PART-II: ABSTRACT OF STATEMENT OF ELECTI~XPENDITURE OF CANDIDATE

Sr. Particulars Amt. Incurred/ Amt. Incurred/ Amt. Incurred/ Total No. Auth. by auth. by Pol. auth. by othe~s Election

Candidate/ Party (in Rs.) · (in Rs.) expenditure Election agent (3)+(4)+(5)

(in Rs.) -r Expenses in public meeting, -

rally, procession etc. :-

I. a : Expenses in public l)Jt;~CJ 19Y1J-v ,.

meeting, rally, procession -- - .... - I

etc. (ie : other than the ones

with star Campaigners of the

Political party (Enclose as

per Schedule- I)

I. b : Expenditure inpublic

meeting rally, procession etc.

with the Star Campaigner(s) - ....-- ~ - (ie: other than those for

general party propaganda)

(Enclose as per Schedule-Z) r-. ~·.v~

Place: l)m6r:UC> , Date:

VIII Whether the party is a recognised political party Yes/We

If candidate is set up by a political party, Please

mention the name of the political party .YII

Name and Address of the Election Agent VI

Date of declaration of result ·v

IV Nature of Election (Please mention whether

General Election to State

Assembly I Lok Sabha I By- election

III Name of State/Union Territory

Sh./Smt./Km. I Name of the Candidate

~~'4 Signature of the Candidate

Name

TI Number and name of Constituency

PART-I

ABSTRACT STATEMENT OF ELECTION EXPENSES

r

II Campaign materials other . than those used in the public

meeting, rally, procession

etc. mentioned in S. No. I 15f?~& - ........ 1offt/&7 .. above (Enclose as per

Schedule-J)

III Campaign, through print and

electronic media including

cable network, bulk SMS or

internet and Social media - - --- - -- (Enclose as per Schedule-4) G-/'

IV Expenditure on campaign

vehiclesfs), used by '!Jtooo ~ Ydt~· . - - candidate (Enclose as per

schedule-5)

v Expenses of campaign

workers/agents (Enclose as J6}65.:(_ - ,/63oSe;( I ....- per Schedule-6)

VI Any other campaign

expenditure o~co~'ly jt!!Y!} - ...... «coo Grand Total

....... 10/)0tf{) -- ~ /O!)WO -

PART III : ABSTRACT OF SOURCE OF FUNDS RAISED BY CANDIDATE

"' - Sr. . Particulars Amount (in Rs.) No.

I Amount of own fund used for the election campaign

(Enclose as per Schedule - 7) lo~OJtJ()O - II Lump sum amount received from the party (ies) in cash or cheque

etc. _,

(Enclose as per Schedule-S)

III 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 I 0 < <9 (J(/{) r:

JJA .. - YV .

I ...... - v~\

.J

(]) 11 f- 5 4 B(,;, • . ci. 11/it', - t3- I• - ii,, /?Pi ,;/ idt;nz 1-- "" ";/~ .rirJ ~~J;

{j!!Jl-Slf ll, ( S?,76 ~ -9.14'if 15.;o-llt ,r,;;.; ~lffP;,~ ,....,._,, s 4,,.~>o

(ti HP-:i... 15 j ~Jo ::> .u;,14 J:t- / frlo IV /f~ ~2.~JJ '(/,,;r-D ?. .).:vra?J

0/ H12- 37J) j {b~ -51 L-9-J't fr t<?J<JJlu;;; ;>). f.0 cy,-, = ·22 """"

~ /-JR<'.>J\-l j3'11(s- ~~/~-0~ /'3r/o)f(rf7'1 /7f,py.J(J.,., • t7=>'

~ )/ Ro;<, f w ~ '1 J. 7.--',. 11./ .J.J2 /'S-lo I It ;r;:;; n r.w !(I_, 0 /'/<YfJ"O

<Z> H RSlt ~I ~ \ 4 b n1.1~J I 5.fo IY d,.., 17 I:i>J k 1=0 J?pn;>

~HR '.H.D 1 &ti~.? 27>-'Jt~:P /']./~/~,I;;;, 17f,j;J4'/Pv ~ !'?<='

fJ) )f fl::ftc / S •1./9 1-/o I~-!/- IJ-fo If; Jf7 13 ~Yf"'2>&-=- / 3=7

@ 11R.~7C / 9q92- ),..10.14~ ls~r"~Jltrr~ 13/4tJJ11~ ?- f'SO?YZJ

GD ·H R7o fl J 6~22 ~9~9,rtt.ff t3kJ·lit~ ~!WP ~ 1~<7

@ H be ('). r Gxs711 ~- 9. I 4 ~ 1'6·1 o- J L11r "'1 I\' ,R;n fr;1:7 "' I':>="'

@ 'Dl.. 7 cf } 6~ e ;ii 7--j.11./if (3-1~ IC, f'l'o/ 15 f>;;;i ;.;z;n ?- Is=

<ii) H l\o ;l. I\ j S ~ 11 ?. r], o- I~ <{ /?, 1 olf,- //'.::; P f);n bf,.tPV " ; ;;:

111 {;- 13' fe>ll( rf-;;; I~ f4iJ YI~ ) ®i H'f/.-17B ! 7~70 :s IO·,~, "= @ H~.tJ2l) 1~ );</)::) tctk /g~/d ry rfM If /ltiit><. /l:%V f;~

:B- -- {47;- Wt <T"PV @) 1-1)Lz,2 fl, J "1 ~ \' ~r/C> IV, 21 !J,rfo I ct /f n) JI ~

7 c;ft(J'~ c-: ~J ~

n .-r-~ r- *b'<"'~

this __ day of

~~--,J._~~ ~ltAN'(l .!tN&/1

Deponent

Solemnly affirmed/sworn on _______ , Before me, . S "'{ t O (Signature and seal of the Attesting authoriti\J ~"--.I-- d\.-

? ~ NOV 20Vt '{ "u1\.\~ ·. .. •\ ~01~R r\ar'f>'t~"

':l..~13p..LP.. l

Deponent

)

Before the District Election Officer Ambala (Haryana) (District, State/Union Territory) Affidavit of Presently at _ I /.<&:8. Nfrt L-- ,S:r ,,,., lb H son of ~g, lf+--t.a- R frH aged '::1q._ years, r/o y.p. o. !NA-fut.A 7l HsSruta /])UTT J}M {)~hereby solemnly and sincerely state and declare as under :-

\)1(//£) f) (1) That I was a contesting candidate at th~eneral election to the ~ Sabha ~ os-r» 'n?.

~ ¥~~.ion-2014 of Haryana from ~moa C) Parliamentary Constituency, the I /;Y,,} ~ . .,_ w --resfil:t'of which was declared on Joe 05 2014. /7' /t) .... o!t)lf,' -~,,~ ,, .

~I ' That Lk~pt a separate and correct account of all expenditure incurred/authorized by

g m.e/~~ i lection agent in connection with the above election 159')3 20 l-4 to ...::,,

,..,. 4 (the date on which I was nominated) and the date of declaration of the ~ t..":~- · ··· -· . '10 ... rJ..Olv "\::: t~ ii- ...y::. re thereof, both days inclusive.

~ .... f.3FThat the said account was maintained in the Register furnished by the Returning

Office for the purpose and the said Register itself is annexed hereto with the

supporting vouchers/bills mentioned in the said account.

( 4) That the account of my election expenditure as annexed hereto includes all items

of election expenditure incurred or authorised by me or by my election agent, the

political party which sponsored me, other associations/body of persons and

connection with the election and nothing has been concealed of with

held/suppressed there from (other than the expense on travel of 'Leaders' covered

by Explanation I and 2 under section 77(1) of the Representation of the People Act,

1= 1951).

(5) That the Abstract Statements of Election Expenses annexed as Annexure II to the

said account also includes all expenditure incurred or authorized 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.

(6) That the statements in the foregoing paragraphs (I) to (5) are true to the best of my

knowledge and belief, that nothing is false and nothing materi~~°lJW

concealed. t<ll ANl)ft-- { t>-1~ 1-1

Affidavit

Schedul~ 1

Expenses in public meeting, rally, procession etc. (ie: other than those with Star Campaigners of the Political party)

s. Nature of Expenditure Total Amount Source of Expenditure No in Rs.

Amt. incurred I Amt. Amt. incurred Auth. by incurred I by others Candidate I by Pol. agent Party with

name

1 2 3 4 5 6

1 Vehicles for transporting visitors 7tJt:tJ~ " rccco- - - 2 Erecting Stage, Panda! & Furniture, Fixtures, '

poles etc. c9~t{rl[J &tJrJ~ ~

3 Arches & Barricades etc. -.. ~

4 Flowers/ garlands - - 5 Hiring Loud speakers, Microphone, amplifiers,

comparers etc. - - 6 Posters, hand bills, pamphlets, Banners, Cut-

outs, hoardings . ---- ~

7 Beverages like tea, Water, cold drink, juice etc. .,__, __.,,.

8 Digital TV -boards display, Projector display, tickers boards, 3D display ..-- -

9 Expenses on celebrities, payment to musicians, other artists remuneration etc.

10 Illumination items like serial lights, boards etc.

11 Expenses on transport, Helicopter/ aircraft / vehicles/ boats etc. charges ( for self, celebrity or. any other campaigner other than Star ~ CamP.aigner)

.... - 12 Power consumption/ generator charges

13 Rent for venue ~ 14 Guards & security charges - 15 Boarding & lodging expenses of self, celebrity,

party functionary or any other campaigner - including Star Campaigner

16 Others expenses - Total ~ J.Cfrlo

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)

Schedules- 1 to 9: Details of Elections Funds and Expenditure of Candidate '1

I I , I

S. No Date and Name of the Star Amount of Expenditure on public meeting Remarks, if any Venue Campaigner(s) & Name of Party rally, procession etc. with the Star

Campaigner(s) apportioned to the candidate (As other than tor general party propaganda) in Rs.

1 2 3 4 --- 5

~ -------- 2 -- c-- A I( l

3 .i-> 4

Total

Schedule-3 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).

s. Nature of Expenses Total Amount Sources of Expenditure Remarks, if any No. in Rs.

Amt. By Amt. By Pol. Amt. By others candidate I Party agent

1 2 3 4 5 6 7

1 Ct) I ffind':r!ue sico ... aa: - ,_.. - 2 t1nr-P9r1-lln9 CJJ.?JJ 9'J9f}-- 3 Jkr};)flt~ l.!:;oo ..- -./.'3StJlJ 4 1)fjp_y t/t'/9o0 f/9'9!JO r. ter» -1- oeu- > Total lf~9,l<ff K7~~J/J Schedule- 4 Details of expenditure on campaign through print and electronic media including cable network, bulk SMS or internet or social media etc. for candidate

s. Nature of Name and address Name aQ.d address of Total Amount Sources of Expenditure No medium of media provider agency, reporter, stringer, in Rs.

(electronic I (print /electronic company or any person to Amt. By Amt. By Amt. By

print) and /sms /voice/ cable whom charges I candidate/ Pol. others

duration TV, social media commission etc. paid/ agent Party

etc.) payable, if any Col. (3) +(4)

1 2 . 3 4 5 6 7 8 1 2 l-fV{ I - ~ 3 ~

4

Total

j)A IY\r- . ( " v

,..

"'-·

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 vehide No. of Total amt. Source of Expenditure No Vehicle & Days for incurred/

Type of Rate for Fuel charges Driver's which auth. in Rs.

Amt. By Amt. By Pol. Arnt. Vehicle

Hiring of (If not charges used candidate/ Party By

vehicle/ covered (If not agent other maintenan under hiring) covered s ce under

hiring)

1 2 3a 3b 3c 4 5 6 7 8

·1

2

3

4

Total ¥36~0 11f_dJ)-- Schedule- 6 Details of expenditure on Campaign workers I agents

s. Date and Expenses on Campaign workers Total amt. Sources of Expenditure No Venue

Nature of Expenses Qty. No. Of workers incurred/

Amt. By Amt. By Pol. Amt. By /agents

auth. In Rs. candidate/ Party others agent

1 2 3a 3b 3c 6 7 8 9

1 Campaign workers honorarium/ salary etc.

2 Boarding

3 Lodging cf63,<9 ,_. 4 others . -

Total J!J.16>J Schedule- 7 Details of Amount of own fund used for the election campaign

S. No. Date Cash DD/ Cheque no. etc. with Total Amount in Remarks details of drawee bank Rs.

1 2 3 4 5 6 1 tn )lJ t>O 'CJ .... 109Jr1)0 ,.-

2

3

4

.Q A

" ,-

.j

L

Total

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 DD/ Cheque no. etc. Total Amount Remarks, if No. with details of drawee in Rs. any

bank

1 2 3 4 5 6 7 1 ---- 2 ~1 ( 3 -- ~ 4

Total

schedule- 9

Details of Lump sum amount received from any person/company/firm/associations/body of persons etc. as loan, gift or donation etc.

s. Name and address Date Cash DD/ Cheque Mention Total Amount Remarks No. no. etc. with whether loan, in Rs. .

details of gift or drawee bank donation etc.

1 2 3 4 5 6 7 8 1 ~

~

2 1 I I -- ----- 3 -------

1'-(( L..

4 Total