telangana state election commission · created date: 3/11/2019 7:45:35 pm
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ELECTION COMMISSION OF INDIANirvac-han Sadan, Ashoka Road, New Delhi_l1000176IECI/INSTiFIINC/EEM/EEPSi261qlvot. ttt --bated:5th
March,20t9
The Chief Electoral Om""r, ofAll States and Union Territories
Subject:-Corrigendum- Form 26- Compendium of Instructions on Election ExpenditureMonitoring (February, 20 I 9)_Reg.
Madam/Sir,
I am directed to refer to the commission's letter of even number dated 2gth Februa ry, 2019
regarding amended Form 26 and, to state that against item no. 8 (iii) under part,A, of the said
Form, the words "D were inadvertently
mentioned, instead of .,
aircrafts and helicopters)". As such, you are requested to kindly substitute the words ..Dues to
" in place of
2' corrected Form26 (English version only) is being forwarded herewith with the request to
bring this to the notice of DEos, Ros, candidates, political parlies and all election authorities and
incorPorate the same in the "compendiurn of Instructions on Election Err.rrditu.. Monirorin*
(Februar)r. 20 1 9)" accordingly.
Yours faithfully,
KUMAR)SECRETARY
Form 26
(See rule 4A)
Please affix your
recent passport
size photograph
here
AFFIDAVIT TO BE FILED BY THE CANDIDATE ALONGWITH
NOMINATION PAPER BEFORE THE RETURNING OFFICER FOR ELECTION
TO………………..(NAME OF THE HOUSE)
FROM……………………………CONSTITUENCY (NAME OF THE
CONSTITUENCY)
PART A
I………………………………..**son/daughter/wife
of………………………………………………….Aged……………………………..y
ears, resident of……………………………………………………………(mention
full postal address), a candidate at the above election, do hereby solemnly affirm and
state on oath as under:-
(1) I am a candidate set up by------------------------------
(**name of the political party) / **am contesting as an Independent candidate.
(**strike out whichever is not applicable)
(2) My name is enrolled in…………………………………………(Name of the
Constituency and the State), at Serial No……….in Part No……………..
(3) My contact telephone number(s) is/are………………………………………and my
e-mail id (if any) is…………………………… and my social media account(s) (if
any) is/are
(i)……………
(ii)……………….
(iii)………………….
(4) Details of Permanent Account Number (PAN) and status of filing of Income Tax return:
Sl. No. Names PAN The financial year for which the last Income-tax return has been filed
Total income shown in Income-tax return (in Rupees) for the last five Financial Years (as on the 31
st March)
1. Self (i)
(ii)
(iii)
(iv)
(v)
2. Spouse (i)
(ii)
(iii)
(iv)
(v)
3. HUF (If the Candidate is Karta or Coparcener)
(i)
(ii)
(iii)
(iv)
(v)
4. Dependent-1 (i)
(ii)
(iii)
(iv)
(v)
5. Dependent-2 (i)
(ii)
(iii)
(iv)
(v)
6. Dependent-3
(i)
(ii)
(iii)
(iv)
(v)
Note: It 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 me. (Tick this alternative if
there is no criminal case pending against the Candidate and write NOT APPLICABLE
against alternative (ii) below)
OR
(ii) The following criminal cases are pending against me:
(If there are pending criminal 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)
Table
(a) FIR No. with name
and address of
Police Station
concerned
(b) Case No. with Name
of the Court
(c) Section(s) of
concerned
Acts/Codes involved
(give no. of the
Section, e.g.
Section…….of IPC,
etc.).
(d) Brief description of
offence
(e) Whether charges
have been framed
(mention YES or
NO)
(f) If answer against (e)
above is YES, then
give the date on
which charges were
framed
(g) Whether any
Appeal/Application
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 criminal offence. (Tick this
alternative, if the candidate has not been convicted and write NOT APPLICABLE
against alternative (ii) below)
OR
(ii) I have been convicted for the offences mentioned below:
(If the candidate has been convicted, then tick this alternative and score off alternative
(i) above, and give details in the Table below)
Table
(a) Case No.
(b) Name of the Court
(c) Sections of
Acts/Codes involved
(give no. of the
Section, e.g.
Section……. of IPC,
etc.).
(d) Brief description of
offence for which
convicted
(e) Dates of orders of
conviction
(f) Punishment imposed
(g) Whether any Appeal
has been filed
against conviction
order (Mention YES
or No)
(h) If answer to (g)
above is YES, give
details and present
status of appeal
(6A) I have given full and up-to-date information to my political party about all pending
criminal cases against me and about all cases of conviction as given in paragraphs (5) and
(6).
[ candidates to whom this Item is not applicable should clearly write NOT
APPLICABLE IN VIEW OF ENTRIES IN 5(i) and 6(i), above]
Note:
1. Details should be entered clearly and legibly in BOLD letters.
2. Details to be given separately for each case under different columns against each
item.
3. Details should be given in reverse chronological order, i.e., the latest case to be
mentioned first and backwards in the order of dates for the other cases.
4. Additional sheet may be added if required.
5. Candidate is responsible for supplying all information in compliance of Hon’ble
Supreme Court’s judgment in W. 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: 1. Assets in joint name indicating the extent of joint ownership will also have to be
given.
Note: 2. In case of deposit/Investment, the details including Serial Number, Amount, date of deposit, the scheme, Name of Bank/Institution and Branch are to be given.
Note: 3.Value of Bonds/Share Debentures as per the 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 income and who are dependent on the candidate for their livelihood.
Note: 5. Details including amount is 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.
S. No. Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3
(i) Cash in hand
(ii) Details of deposit in Bank
accounts (FDRs, Term
Deposits and all other
types of deposits
including saving
accounts), Deposits with
Financial Institutions,
Non-Banking Financial
Companies and
Cooperative societies and
the amount in each such
deposit
(iii) Details of investment in
Bonds,
Debentures/Shares and
units in
companies/Mutual Funds
and others and the
amount.
(iv) Details of investment in NSS, Postal Saving, Insurance Policies and investment in any Financial instruments in Post office or Insurance Company and the amount
(v) Personal loans/advance
given to any person or
entity including firm,
company, Trust etc. and
other receivables from
debtors and the amount.
(vi) Motor Vehicles/Aircrafts/ Yachts/Ships (Details of Make, registration number. etc. year of purchase and amount )
(vii) Jewellery, bullion and valuable thing(s) (give details of weight and value)
(viii) Any other assets such as
value of claims/interest
(ix) Gross Total value
B. Details of Immovable assets:
Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated.
Note: 2. Each land or building or apartment should be mentioned separately in this format.
Note: 3. Details should include the interest in or ownership of offshore assets.
S. No Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3
(i) Agricultural Land
Location(s) Survey number(s)
Area (total measurement in acres)
Whether inherited property (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
(ii) Non-Agricultural Land
Location(s) Survey number(s)
Area (total
measurement in sq. ft.)
Whether inherited
property
(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
(iii) Commercial Buildings
(including apartments) -Location(s)
-Survey number(s)
Area (total measurement in sq. ft.)
Built-up Area (total measurement in sq.ft.)
Whether inherited property (Yes or No)
Date of purchase in
case of self - acquired
property
Cost of property (in case of purchase) at the time of purchase
Any Investment on the property by way of development, construction etc.
Approximate current market value
(iv) Residential Buildings (including apartments):
-Location (s)
-Survey number(s)
Area (Total measurement in sq. ft)
Built up Area (Total measurement in sq. ft.)
Whether inherited property (Yes or No)
Date of purchase in case of self – acquired property
Cost of property (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 interest in property)
(vi) Total of current 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 give separate details of name of bank, institution, entity or individual and
amount before each item)
S. No. Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3
(i) Loan or dues to Bank/Financial Institution(s)
Name of Bank or Financial Institution, Amount outstanding, Nature of loan
Loan or dues to any other individuals/ entity other than mentioned above.
Name(s), Amount outstanding, nature of loan
Any other liability
Grand total of liabilities
ii) Government Dues:
Dues to departments dealing with Government accommodation
(A) Has the Deponent been in
occupation of accommodation
provided by the Government at any
time during the last ten years
before the date of notification of
the current election ?
(B) If answer to (A) above is YES, the
following declaration may be
furnished namely:-
(i) The address of the
Government
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 the election is notified or any
date thereafter].
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.
YES/NO
(Pl. tick the
appropriate
alternative)
(iii) Dues to department dealing
with Government transport
(including aircrafts and
helicopters)
(iv) Income Tax dues
Self Spouse HUF Dependent-1 Dependent-2 Dependent-3
(v) GST dues
(vi) Municipal/Property tax
dues
(vii) Any other dues
(viii) Grand total of all Government dues
(ix) Whether any 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………………………………………………
(b) Spouse ………………………………………….
(9A) Details of source(s) of income:
(a) Self ……………………..
(b) Spouse …………………..
(c) Source of income, if any, of dependents,…………………….
(9B) Contracts with appropriate Government and any public company or companies
(a) details of contracts entered by the candidate………….
(b) details of contracts entered into by spouse ……………
(c) details of contracts entered into by dependents …………………….
(d) details of contracts entered into by Hindu Undivided Family or trust in which the
candidate or spouse or dependents have interest …………………………
(e) details of contracts, entered into by Partnership Firms in which candidate or spouse or
dependents are partners …………………………………………….
(f) details of contracts, entered into by private companies in which candidate or spouse or
dependents have share ………………………..
(10) My educational qualification is as under:
…………………………………………………………………………
(Give details of highest School / University education mentioning the full form of the
certificate/ diploma/ degree course, name of the School /College/ University and the year
in which the course was completed.)
PART - B
(11). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A:
1. Name of the candidate Sh./Smt./Kum.
2. Full postal address
3. Number and name of the constituency and State
4. Name of the political party which
set up the candidate (otherwise write „Independent‟)
5. Total number of pending criminal cases
6. Total Number of cases in which convicted
7. PAN of Year for which last Income Tax Return filed
Total Income Shown
(a) Candidate (b) Spouse (c) HUF (d) Dependent
8. Details of Assets and Liabilities (including offshore assets) in Rupees
Description Self Spouse HUF Dependent-I Dependent-II Dependent-III
A. Moveable Assets (Total value)
B. Immovable Assets
Asset
I Purchase Price of self-acquired immovable property
II Development/construction cost of immovable property after purchase (if applicable)
III Approximate Current Market Price -
(a) Self-acquired assets (Total Value)
(b) Inherited assets (Total Value)
9. Liabilities
(i) Government dues (Total)
(ii) Loans from Bank, Financial Institutions
and others (Total)
10. Liabilities that are under dispute
(i) Government dues (Total)
(ii) Loans from Bank, Financial Institutions and others (Total)
11. Highest educational qualification:
(Give details of highest School /University education mentioning the full form of the
certificate/ diploma/ degree course, name of the School /College/ University and the
year in which the course was completed.)
VERIFICATION
I, the deponent, above named, do hereby verify and declare that the contents of this
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 of Part A and B above;
(b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned
in items 7 and 8 of Part A and items 8, 9 and 10 of Part B above.
Verified at………………….…..this the……………………………day
of……………………………….
DEPONENT
Note: 1. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations.
Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First 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 sworn.
(Ministry of Law & Justice Notification No. H11019(4)/2018-Leg.II, dated 10th
October, 2018
and Notification No. H-11019/13/2016-Leg. II, dated 26th
February, 2019)
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