zile ram sharma

ABSTRACT STATEMENT Of ELECTION
EXPENSES
PART -I
II
Nu m bel' and name of Constituency
. '--Name of Stata/Union Territory
, ,.'I·II
IV
.r
.h
IV
~3,~M
r
Nature.of Election
(Please mention.whether
General
EI~tion
to state Assembly f,eok
SabhaJ;'/m,y,e~ election)
Date of declaration of result
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VI
VII
I
I
i VIII
I
Name and Address of the Election
Agent
If candidate
is set up by-a political
party, Please mention the name of the
political party
Whether
the p-arty is a recognised
political party
,
B~·t-SJ~
-
.9.,. M.~~-t
N Ft •
Yes/No
•
Date:
I.J---/o-
Lt
Signature
1~4,
, Place:
PART-II:
i
~C)I
of the Candidate
Name
_.
AB~TRACT OF STATEMENT OF ELECTION EXPENDHURE OF CANDIO r HE
I
rS, ~~-o, I Partic~lars
Am r.
Incurred
/Auth,by
Candidate
/ Election
t
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I Exp.enses
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in public meeting,
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-+~3
~_~+__
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I (3h I
I author
d by
others
(in Rs.)
f
-
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'-6'1i7S I
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443
I Total
iz e
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5
I 6
.--=-----1---·
-
etc ..I.;J:
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authorize
d by PoL
Parry
(in Rs.)
I Arnt.
lncuned
rally, procession
Expenses in public me'eting, rally,
I procession etc. (ie: other than the ones with
I Star Campaigners of the Political party
___ iJEnclose as per Schedule-I)
"
1. b: Expenditure
in public meeting rally,
• t1 processiou
etc. with the Star Campaigner(s)
(ie:
other L1t;;/} those for general party propaganda)
..
; (Enclose as per Schedule-2)
I!
Campaign materials other-than those used in the,'
I public meeting, rally, procession etc, mentioned
I
Incurred/
agenr(in
Rs,)
~_- __-_-_-~i~2
,i J
Amt.
I
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i~Ject;or, CXPC:l,:]i'.'
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:~-~:~--~=~T:::_-~~.~~-~:.-i~--~~--=-
-- --------------------
S.No. I above(EJlclos~.3~~chedule-3)
'7""
I,
,
1,.1Campaign, through print and electronic media
~3VlrO
tncluding cable network,
bulk SMS or Internet
I
i
__
------I...:.-:!lci
Social
media
(Enclose
as
per
Sch~l
- ------------------+--------- i
,
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Expenditure on campaign vehicle(s), used by
;3'iS{,vo,
~
candidate(Enclose
as per schodule-B]
r------ -----Expenses ofcampaign
workers I agents
7616'1
--(Enclose as 2er Schedule -6)
-- -Any
other
c3mpa,ign
~enditllre
I
---j-Grand Total
7"'''1.>7
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PART Ill: ABSTRACT
f----.--:.-I__~~o
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1
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11
--c:-:-__
III
l..-__
OF SOURCE
OF FUNDS RAISED
I
BY CANDIDATE
~
I
!
If-I
!
-
-
-,-
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Particulars
,2
Amount of own fund used for the election campaign
(Enclose as per Schedule - 7)
,
I
,
Lump sum amount received from the party (ies) in cashor cheque etc
+_(l---:E:.:.n.:,:c:.:,:lo,,;;e
as per Schedule -8)
Lump sum amount received from any person/ company! firm,' associauons
persons. etc. as loan" gIft or donation ere.
(Enclose as p'er Schedule -9)
Total
I
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4~tS
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1-1, L-
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"7 .::_
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bOclYJf
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_ _ _
-'4b{,s7 .:":
(ill Rs,
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T:; ---
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Details of Ejections
Funds
of Candidate
and Expenditure
,
-
;li('c{ing, rally. procession
etc. (it!. other
those
than
e of Expenditure
Mm :.ltar C.'lmp.llgrof.r,: •.,I HI.., Polil ic;,1 party]
--,
Total Amount
in Rs,
Source
of expenditure
I\mt. incurred •./
Auth. by Candidate
/ agent
Amt.
incurred /'
by Pol.,
Purty with
Amt. incurred
by others
name
-
1
2
1
Vehicles for tr.mspor
f.
Frprtine
3
Arches & Barricades
4
Flowers/
5
Hiring Loud SpP;Jkf'fS, Microphone,
comparers etc.
6
Posters, hand bills, pamphlets,
hoardings
3
S
4
6
,-,
"
ting visitors
~...
~.
1'1 7
8
9
.
.
St;lep, Pa nri a] 8-. Furniture,
•...•:'1.~n_
t: ,
13
)..CfP>
amplifiers,
Banners,
Projector
-
Cut-outs,
,t,rl.jt:J -
cold drink, juice etc.
display,
display.
-
tickers
47'~
•
n terns
serial
JIi<C
to musicians.
lights,
boards
other
..
etc.
:;:~vd II d"~pU' L. HelicllpLer/
2.5 d
aircraft / vehicles/
(ful self. celebrity UI" any other
other than Star Campaigner)
dldlge~
campaigner
"2
.~..
Expenses on celebrities,
payment
artists rem neration etc.
C"
"
etc.
like tea.Water,
Digital TV -boards
boards. 3D display
h
. .•.
t9cfb -
poles etc.
garlands
Beverages
-
Fixtures,
-
Po .•..e. consumption/
generator
charges
-
SCT1>r>
, Rent for venue
g
Guards & security
15
Boarding & lodging expenses
of self, celebrity. party
functionary or any other campaigner
including Star
charges
Campaigner
16
Ol],t:t'~ expenses
-
.
----_
..-------_.-.-
-
..
Total
ichedule~xpenditure
or general
'
.21,.l,~ ~
2
in public- meeting
rally, procession
ete. with the Star Campaigner(s)
as apportionedtc
than
[ie: other
candidate
those
party propaganda)
:
447
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Dale
Venue
alld
AIIIL'Lllit uf Expenditur e 011 public " =prot essiou
el c. wiLh the Star Call:--_
apportioned
to ~he candidate
(As other general party propaganda)
in Rs.
(~) &
Name of Lite Star Carupaigue:
Name of Party
f.----+-----------I-----------------t-=--"4
2
3
1
v
2
••...
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3
-
4
Total
Schedule-S
Details of expenditure
on campaign
materials, like handbills, pamphlets,
posters, hoardings,
video and audio cassettes,
COs/ OVDs, Loud speakers, arnphfrers, digital TV I board display,
election campaign (ie: other than those covered in Schedule- 1 & 2)
S. No.
Total Amount
Rs.
Nature of Expenses
in
Amt. By
carididate
agent
.
1
1
I-},$.
2
..Ht>Q)l..~
3
.$-h~
.!" '1 tflYD
.
'..24~o
Remarks,
of Expenditure
I
4
3
2
Sources
banners, cut-outs, gates & arches,
3 0 display etc. for candidate's
Amt By Po!.
Party
Amt. By others
5
6
if any
7
.,
-
-
r---~--~~~--~~----r_~--~--~--------_;--------~~----------~------eu;..,~"(f Mq~
4
~~-
Total
Schedule-
.)(.(73 -
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~3.2-S:>;'3t7
).& ltt. 7~ -
4-
r-~------------------------------------------------------------------Details of expenditure
on campaign
media etc. for candidate
throughprint
and electronic
media
including
cable network.
bulk 5 ·15 or inter n et o rso
;;:I
r--.------~--------~----------~------------------_
S. No
Nature
of
.mediurn
(electronic.
print) and
duration
I
Name and address of
media provider (print
lelectronit
Isms I
voice] cable TV, social
media etc.)
Name and address of agency,
reporter.isrringer,
company or
any person to whom charges I
commission etc. paidl payable,
if any
Total Amount
in Rs.
Sourc so
Amt. B candida
agent
Expen
.J-e
Arnt, B:
el
Pol. Part
B
ot. crs
Col. (3) +(4)
1
2
3
5
4
6.
8
7
2
r---·-r·----------~--------------;_-----------------------~-----------~----------~-_
13
r--:-I~ t
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~-- __----------L--~---------l----------.-L
448·
.....
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1
·5
's of expenditure on campaign vehicle (s) and poll expenditure on vehicle(s) for candidate's
S No Regn. No. of
Vehicle &
Type of
Vehicle
Hiring Charges of vehicle
2
1
Rate for
Hiring of
vehicle /
maintenanc
e
Fuel charges
Drivers
(lf not covered charges
under hiring)
.(If not
.•• covered
under
hiring)
3a
3b
iHo.ofDays
(or which
used
3c
Total arnt,
incurred/
auth. in Rs.
Source of Expenditure
Amt. By
candidatej
, agent
5
4
election campaign
6
Aint. By Pal.
A
Party
mt.
By
oth
ers
7
8
17~51JC'-
1
/rlVO
2
3
4
Total
Schedule-
6
~------------------------------------------------------------------------------------i e i f expenditure on Campaign workers / agents
- • 0 ~ are
and
Qty.
t arure of Expenses
1=
1
No. Of workers /
agents
Total amt.
Sources of Expenditure
incurred/ auth.
Amt.By Pol.
In Rs.
Amt, By
Party
candidate/
agent
3c
6
Expenses on Campaign workers
3b
3a
7
------~
..
Amt. By
others
8
9
Campaign workers
1
hunorarrum/
salary
etc.
2
Boarding
p...t~t·
3
Lodging
+
0 •.-.;,'
4
Others
~ry
---
IS (64 -
I----I-------....--.jl-----~~--------I_----+------------t__;~_:_':=__=:::_t_--------'---t_-------:-.-' ...
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~--+_------~~~~~r---"~----+_----_r----------_r------~--t_--~----_t--------.-~---
-
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--
-------l
Total
,
7~16~ ~--.L:..=~-------.:~--~---,------------------------~--.:..::.....:...----......L-------."
.......•.. ~_ .....
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Schedule- 7
EWh~~-ou-n-t-o-f-.o-w-n-f-u-n-d-u-s-e-d-fu-r-t-he--el-e-ct-io-n-c-a-m-p-a-i-g-n-------.-.------.--------
:
I Date
.
I
Cash
I
.
d~~~_;e_he_b~~.
~_I~_.1_10_:_e_tc_.
_W._"h detai
I, of
.~~~
. Total Amo""t
;"
R'JR,m;Ck~
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449
7~ )~6J
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1
2
i----
,
4
3
1
AI
2
5
.-?
,
~-./
-:
3
4
~
Total
-~
Schedule-
8
'Details of Lump sum amount
S.No.
Name of the Political
1
from the party [ies)
re
Date
Party
2
4
3
./'"
2
//
.:
3
r\"
or DD or by Account
Transfer
DDj Cheque no. etc. with
details of drawee bank
Cash
,
1
cash or-cheque
V
Total Amount
Rs.
Remarks,
in
any
6
f
I
7
.\/
-- "----------------
4
Total
Schedule-
----
-----_ _..
-_.
9
-
Details of Lump sum amount
etc.
S.
No.
Name and address
1
2
received
from any person/company
Date
/firmjassociations/body
001 Cheque no.
Cash
etc. with details
of drawee bank
3
5
4
./
of persons
ete. as
--Mention
whether
loan,
gift or donation
etc .
Total Amount
Rs.
6
7
13
,
4
~- -
---
----
-:
I
- --
------,
~-
- ~
I
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5:-
(a) copy of the order containing
list of all vehicles for which permit issued by the RduI "i,,1S Of/kef' to be enclo~~L1.
(b) If the vehicle is owned by the candidate/his
relative/agent
are used for election purpose,
notional
cost l'(!lIJ r' uf
all such vehicles. except one vehicle if owned and used by the candidate, notional
cost 'of fuel and driver'> sal:,!}, fOI
such vehicle, shall be included in total amount of expenditure
in the above table.
450
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Total
Note;
1. In Schedule
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ANNEXURE-IV
35 AA 1 29630
~=.:....!~~F~ID~A~VI~T
Before the D'trict Election Officer
Affidavit
of
Sh.
ISwt'Ms.
.1~8RII.f.U:(District,
~.Ihl; RJt.r:r:! SH.rftR."M.A.~
.$.HftR!':1.~..:Sonlwife/daughter of
:&.b..__J)~B:~.I:tki __1>-J~_II:. .kJt.lll:J.ru..___
.
1.
2.
3.
4.
5.
6.
aged
State/Union Territory)
S/o,
S1:- ..
years, r/o
~
We
HUJ.fU.
hHtj_C.1fB.l}
_
do hereby solemnly and sincerely state and declare as under:-
That I was a contesting candidate at the general electionlbye-election to the House of te people/Legislati
~sembly
of .1:tfH~~.A.-llfL.....................
from .AS$.~.H/)H~.~3 Parliamentary/Assemb
constituency, the result of which was declared on .. J.!Jlt{}.J.~.o.l!i
.
That limy election agent kept a separate and correct account of all e~nditure
incurred! afthqrized by me {
~ me/my election agent in connection with the above between ~'1.9l9-. '1 10 ItJ (J& 1~0 I~ ( th
date on which I was nominated) and the date of declaration ofthe result thereof, both days inclusive,
lPat the said account was maintained in the Register furnished by the Returning Officer for the purpose am
the said Register itself is annexed hereto with the supporting voucherslbills mentioned in said account
111at the account my election expenditure as annexed hereto includes all items of election expenditure
incurred for authorized by me or by my election agent the political party which sponsored me, other
associationslbody of persons and other individuals supporting me, in connection with the election, and
nothing has been concealed or withheld!suppressed there from (other than the expense on travel of leaders
covered by Explanations 1 and 2 un~er section 77(1) of the Representation oftlJe people Act, 1951).
That the Abstract Statement ofEJectJon Expenses annexed as Annexure If to the said account also includes alJ
~~fJCI!d~ture
incurred or authorized by me, my election agent, the ppolit5ical party which spdnsOJ!edme; other
associations/body of persons and other individuals supporting me, in connection wilD IDt' electIOn.
That the statement in the foregoing paragraphs(J) to (.5) are true (0 my knowledge and belief that nothing is
i;lse and nothing matena/ has been concealed.
l
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