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Affidavit to be Furnished by the candidatealongwith Nomination Paper Before the Returning Officer
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No. Galli, resident House 167, of Aged J. , son .l, At$rasio Monserrate of JoeMonserrate, 49 years, on affirm andstate oathas Election, hereby do solemnly Taleigao, Goa,a candidate theabove at under$ (1)I am a candidate up by Indian National Party, set Congress
r
1
S I .N
Names
Totalinco ne yearfor The financial shownln whichthe last Income- Income T tax returnhas been (ir Return filed RuDees)
AEOPM8398H
AFGPM4451G
2010-11
2
3 4 5
and 47 The detailsof caseswherethe coun 143.1 i 4AJ 49.153,324,325,326,332,333'427 Act to nd Sec. 3 of the Prevention PublicProperty of Sections hastakencognizance. of Act and Description the offence It is alleged that the accused led a morcha to Panali stationon accountof the failureon the part of the police taken whichcognizance lt elements. ls to inspector arrestcertainanti-social led by Ata.nasioMonserrate alleged that the crowd , station the and violenvunlawful attacked police 34 , v u/s r . , , w u l o . 92/10/C J t v t f I at r r d l t ll. Caselno. J z t t v t v -- JMFCa t . dPanaji r . !353 r/w v a ,IPC fl. uasc aftercomi[lg others amongst thatthe deponent It is alleged know about the afrest of his wife forcibly tried to entef t
1 7 c c N o . 9 2 / 1 0 /-c 4 . 0 2 0 1 0
No. Petition 8'1/2010. 1& Criminal 2/201 No. Petilion (s) (s) of Details Appeal i Application the 1 No. Criminal 421201filedbefore (if any)filedagainsi the Writ Petition for revision Goa. at of Bombay Panaji, HighCourt
-------NrL------
etc') of myself, (5)That lgive hereinbelow the detailsofthe assets(movableand immovable my sPouseand all dePendents: A. Detailsof movableassets : (Note: will of l indicating extent ownership alsohaveto be glven the l Assets iointname in the Amount, Daieof Deposit, scheme, Numbef, 2Incaseofdeposiulnvestment,thedetailsincludingserial are and Nameof Bank/lnstitution Branch to be given in valuein stockExchange respectofllisted market as per 3. Valueof Bonds/share/Debentures the current be should gaven. companies and companies as per booksin caseof non-listed of dependent the income the candidate' on substantially a heremeans person, 4. Deoendenf. givensepefately respect eachinvestment) in of is including amount to be 5. Details
Sr
No r)
(ii)
Degcription
Cash in Hand
Self
INR
2 472.857 tNR
Spouse 2.472,451
Depsnddnt 1 l
(FDRs, and TermDeposits allother including Saving typesof Deposits withFinancial Deposits accounts), Financial Non lnstitutions, Banking and Companies Cooperative and the amountin each societies suchdeposit
(iii)
tNR
6 4 5 29 9 3 t N R
6.452,993
- Not Applicable-
in of Details investment Bonds, and Debentures/shares unltsln Fuodsand otheF companies/Mutual andthe amount
rNR 3,240.349
Details investment NSS,postal of in policies Savings, lnsurance and investment any Financial in nstfument Post office or in Company the amount and rNR Personal loans/advance givento any or entity including firm, , Tfustetc and other receivables from debtorsand the amount. rNR MotorVehicles/Aircrafts achts/Ships (details lvlake, of Registration etc,Yearof No. Purchase amount) and
(vii) Jewellery, bullion and valuable thjng
2,875,263 rNR
2,875,263
16,647,743 INR
16,647,743
rNR
'11,796,891 INR
11 , 7 9 6 , 8 9 1
1765.5 gram= Per 1765.5 gram= Per tNR 2,634.956 INR .1,089,973
tNR
_ 1,089,973
( N o t e r1 Properlies jointownership in indicating extent jointownership alsohaveto be indicated the of will 2 . Eachlandor buiiding apartment or should mentioned be seperately thisiormat.) in
INR
2]77sA0 INR
2,177,600
rNR
5,022,500
IN R 9.7
7,{' sq.ft.)
Whetherinheritedprooertv (Yesor uate ot purchaseIncaseot sell acouiredorooertv Costof Land(incase purchase) of at the time of purchase Any Investment the land by way ol on develooment, construction etc.
- Vll As oer Annexure Vll As perAnnexure INR tNR INR 8,974.058 t N R 8,974,058 38,128,750
rNR
3 8 , 1 2 8 . 7 5t0 R N
INR 68.'t81.850 NR I
(vi)
Others(such interest prooedv) INR as in lotal of uurrent Marl(et value ot (l to (v) above INR
68.18'1.850
- Not Applicable-
(5) | give hereinbelow the detailsof liabilities/ dues to publicfinancialinstitutionsand government (Not6:Pleasegive separatedetailsof nameof Bank,institution, :entityor individUal and amountfor each item D e p e n d e n t | D e p e n d e n tI- D e p e n d e n t S . N ( Description Self Spouse I 3 Loan or dues to Bank/Financial (i) - NotApolicable Institution(s) tNR 2.636,430 INR 2,636.430 Nameof Bank Amount outstanding Nature loan of Loanor dues to anv individuals/ Entitvother than mentionedin (i) above. Name(s) Amount outstanding Amount outstanding Nature loan of As perAnnexure Vlll As pef Annexure Vlll As per Annexure Vlll As per Annexure Vlll As per Annexure Vlll As per Annexure Vlll - NotAoolicable - NotApplicable - NotApplicable
rNR 3 3 , 9 2 2 , 7 6INR 9 33,922,769 As perAnnexurelX As perAnnexure lX As perAnnexurelX As perAnnexure lX As perAnnexurelX As perAnnexure lX - lX As perAnnexufe lX AsperAnnexure rNR 692,351 NR 692,351 - lX As per Annexure- lX As perAnnexure t N R 3 7 , 2 5 ' 1 . 5 5 0 .INR 37.251.550.00 00
NIL
- NotApplicable -
(8) My educational qualification as unoer: is Shri Atanasio Monserrate SeniorSecondary Examination( council ofSecondaryEducationMohali)intheyear2009 (Givedetails highest of School University / education fullformof the certificate/ with diptoma/ degree course) (Name ihe School of /College/ University the yearin whichthe course and was comoleted.) ABSTRACT THE DETAI. S G I V E N N ( 1 )T O ( 8 )A B O V E : OF I 1
Name of the candidate
2 Fullpostaladdress
Numbef and Name constrtuency and state of th
F r o m 1 - S t .C r u z G o a . 3 ,
Nameot the Polltical partywhich set up the candidate (otherwise write 'lndependent')
N a m eo f t h e b a n k
Corporation Bank-Tonca A x i s B a n kL t d . 4 l 8 5 4 ( Bankoflndia 15921 Jennifer ) Bankof India( Atanasio A/c 9870 ) ifef Canara Bank23169( Jenn ) C o r p o r a t i o n n kl l 7 l 7 ( J e n n i f e)r Ba Bank 1323 Corporation Corporation Bank I458 Corporation Bank 1558 Bank 1586 Corparation Corporation Bank9699 Bank SB/01/00q407 Corporatior'r Corporation Bank Toncali00 D e n a a n k6 1 0 3 B ( Jennifer HDFC00591000046740 ) HDFCBank76528 HDFCBank 372 I C I C IB a n kI 1 7 0 8 l c l c l B a n k0 0 1 5 0 1 0 1 9 0 I f l D B l B a n k i i 2 l 4( J e n n i f e) 2 ( KotakBank20000304 Atanasio ) KotakMahindra No. 1000!103 A/c Mapusa UrbanBank CD/ 25803 Mapusa UrbanBank SB/ I i754. OBC/CTB
A/c Tvpe
FixedDeposit Savings Sav ings Savings Savings Savings A/c Current Savings Savings Savings Savings Savings Savings Savings Savings Savings Savings Sav ings Savings Savirrgs Savings Savings Current A/c Savings Savings Savings Savings Savings Savings Savings Savings Savings CurrertA/c Current A/c
oBc/cTB r69 r3
OBC/GTBA/c No. l3 170 ( S B I I 1 0 3 5 8 8 i 6 8 J e n n i f e)f 1 S B IA / cN o . I 1 0 3 1 6 0 2 1 7 9 Syndicate BankA/c 13893 Uco Bank2578 UTIBarrk /cNo.39224 A Coryoration Bank 1595 I C I C IB a n kI 4 9 3
Total
50% share under communionof assets Shri.Atanasiol\4onserrate
A N N E X U RIE I Investment Shares& Mutualfunds as at 31/03/2011 in N a m eo f t h e f u n d / C o m p a n y a) Mutual Fund KotakMahindra Mutual Fund DSPMerryl LynchlMututal Fund a) Shares ln RajHospitality Ltd. Pvt. (1997Shares Rs.304492 per share) at Total 50%shareundercommunion assets of Shri.Atanasio Monserrate Smt.Jennifer lvlonserrate C o s t( i n R s . ) 200,000 00 200,000.00 6,080,698.71 6.480.698.71
3,240,349.00 3,240,349.00
eatoup viildaEin
LICPoticy 930912470 No. LICPolicy 930755903 No. Torat(a) provident Public Fund Total(b) GrandTotat(a+b)
1,250,000.00 1,500,000.00
Valueas on 3113t2011
5mt.Jennifer Monserrate
2,875,263.0O 2,875.263.OO
ANNEXURE IV
n"" ?ers9!.ellq3rs&dv.
Namesof the panies eduance To*ardspiilrasibi proiiE Advance purchase Flar for of
AmountRiiEin
3113t2011 2,400,000.00 | ,47 9,479 .OO 666,666.00 666.666.00 666.666.00 r.i0.000.00 t50,000.00 250,000.00 t09,500.00 800,000.00 250,000.00 t00,000.00 I 5t , 6 6 6 . 0 0 250,000.00 436,000.00 849.000.00 r00,000.00 230,678.00 9.000.000.00 500,000.00 500,000.00 600,000.00 l]8,012.00 r,400,000.00 500.000.00 8.-r21.668.00 2,t7t,900.91 78,445.00 40,003.00 t0,000.00 56,500.00 261.400.00
ClaraPholomena Dias MariaRitaDias RitaAntonefta Dias VelhoConstruction Verner Velho palyekar Devidas EdwinMascarenhas CroupCorstruction Curudas Mayekar lnacioPereira .iayesh Micheal Viegas Rui Pinto Verner Zacquaris Monteiro Sharayu Automobiles Advalpalkar Constructions Caetano Souza D Digirech FlorieViegas Cood EarthDevelopers MudhirCupra Udayl\4adkaikar Raj Hospiraliry Ltd pvt RohitMonserrate Priority Automobiles Kala Moters RentReceivable TDS Receivable(Ninad Laud) TDS Receivabte(Edith de) Kotal Securities
3J.295,485.96
16,641.74?.c)8 t6,647,712.98
Four Wheelers Toyotaprado Mercedes BenzC 230 Mercedes BenzE CDI 350 ruercedes BenzG 655AMG l a t aX e n o n Maruti Omni Maruti Omni fMaruti Omni Maruti Omni Hyundai ii0 SkodaSuperb ToyotaFortuner Toyota Captiva Two Wheeters RoyalEnfield et Bu Kinetic Honda Kinetic Honda TVS Scooty TVS Scooty Kinetic Honda Kinetic Honda KineticHonda Kinetic Honda Kinetic Honda Kineiic Honda Kinetic Honda TVS Scooty Kinetic Honda ryS Scooty Honda Dio Kinetic Honda Kinetic Honda
cA_08-F_0001 cA_o7_E_010.1 GA_07_L-0026 cA_07_L_OOO1 cA_07-c_7178 cA-07_E_3129 cA-07-C_6932 cA_07-c_6933 cA_07_C_6934 cA_07-E_0380 cA-07_L_0333 cA-09_E_0333 cA_09_D_0s33
04t07t200s 20t07t2010
cA-07-H-3162 GA-01_H-2500 GA-01_H-7376 cA-01-Y-2753 cA-07-B-2995 cA-?1_Y_1249 GA-01_Y_6330 cA-01_Y_0650 GA-01-Y_6221 GA-o1-Y_6218 GA-01_Y_0674 cA-01-H-6560 GA-07-8_2627 GA-01-Y-6247 GA-07-H_8708 GA-07_J_3634 GA-01-Y_6247 GA-01-Y-2862
25/07t2ao5 13/'10t1999 01t06/2001 12/08t1999 11t05t2001 14t05t2001 16/08/1999 06/04/1998 24t03/2005 16t05t2001
Total Value
ffi
ANNEXURE VI Business Assets(Hear ine) uusrness Assets(Raj Constructions) Total
23,593,781.00 11, 7 9 6 , 8 9 1 . 0 0 11 , 7 9 6 , 8 90 0 .1
::rT"';.c:':d;::"*llry
z,tzg.gqsno
1,089,973.00 1,089,973.00
36/55)
Dhavem Field, Corlim Tiswadi_Goa (surveyNo 35/40) Dhavem Field, Corlim Tiswadi_Goa (surveyNo 37120) Dhavem Field, Corlim Tiswadi-Goa (survey 3S/23) No Dhavem Field, Corlim Tiswadi_Goa (surveyNo 34/30) Dhavem Fteld, Corlim Tiswadi_coa (surveyNo 34/SO) Dhavem Field, Corlim Tiswadi_Goa (surveyNo 36/53)
412,500.00
1
Property nearchurch at (Survey No. 17011) property Taleigao at (Survey 167/7) No.
065.d1
182.00
18/09/1985 'i8lp9/1995
432,000.00l
336,000.00
'o:1 schoot (reased) No raleis ::::^1 at Tateigao(Survey (ptot 6&10), Hroperty No. i6715) (attached t"o Casa Monserrate)
5,858,200.00 1,820,000.00
1 , 5 4 0 . 0 0 12tO3/2010 1,414.00
3,203,200.00 1 5 , 4 0 0 , 0 0 0 . 0 0 384,000.00 1 4 , 1 4 0 , 0 0 0 . 0 0
37,218,20Q.0Q
30t07t1997 2
KamatMansion ShopNo 1, 2. 3, 4 Mnamar KamatMansjon ShopNo.5,Miramar KamatMansjon ShopNo.7, Miramar at Pooja npts.,Opp.KamatMansion, Tonca llop Snopat KamatClassic. Tonca No.FF3 VelhoTradeCentre, at panajj :hop KamatMansion, Shop. No.6,Miramar KamatMansion Shoppremises (No g), Miramar KamatMansion Shoppremises (No g), Miramar K a m a M a n s i o S h o pN o .1 0 ,M i r a r n a r t n
flf;: "t
2st11/1999 Q4/10/1999 12t07t2000 13t07t1992 21t04t1999 02103/1999 09/06/2000 18/09/1995 06/08/1999 04t10t1999 21t04t1995, 19/06/1995, 28/0711997. 1 1 2 . 2 0 23106/1990
't
4,000,000.00 1,000,000.00 900,000.00 300,000.00 500,000.00 250,000.00 900,000.00 100,000.00 495,000.00 600,000.00
Houseat Taljegao (Survey No. 167/6) Bungalow Tateigao at (Survey 169/3) No. SmallHouseat Taleigao (Survey No. 167i2) House Cazacho at Accor,Taleigao (Survey No. .Umatt 186t2) KamatMansion No.2 Flat KamatMansion No.3 Flat Kamatl\/ansion No.4 Flat KamatMansion No.5 Flat Flatat CruzApts,La Campala, Miramar FlatNo 5-5(26), KamatClassic, at Tonca flat No.501,5th Floor, park,St.paulRoad, Central Bandra (W) FlatNo.307,Rahe.ia Residency, Bangatore
1 , O O O , O O 0 . o 0 5,775,000.00
8,400,000.00
1,OOO,OOO.OO7,455,000.00
300,000.00 16,590,000.00 800,000.00 3,920,000.00 94.00 2000 | 70o,ooo.oo 3,290,000.00 107 .00 23tO9t2O00 900,000.00 3,745,000.00 I 108.00 16t05t2000 900,000.00 3,780.000.00 I 140.00 20/01t1986 | 280,000. o0 4,900,000.00 126.00 2 1 t 0 4 / 1 9 9 9I 1 , 0 0 0 , 0 0 0 . 0 0 4,410,000.00 83.33 22/12t2009 10,000,000.00 10,000,000.00 | 159.70 1 9 / 0 4 / 1 9 9 3 1 . 0 6 8 ,1 6 . 0 0 1 I 3,992,500.00
1 7 , 9 4 8 11 . 0 0 ,6 32,348.316.00 136,363,700.00
o t a l( 1+ 2 + 3
Smt.
S h r i .Atanasio Monserrate
68,181,850.00 68,181,850 0
Nameof Institution
Natureof Loan Loan lHousing lCar Loan t^ Loan luar Car Loan Car Loan Car Loan Dr. Bal in Savings Nc
Amount O/S
3,s71,928.00 421,334.12 49.812.18 73 , 8 7 . 0 7 4 48,304.29 1,107,544.54 62.-1 I
5,272 .39 ,859 Shri.Atanasto Monserrale Smt.Jennifer Monserrate ANNEXURE IX Loanor dlrect 2,636,430.00
2.636 430 00
on 31t3t2011
3,803,893.60 9.t24,967.00 I , r 7 5t,7 8 . 0 0 700,000.0b s00.000.00 600,000.00 r.s00,000.00 r.000,000.00 r,700,000.00 3,I50.000.00 2.s00,000.00 r6,000,000.00 r,000,000.00 2,r60,000.00 169,000.00 s00.000.00 500.000.00 t-50.000.00 1s0,000.00 700.000.00 900,000.00 2.50.000.00 800,000.00 600,000.00 r0,050,000.00. 985.000.00 3,307,500.00 3,620.000.00 250,000.00
@s Atanasio bnrr.
Monserrate
Smt.Jennifer Monserrate
Sundry Creditors Provisions Total
718,546.09
606. r5s.00
fir
VERIFICATION l, Atanasio Monserrate, Deponent, J. the abovenamed, herebv do verifvand declare thatthe contents this of affidavit the contents the annexures and of enclosed herewith trueand correct the bestof myknowledge are to and belief, partof it is falseand nothing no material beenconcealed has therefrom.I further declare that :' (a) Do nothaveanyotherconviction pending or casesagainst otherthanthosernentioned items3 and 4 me in above: (b) I, my spouse, my dependents not haveanyassetor liability, or do otherthanthosementioned items5 and 6 in above.
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