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FORM VI
See rule 22
Nomination Paper
tit
is
tilection for the Cantonment Board, KIRKEE to be held on
(To be filled by the Proposer)
I hereby nominate
3
as a candidate for election from Ward No.
election referred to above.
o22--e • ..clts56•( • A
Full name of proposer
2.
at the
1.12Attamiral
Electoral roll •
Number of proposer
1
.
Ward No.
c
Roll No
Part No.
Name of candidate's Father / husbaridMO )19tVA
' (13
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Full postal address of candidate
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Electoral roll No. of candidate.
1;
R0
Ward No
5-
2--Us
Part No.
Date I
2_1) I
lb
(••
Signature of Propos
(To be filled by the Candidate)
I, the above mentioned candidate, hereby declare that to the best of my knowledge and belief
I am eligible for election as a member of the Cantonment Board and assent to this nomination. The
symbols I have chosen are in order of preference.
(Ome ,ra •
ii)
iii)
ru,i
o,(i cce.A-- •
Date :
Signature of Candidate
e-
002
206
Further declaration to be made by a Scheduled Caste or a SchedUled Tribe candidate.
I hereby declare that I am a member of the
*caste/tribe which is a
Scheduled Caste / Tribe of the State of
in relation to
(area) in that State. •
Dated :
Signature of Candidate
To be filled by the Returning Officer
Serial No. of nomination Paper
12
This nomination was delivered to me at my office at
on
tf) 112-11
206
4.49 run •
(hour)
(date) by the *candidate / proposer / election agent
Date 1011 211/1.
—1'1E40
121-1
Officer
Kirke* Contonmot Board
*Strike off one of the alternatives as necessary
004
Price Rs. 300/- per set
KIRKEE CANTONMENT BOARD ELECTION : 2015
Acknowledgment regarding receipt of Sets of Nomination Papers
No.
Ward
Name of candidate -
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Full Address Uf° 't
-
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5Phone No
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From
To
From
No.
Details of Documents
Sr
No.
1
2
3
4
5
6
7
8
Form
Number
NP - 1
NP - 2
NP – 3
Name of Form
Blank Nomination Form
Undertaking:- Caste Validity Certificate
Form of affidavit regarding offences
Form of Power of Attorney for appointment of Election Agent
Appointment of Polling Agent
Extract copy of Cantonment Act & Electoral Rules ( Sec 28,29,30
& Rule 38 )
Notice regarding withdrawal of Candidature
Copy of Form A & B as per Hand Book for RO issued by
Election Commission of India ( Annexure XXIII )
NP - 4
NP - 5
NP - 6
NP - 7
NP - 8
MP-
Sets Documents mentioned above have been received.
Date vo 1122014
Signature & Name of Candidate or
his Representative
Name
\coAsAl -r
c;ortlotik t4
006
NP- 2
UNDERTAKING
(About submission of Caste Validity Certificate)
son /daughter /wife of
Li
Aged
yvNei
ShrWAD1 .
Al
t
(self name)
(Name of Father/husband)
i„--5 -
years resident of
Lrb \
(Address)
d, cA_A
r
I, Shri / Smt.
6-10% Col) i l9c) at
ti? U■SL-• Lit \kb t)3
Hereby undertake as follows :1.
I am submitting my nomination form for contesting the election of Kirkee
Cantonment Board from ward No
2.
As I do not possess the Caste Validity Certificate issued by the Caste
Verification Committee, I am enclosing the true copy of application submitted to
the Committee for verification/ the proof of submission of application. I hereby
undertake to prove and submit the validity of Caste Certificate within four (04)
months from the date my winning the election.
3. I am aware that in case I fail to submit the Caste Validity Certificate within the
stipulated period of four (04) month, I will not be eligible to be a member of the
Cantonment Board.
Place : Kirkee
Date :)--t
I
2__
Signature of Candidate.
008
NP-5
FORM
APPOITMENT OF POLLING AGENT
Election to the Kirkee Cantonment Board
who is a candidate
a candidate / the election agent of
(Name
and
Address)
.
at the above election do hereby (appoint 1),
at /
P u n e 1 as a polling agent to attend polling station No.
rt ' 19 •
place fixed for the poll at
Place \tt_,\
Date
ZA
Lc.
Signature of Candidate/ Election Agent
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I agree to act as such polling agent.
Place
Date
P
e--
I 2...1 20 If •
Signature of Polling Agent
Declaration of Polling agent to be signed before Presiding Officer
I hereby declare that at the above election I will not do anything forbidden by geIest-ion Se c;-i cn-k
128 of the Representative of the People Act, 1951, which 1 have read / has been read over to me
and the provisions of law applicable and which are true being in force.
Date
Signed before me
Date
Signature of Polling Agent
Presiding Officer
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FORM
I
(See Section 28 (2 (iv)
Affidavit to be furnished by the Candidate before the Returning Officer for Election to
Ward No.III in Kirkee Cantonment Board.
1. I, MR. KADIR AHMED KARNALKAR son of MR. MOHAMMED ALI
I KARNALKAR about : 44 years, resident of 401, Old Bazar, Gawali Wada, Kirkee, Pune
411 003 candidate at the above election, do hereby solemnly affirm / state on oath as
111 under:
014
1.
I have not been sentenced of any offence(s) punishable with imprisonment for two
years or for any offence under Chapter — IX A of the Indian Penal Code (45 of
1860) in a pending case(s) in which charge (s) has / have been framed by the
Court(s) of Competent Jurisdiction.
If the deponent is accused of any offence(s) he / she shall furnish the following
information.
i. Caste / First Information Report No : No
--::„- It ii. Police Station(s) No District (s) Pune.
; U 1)
I 0—,
) iii. Section(s) of the concerned Act(s) and short description of the offence(s) for
.e„ 0
i which the candidate has been charged — )4
--.4:',/
iv. Court(s) which framed the charge(s) have been framed :
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v. Date(s) on which the charge(s) : No
vi. Whether all or any of the proceeding(s) have been stayed by any court(s) of
competent Jurisdiction and if so, details thereof : No .
2.
If the deponent is convicted and punished by a Criminal Court for a term
exceeding two years for an offence which is declared by the Central Govt. to be
such as to unfit him / her to become an elector or has been sentenced by a Criminal
Court for any offence under Chapter DC-A of the Indian Penal Code (45 of 1860)
he / she shall furnish the following information :
i. Case / First Information Report No. / Nos.
ii. Court(s) which punished
iii. Police Station(s)
—t--
NRI
-Pc
t,,)
District(s)
State (s)
iv. Section(s) of the concerned Act(s) and short description of the offence(s) for which the
candidate has been sentenced
W Pr
v. Whether the sentence (s) pronounced :
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vi. Whether the sentence(s) has / have been stayed by any Court(s) competent
jurisdiction and if so the details thereof
3.
That I state on oath that I comply with all the qualifications mentioned in Section 28,
29 and 30 of the Cantonments Act 2006 and Rule 38 of Cantonment Electoral Rules, 2007.
016
4.
My Educational Qualification is as under :
a)
All Saints High School — Kirkee Pune — S.S.C. (Maharashtra Board)
VERIFICATION
I, the above named deponent, do hereby verify and declare that the contents of this Affidavit
are true and correct to the best of my knowledge and belief , no part of it is false and nothing
material has been concealed therein.
Verified at Pune on this
ta
day of December 2014.
Signature Of Deponent
•notes. o RoniStered
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BEFORE
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POWER OF ATTORNEY
A Letter of Power of Attorney for Appointment of Election
°Agent for election of Kirkee Cantonment Board, Ward No. Ill
to be submitted to the Returning Officer.
I, MR. KADIR AHMED KARNALKAR son of MR. MOHAMMED ALI
KARNALKAR about : 44 years, resident of 401, Old Bazar, Gawali Wada, Kirkee, Pune
411 003 do hereby appoint Mr. P.K. Salunke, age : 49 years, residing at P.C.D.A. Near
G.P.O., Pune 411 001 as my Election Agent for ensuring General Election of Kirkee
Cantonment Board of Ward No.
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My aforesaid Election Agent will represent me in the said Cantonment Board
Election 2015 and I hereby authorize him to appoint polling agent, to apply for
permission to hold meeting for the said Election, to make application for the same,
to make applications for the said election to the concerned authority as and when
fecessary, to remain present in the election office, to receive necessary application
Non my behalf, to collect letters ; orders from the Returning Officer appointed for
'aid purpose by the Pune Cantonment Board and to make application, to remain
024
present for the meeting organized by the Returning Officer and do all such acts and
things on my behalf as my election agent of Ward No. 5. for the Cantonment Board
Election 2015 and same will be binding on me as if it would have been done by me as
if personally present.
Signed at Pune on this 10 day of December 2014.
Kirkee
Date:0.12.2014
MR. KADIR AHMED KARNAL
Executant
Kirkee
Date: 10) ) 14147,
MR. KADIR AHMED KARNALKAR
Executant
Wed ReOstered
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JAGTRNAYH G. GI UGE
NOTARY
GOVT. OF INDIA
O DEC V114
026
No.7/1/Property/POffice of the Cantonment Board
Pune 411003
Kirkee
2014
Date: I b December
. Tel No. 25817510
To,
Shri. Kadir A. Karnalkar
R/a. 401/5, Gawliwada
Kirkee Pune - 411003,
SUB: CERTIFICATE
Ref: Your application Dt. 10/12/2014.
The requisite Certificate required by you is appended below. The same will not be used
against the Cantonment Board for any Court matter.
CHI
ECUTIVE OFFICER
KIRKEE CANTONMENT BOARD
CHIEF EXECUTIVE OFFICER
q JAM) 'motif
CERTIFICATE
To whomsoever it may concern
This is to certify that after verification of the Property Tax Register maintained by
Cantonment Board, Kirkee, There is no due against the name Shri. Kadir A. Karnalkar R/a.
401/5, Gawliwada , Kirkee Pune - 411003.
This Certificate is issued to the applicant at his bonafied request.
EXECUTIVE OFFICER
KIRKEE CANTONMENT BOARD
CHIEF EXECUTIVE OFRCEN
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