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PART-IV
FORM OF AFFIDAVIT
(1)
(2)
That | /my election agent
kept a separate and
rized by me / my
erecio,
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....'-...-......... (the date
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on whiclrtwas nominatedr
Inated) and lhe date
.l-.-..
ofdeclaration
Don oays
oftlho Bsutt fErcof.
"* ""r.l. ^,"jlll]_5n
inclusive.
p)
That the said account
was maintained in I
PUPoss and the sai,c R*,r,., or.,r,,
uoned In the said
(4)
account.
.nr1u-l,Tisteltumish€d
texed hereto with the
;lifiilffilffi
connection with the
from (other than tie
*.
by the Retumin0 officer
tor ihe
supporting voucl|orri/
bills mon
annexed hereto incrudes
a, items or erec{ion
sleclion agent, the political
party rvhich
l',T:ffii?::: :
sponsored me, other as;;ffi#,]:Jmy
(5)
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and othef individuatt tuppotting
electio;;;;rf,]"":T::ns concealed
tu'
in
or withh.ld/suppr€ssed
hare
expe;;;#l11lT Ten
bv Expranations r erc
2,ndar
R"el{;.r; ;;:;"J;,fi:lfi;covered
:::tly.i.(ll
nal the Abstract Statement
I
of Election_Exp€nses
annexed as AnnexurB ll
to the said accounl
atso includes all expenditure
incuned or autho^"C
;ffiffi',Tfl?:
:lfffi:ociations
/ bodv or
ly,", ,y rfu.tioa,*"r, *,
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(6)
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of my kn.w,edso
Deponent
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Solemnly affrmed / Stvom
bv
of201........,............ Before
me,
.... ..
.. ............ at..
(Si0;6
lureandsealoftheAteso*.."ii,r,irln
oroath commission orNotary pubric)
.
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AFFIDA\17
26AA
3285
BEFORE THE DISTRICT ELECTION OFFICER, NAGAON (ASSAM)
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Affidavit ofsri ArgoorlNta Deka, Wife ofSri Akashdeep Deka,
,.n
.
I, Sri Atrgoorlata Deka, Wife ofSri Akashdeep Deka, Aged 30 years, resident ofvill:
Pub-Bhakatgaon, P.O. Kapahera, p.s. Mikirbheta, Dist. Morigaon (Assam) do hereby
solemnly and sincerely state and declare as under :-
l.
That'I was a contesting candidate at the gpn€{€l-€ls€Cei,S}€-€l€€+iofi.lg [h€
I+€lls€----€{--+€-,"e€et€l Legislative Assembly of Assam from g4
Bata&avaPa+liasentary/Ass€mbly
on l9
'
constituenoy, the result ofwhich was declared
May, 2016.
2. That Vmy election
agent kept an sepamte and co ect acoount ofall expenditure
incurred / authorized by me / my. election agent in connection with the above
election between 22no day of March 2016 to lgth day of May, 2016 (the dats on
which.l was nominated) and the date of declaration of rasult thereof, both day
tncluslve.
3.
P:ii*t',ii'ii
That the said account was maiftained in the R€gister fumished by the hetuming
Officer for the purpose and the said Register itself is annexed thereto with the
supporting vouchers / bills maintained in the said account.
Contd...,2..
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4. That the account ofmy election expenditure as annexed hereto includes all items
ofelection expenditur€ incuned oriuthorized by me or by my election agent, the
political party which sponsored me, other associationsfuody of persons and other
individuals supporting me, in connection with th€ election, and nothing has been
other than the expenses on tmvel
concealed or withheld/suppressed therefiom
under section 77(l) of the
of 'I,€ader' oovered by explanation and
?
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(
2
Representation of the P€ople Aot,195l).
f"'
That the Abstract Statement ofEleotion Expenses ann€xed as Annexure [I 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
ofpersonJand other individuals supporting me, in connection with the election'
That the statements in the foregoing paragaph
knowledge and belief, that nothing
concealed
(l)
ro (5) are true to the b€st
ofmy
is false and nothing material has been
a"*l^L
I
D,,"'
DePonent
Solmnly aftirmed / swoh bt sri Aosoortlrr Dekt
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it
at Nasaon,
ttriJdav orrue
.2016
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ofElections Funds
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