. Details of movable assets

extent ofjoint ownership will also have
to be
Noter l.Assets In joint name indicaung the
9iven.
including Serial Number' Amount' date of
t{otel2. In crse of deposivlnvesttnent, he details
and Branch are to be given
deposit, the scheme, Name of the Banvlnstitution

as per current market value in stock

c\change
Note: 3. Value of Bonds/Share Debentures
should be
per books in case of nonlisted companies
in respect of listed companies and as

イ
 son(S)′ daughte(s)Ofthe canddate Or spOuse and
Note:4｀ Dependenr means parenrs′
ЫOOd Or mamage′ who haVe no
any other persOn related tO the Canddate whether by
h00d
separate means ofincome and whO are dependent on the candidate for theirllVe‖

Note:5 DetalS including amountiS tO be given Separately in respect of each inveStment

Chundruvenkata Sri
DescriPtion HarshaDePendent(Son)

Cash in Hand A x Bank′ Tem口 e Street

betalls oF depost in l sBI Dwarabpul
Branch′ KaknadaAlc
Bank AcCOunts(FDRs Branch′ Panlagutta′
No 916010083610636
Terrn Deposits and a‖ Hyd.Alc
Balance in the AcCOunt
other wpes of No 30617706398
Rs.10,000/‐
2 Karur

灘馨 槻 獅騨
i帯‖
Insttulons′ Non‐
J
A/C
l『 怖′
Bankng Finandal No 145115500004
companlesand 1760
c00perauve socieues Balance in the
and the amountin above AccOunts
each such depOSit Rs 20319/‐

Sri Bhavani Cast ng SBI POICy

Mic Electnc
De● lS bF mvesment N01K049262010
Ltd(1150 units)
in bonds Amt Rs l′ 50′ 000/‐
Rs 4′ 50,000/‐
TOtal vdue
Debentures/Shares
Rs 5′ 00,000/‐
and units in (PreSent value
Rs.47′ 000/う
Companies)mutual
funds and others and
―

GtaG of investment m

in NSS. Postal saving, l.EdelWOSS tOに 0

1lfe insurance
Insumnce Policies and
Co Ltd
Investment in any
financial instruments No.500126870E
in Post Office or 2.EddWdSStOK0
life insurance
Insurance ComPanY
Co Ltd
祈 メ

and the amount

NO.200103773E
3 SBI Ufe
insurance co.ld!
 No lK048008504

TOtal amount:
Rs 3,24′ 000/‐

N‖ Rs l′ 00′ 00,000/‐
N‖
(V)

∬冊 脚 鳳
mm電
綿 in上 N‖
Nl
(Vl) Totor
vehicles
/Ai rcraft s/Yachats/Shi
淵謂帽 駐′
ps(details of make, lyear/
2018)
reqistration number
Value
etc., year of Purchase n_1′ 0`'ln
and amoud- ヽ0■ ■ フ′ 望
N‖
N‖
bullion and a)Gold:2222GramS
いう Jeweller.,
￨
worht
valuable things (Give
Rs.71,03,456/‐
deBils of weight and
value) b)Predous&
stones
Rs.30′ 00,0007‐
釧
°I需 躍 N‖
Nl
Nl
(輌 1) AnyotherattSuch
dalms/interest RS l′ ●2′ 00,υ υV′
КS■ ′
D`′
・
′o● ′_
ヽフ●′ rs;z,oo,ooo1-
Gross TOtaШ
￨ユ ′

(lx)

B' Detalls of tmmovable Asscts:

joint ownership will also have
joint ownership indlcating he extent of
'
Note: 1. ProPerties ln
to be indic'ted'
c-.r, t'nrl nr hrrildi n● or apa ふ品」
F:面 :be.enuond sepamdy h thS brnat.
chundruヽ ′
enkata Sr
Nandamun Venkata ChundruVenkata
SI N DescriPtion c,iLinthlsrrouse) Harsha(SOn)
Suhasini(Se10
O Komarag『 ￨
N‖
d N‖

岬胃
鵬招 Ⅵ‖age′
U Kothapa‖ e
survey Number(S) Mandaし East
Godavan Dist′
sy.No 1052

四
 Nl Ac 3 20 cents Nl
AreaCfotal
measurement in
Acres) Nl
N‖ No
whether inherited
prope‖ 呼(Yes Or
No) __ Nl
N‖ Year o1 196Z
Date of PUrchase
in case of self-
acouired DroPerty N‖
N‖ Rs 20,000/‐
of Land
(incase of
-cost
purchase) at the
time of Purchase N‖
N‖ N‖
Any Investment
on he land bY
way of
development,
ヽ
J」 ll)tl
N‖ N‖
N‖
Approximate
current market
value
N‖ N Manda Pe● ToWn′ Ea史
Agriculture GodavaH Dist
-Non
land: Location (s) Sy No l10/1&110/3
Survey.Numbe(s)

N‖ N‖ 2455 sq.Yards.
Area(tOtal
measurementin
sOuare Yard主 NO
N0 NO
WtGther inherited
property (Yes or
tto) 21-07-2018
N‖ N‖
Date of Purchase
in case of self
acouired oroDertv
N‖ N‖ Rs^88"3S,000/-
Cost Ofland
OnCaSe Of
purchase)at the
Jme of ourchase N‖
N‖ N‖
Any investment on
fie land bY way of
develoPment
construdion gEl Rs 88′ 38′ 000/‐
N‖ N‖
Approximate
current market
value
cOmmercial N‖
N‖ N‖

buildings
(InCluding
ap● ‖
unents

脚 :‰
釦
 Area(total NI N‖ N‖

measurement in
So.Ft)
N‖ N‖
Buiに up area(total N‖

measurement in
sq feet)
Whether inherited No No No
property(Yes or
No)
Date of Purchas€ N‖ N‖ NI
in C3se of self-
acouired Drooertv
N‖ N‖
Cost of prope町 N‖

(InCaSe of
purchase)at the
time of ourchase
N‖ N‖ N‖
Any Investment
on the land by
way of
development,
construdion etc,,

N‖ N‖
Approximate N‖

cunent market
value

N‖ N‖
Residential H No.8‐ 2‐ 293/82/F/4′
(iV)
buildings PIot No:4′ F‖ im Nagar′
(including ShalkpetHyderabad
apartsnents)locatio
n(s)-
survev.Numbe(s)
N‖
Area Cfotal 450Sq Yards N‖

measurement in
qn ft\
N‖
BJに up area(tOtal 750 Sq.Feet. N‖

measurementin
Sa Ftヽ

whether inherited No N‖ N‖

propertY(Yes or
No)
Date of Purchase 23061993 Nl N‖

in case of self
,.r1l,irpd droDertv
Cost of Property Rs l,9o000ノ ‐ N‖ N‖

(Incas€ of
Purchase) at $e
time of purchase
＼慟

N‖ N‖
Any Investment N‖

on the landby way

of deYelopment
construction etc.,

¨
′
 Rs.430,00,000/-

other (such as
interest in

Rs.4,30,007000′ ‐
Rs 88,38,000/‐
Total of current
market value of
劇 httmms md
msttut OnS′ enUw Or
government(Note:Rease g∼ e separate detals of name of ban、
individuat and amount b€fore each item)

Chundruvenkata
Nandamuri Venkata
Sri Harsha(Son)
Suhasini(Sel0

Loan or dues ■)AxiS Bank′ Loan

to Alc.LTR000802796794
BanlvFinancial 0utstanding due on
institution(s) 30,10.2018 of
Name of the Rs 97′ 48′ 718/・

bank or 2)AxS Ban` Loan

financlal A/c LPR073302190455
institution, 0utstandlng due on
amount 30 10 2018 of
outstanding Rs 33,33′ 528/‐
nature of loan Both are Mortgage
loans
3)HDFC BANK Car
Loan Amount
No.61884736
Rs.14′ 96′ 000/‐

Loan or dues to
any other
individuals/
entity other
than
mentioned
above name(g

Rs l′ 46′ 287246ノ
‐

Government
dues, Dues to 暇呻 試
慨 扁 酬 鳳 酵‖
departments
deallng with
government
accommodation The AddL…
`.
山
 認
●
り 置常I濯 璧霊HL賛誦魚 ￨
喬
:掘 滉モ:■百 「
品htLccOmmOdatiOn′
tOwardS‐

nぶ 珈
∞ :珈 野Ⅲ堪ξ
輩
淋 :
Dues to
department
dealing with
Government
Transport
including
alrcraftS and

Municipal/ProPerty

Grand total of dl

whether any
other liabilities are
in dispute, if so
mention the
amount involved
and the authority
before which it is

(9)De● lS Of Pl燎 劇 On or∝ cupator

(a)Sein Socid Act u載
(b)SPOusel Bugness

躍糊1淵 :誦Ⅷ∬
鶏ec Rend
(b)SpOuse:Through Bugness ‐ ニ ユ
/
2ヽ
2感 ィ
悌
 Interest from personal loan
(c) source of income, if any, of dependent

and any public company or

companies
(98) Contracts with appropriate Govemment

(a) Details of Contracts entered by the

candidate Nil " '

the Spouse Nil '

(b) Details of ContmcG entered into by
the dep€ndents 'Nil '
(c) Details of Contracts entered into by
or trust in which the
by the Hindu undivided Family
(d) Details of Contracts entered into

candidate or spouse or dependents

have interest Nil '

(e)Detallsofcontracts,enteredintobyPartnershipFirmsinwhichcandidateorspouseor
t"'
iJilna.ns.t" Nil "
paitners "p'l'ii" " ' or
or spouse
Companies in which candidate
Jy
(f) Details of contracts
"ntt'* 'n-
dependenE have sha16 " " Nil " '

under
(10). My Educational qualification is as

Bacheloroflavr(LlB),studledatPendekandtawCollege'Hyderabadaffiliadto
ttre vear 1999'
ili"J unr"tittv ind Goursc comPleted ln

PART‐ B

GIVEN IN O) TO G
11. ABSTMCT OF THE DETAIE Snrt.Nandamuri
Name ofthe Canddate
赫 3‐ 310/A/2

蠍 #聯駄
A
63 Nampa‖
Number and name of the conSttuency and State :A湘 ]‖gana
iisenat no.zro in Part t'to
48.

canddate Telugudesam PartY

(Otherv{ise write indePendent)

Not ApplicaЫ e
TO● I Number Of Pendng clmmJ Cases

onMcted
 Year for Total Income
PAN of
which last shown
income
― tax return
filed
AHWPN9516H 2018-19 E:o,ss,:oo
(a Nandamuri Venkata
c hntinirCandidate) N‖ Nl
N‖
(b)Chunl‖
1』 inkata Rs 12.00′ 00U′
三[= N‖
AKUPC8582H

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Cn

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DescriPtion
￢ andamul Sri Ha6ha
venkata SuhaSini -hundruvenkata
(DePendent)
CSelう (Son)-
Uυ υ
RS 7′ Uυ ′ ′ ilpz,eo,ooo/-
A ]●vaЫ e AsSets lTOtal
Value)
Immnvable ASSetS -crl.s4qt,qsll- Rs.38′ 38′ υυu′
B Rs.20,000/・
Rs,1,90,000/‐
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f

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Rs.1,46′ 28,246/‐

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 nnandalinsutuuons and
OtherJOtaり

‖ated
にge′ HYderabad a価
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二I罰常嘉 99'
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1, the deponent abOVe named′

dO httnd declare matthe cOntents OfthlS

amdavit are uue and COreCt tO the beSt Of my knowledge and belief and no part Ofit iS

false and ndhing matelal has been conCealed there from.I futter deClare that,
On or pendlng caSe aganst me Other man thoSe
a)there L no Case Of COnvl“

menuoned ln ltems 5 and 6 of Part A and B abOVe.

aЫ IW,Other than thOSe
dO not haVe any asset Or‖
01′ my Spouse Or my dependenヽ

menuOned in item 7 and 8 0f part A and ltems 8,9,10 0f Part B aboVe

this the 176 day of November'2ol8'

Verified at Hydembad

Deponent

rrlt カお /チ
tl.:,´ 1::^
 nominations'

before an oath Commissioner

or Magistrate of the First
Note:2. Affidavit should be sworn

Class of before a Notary Public'

Note:3.Allcolumnshouldbefilledupannocolumntobeleftblank.Ifthereisno
as the case may
respect of any item' either'1''lil" or "Not applicable"
informadon to fumishin

be, should be mentioned'

Note:4.TheAffidavitshouldbeeithertyPedorwrittenlegiblyandneady.
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 FORM OF OATH OR AFFIRMATION
ARTTCLE r 73 (A) OF rHE CONSTITUTION OF lNDlAl

(To be mode by o condidole for eleclion to lhe Legislolure of o Stote)

I t{ANDAMURI VEIiIKATA SUHASINI having been nominated as acandidatetofilla seat

in
The 4&(ukatpally Leqislative Assembly,Telanagana State do swear in the name ofthe God
that lwillbeartrue faith and allegiancetothe constitution of lndia as by law established
and that lwill uphold the sovereignty and integrity of lndia.

(Signature and name in block

letters of the Candidate)

Sworn in the name of God by Shrimati I{ANDAMURMNKATA SUHASINI at

(Place) at ...,,.............................. (hour) this the

dayof.......................... 200 ......................... before me'

(Signature of
authorised person)
Name Designation and
Seal

{CERTIFICATE FOR RECEIPT OF OATH)

(To be honded over to lhe condidote by lhe oulhorised person)

CertifiedthatNANDAMURMNKATA SUHASINI acandidateforelection tothe4G

Kukatpally, Legis lative Assem bly,Telangana State has made and subscribed the oath /
affirmation as required by the Constitution of lndia before m e at my office at
.......................... (houd on (date).

(Signature of
authorised person)
oate ...,.,.,.,.,...,.............. Name, 0esignation andSeal

'Score oul \ fiich is not opplicoble.

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