B e·Elections to the TSIC-201~f m waYangal Local Authorities' Constituencyro ~ ISLNo. Date Time R lntia

~b \4s.l~ )._-'P1 lcj~FORM2E(See rule 4)

NOMINATION PAPER

Election to the Legislative Council ofTELANGANA STATEfrom a CouncilConstituency WARANGAL(LOCAL AUTHORITIES)

be fit/ached.

PART I

We hereby nominate as a candidate for election to the Legislative Council of

TELANGANA State from the WARANGAL (LOCAL AUTHORITY) Constituency.

Candidates' name CHELPURI VENKANNA Father's/mother's/husband's name

ILAIAH, His postal address H.No. 5-60/2, MARRIMITTA (V), GUDUR MANDAL,

MAHABUBABAD DISTRICT 506134. His name is entered at S.No. 579 in part No.19

of the electoral roll for (I 02-MAHABUBABAD (ST) Assembly constituency.

We declare that we are electoral's and our name entered in the electoral roll for

WARANGAL (LOCAL AUTHORITY) Constituency as indicated below and we append our

signatures below in token of subscribing to this nomination:

Particulars of the proposers and their signaturesSI.No

Elector Roll No. of Full Name Signature DateProposer

Part No. of S.No. inElectoral that part

Roll1 2 3 4 5 61. 20 165 Chevula Srilatha ~.2. 27 530 Gundeboina Srilatha (11. ,:>"()i LOt~ .3. 16 684 Daramsoth Redya \)6"4. 13 743 Jatoth Gangamma (. f '" 'it;'-if (,~d f.. j-~

I 5. 25 168 Daravtu Mounika O$c8~QDI

6. 154 899 Ambaali Ambotu r<B<WO7. 32 329 Daravath Balaji ,~,~8. 26 346 Islavath Neelamma \6·~vtvj9. 106 530 Nunavath Anitha

~Darshanam Ravi \) 0 f?J*10. 117 380

• There should be tern per cent of the electors of the constituency or ten such electors whicheveris less, as proposers.

I, the above mentioned candidate assent to this nomination and hereby declare­(a) that I am a citizen of India and have not acquired the citizenship of any foreign

State/country.(b) that T have completed 42 Years of age;(c) (i) that I am set up at this election by the INDEPENDENT,

(d) that my name and my father's/mother's/husband's name have been correctly spelt outabove in TELUGU (name of the language);

(e) that to the best of my knowledge and belief, I am qualified and not also disqualifiedfor being chosen to fill the seat in the Legislative Council of TELANGANA STATEfrom WARANGAL (LOCAL AUTHORITY) Constituency.

I also declare that I have not been, and shall not be nominated as a candidate at the presentgeneral election/the bye-elections being held simultaneously, to the Legislative Council ofTELANGANA STATE from more than two Council constituencies in the state.

~~J13 0::;Q_Date 14-05-2019* Score out the words not applicable

Signature of Candidate

PART II(To be filled by the candidate)

(1) Whether the cand idate­(i) has been convicted-

(a) of any offence(s) under sub-section (1); or(b) for contravention of any law specified in sub-section (2),

of section 8 of the Representation of the People Act, 1951 (43 of 1951); or Yes/No -NO-(ii) has been convicted for any other offence(s) for which he has been

sentenced to imprisonment for two years or more.

If the answer is "Yes", the candidate shall furnish the followinginformation:(i) Case/first information report No./Nos ...(ii) Police station(s) .District(s) ...... NOT APPLICABLE State(s) .......

NOT APPLICABLENOT APPLICABLENOT APPLICABLE.

(iii) Section(s) of the concerned Act(s) and brief description of the offence(s) for which hehas been convicted........ NOT APPLICABLE ....(iv)Date(s) of conviction(s) ...... NOT APPLICABLE(v) Court(s) which convicted the candidate NOT APPLICABLE(vi)Punishment(s) imposed [indicate period ofimprisonment(s) and/or quantum of

fine(s))......... NOT APPLICABLE(vii) Date(s) of release from prison NOT APPLICABLE(viii)Was/were any appeal(s)/revision(s) filed against above conviction(s) ....

Yes/No. --NO--(ix) Date and particulars of appeal(s)/application(s) for revision filed ......

NOT APPLICABLE(x) Name of the court(s) before which the appeal(s)/application(s) for revision filed .........

NOT APPLICABLE(xi) Whether the said appeal(s)/application(s) for revision has/have been disposed of or

is/are pending... NO(xii) If the said appeal(s)/application(s) for revision has/have been disposed of-

(a) Date(s) of disposal NOT APPLICABLE(b) Nature of order(s) passed NOT APPLICABLE

(2) Whether the candidate is holding any office of profit under the Government of India or StateGovernment? ......... (Yes/No) -NO--If Yes, details of the office held

(3) Whether the candidate has been declared insolvent by any Court? (Yes/No) -NO­-If Yes, has he been discharged from insolvency

(4) Whether the candidate is under allegiance or adherence to any foreigncountry? ......... (yes/No) -NO-

-If Yes, give details(5) Whether the candidate has been disqualified under section 8A of the said Act by an order

of the President? (Yes/No) -NO-

~~.J]- 2DYrr_

-If Yes, the period for which disqualified(6) Whether the candidate was dismissed for corruption or for disloyalty while holding

office under the Government of India or the Government of any State? (Yes/No) -NO­-If Yes, the date of such dismissal

(7) Whether the candidate has any subsisting contract(s) with the Government either inindividual capacity or by trust or partnership in which the candidate has a share for supply

of any goods to that Government or for execution of works undertaken by that Government?(YeslNo) -NO--If Yes, with which Government and details of subsisting contract(s)

(8) Whether the candidate is a managing agent, or manager or Secretary of any company orCorporation (other than a cooperative society) in the capital of which the CentralGovernment or State Government has not less than twenty-five percent share? .(Yes/no) -NO--If Yes, with which Government and the details thereof

(9) Whether the candidate has been disqualified by the Commission under section lOA of thesaid Act. (Yes/No) -NO--If yes, the date of disqualification.--

Place: MAHABUBABADDate: 14-05-2019

Signature of Candidate

PART III(To be filled by the ReturningOfficer)

S 'IN f .. )..-~ena 0.0 nomination paper .This nomination was j.el-ivered to me at my office at?'-'.:!.4.f.1:-Xhour)

on 05-20l9 (date) by the *candidate/proposer.(nameofproposer.~.~ ...................... .....)

Date 14-05-2019

PART IVDecision of Returning Officer Accepting or Rejecting the Nomination Paper

I have examined this nomination paper in accordance with section 36 of theRepresentationof the PeopleAct, 1951(43of 1951)and decide as follows:-

Date 14-05-2019. ReturningOfficer................................................ (Perforation) .

PARTVReceipt for Nomination Paper and Notice of Scrutiny

(To be handed over to the person presenting the Nomination Paper)Serial No. of nomination paper.. .

The nomination paper of CHEPURI VENKANNA a candidate for

election to the Legislative Council of TELANGANA STATE from the WARANGAL

(LOCAL AUTHORITY) constituency was delivered to me at my office at. (hour)

on 14-05-2019 (date) by the *candidate/proposer . All nomination

papers will be taken up for scrutiny at.. (hour) on

(Place).

-05-2019 (date) at

Date: 14-05-2019 Returning Officer

*Score out the word not applicable.

'1'

fTO~ a(1:MII.... TELANGANAl'L'iqi)l'Q'{\ ..tJ"~ _. 1'", ..... ,1 ,.~j..,J·.J;t;iI~ ~~.m '.:,INL-- t

• " "'. CJ 2. .0 . /Q. r r: ~.y.~ ":)v e,_..~ . ' ..~""'"~-'''~'~'~):'~J ~ (,j.J U ""''/) / v C-

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~~k-r , " .... .: :" ... <.",",:-.'1,;nah,~t;.c~ ~:...::~:::4:i~1i)'I

i

(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 CHELPURI VENKANNA enrolled in I02-MAHABUBABAD

(ST) LAC, IN TELANGANA STATE (Name of the Constituency and the

state), at Serial No.579 in Part No. 19.

(3) My contact telephone number(s) is/are ... 9948880942 and my email id

(if any) is and my social media account(s)

(if any) is/are NIL

(4) (i) Facebook : NIL

(ii) twitter : NIL

(iii) NILDetails of Permanent Account Number (PAN) and status of filing oflncome tax return:

Sl. Names PAN The financial yeaiTotal mcome shown in~o. for Income Tax Return(inwhich the last Rupees) for the last fiveIncome- tax return Financial Years completed

has been filed (as on 31 st March)

2017-18 NIL

2016-17 NIL1 CHELPURIVENKANNA NO PAN 2015-16 NIL(SELF) ALLOTTED

2014-15 NIL2013-14 NIL2017-18 NIL

2016-17 NIL2 CHELPURIHEMALATHA NO PAN 2015-16 NIL(SPOUSE) ALLOTTED

2014-15 NIL2013-14 NIL

(i) NIL

jHUF (If the Candidate is ii) NIL3 jKartaiCoparcener NIL NIL (iii) NIL(iv) NILv) NIL(i) NIL(ii) NIL

_-~"4., ~:.:>~ DEPENDANT 1 NIL NIL (iii) NIL,/,~()I~~\~ (iv) NIL2fP-FR'~\ (v) NIL --

~~.1·1t1p()OqiX(II/~f.' ~~ENDANT 2 NIL NIL (i) NIL rrrT~'£:' ~,rr!"l\. ... i}~~ P"'w., 'tY ,),_'I.& ' i'l

~ '&:xlff:JOd-!2- T.~S,' '..;/\:_." <:i{/.,'h~ "II)( 'Ii' ".11{!: /1• Ilcy (~ I.'J. . l'f-'

TE & NM.A., us,

ADVOCA OTARYKESAMUDRAM,

{i)ist.war~:\Qal, (Te.langana)

I~

.._'

(ii) NIL(iii) NIL,(iv) NIL(v) NIL(i) NIL(ii) NIL

6 Dependant-3 NIL NIL (iii) NIL{IV) NIL

IfV_} NILNote: It is mandatory for PAN holder to mention PAN and in case of no PAN, it

should be clearly stated "No PAN allotted".

(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: NOT APPLICABLE

(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 PoliceS tat ion NILconcerned

(b) Case No. with Name of the Court NIL

(c) Section(s)of concerned Acts/Codes involved (give no. of NILthe Section, e.g. Section of IPC, etc.).

(d) Brief description of offence NIL

(e) Whether charges have been framed (mention YES or NONO)

(f) If answer against (e) above is YES, then give the date NOon which charges were framed

(g) Whether any Appeal/Application for revision has beenNOfiled against the proceedings (Mention YES or NO)

3

:~,K _ Sl~.r'/1u D~!;-\ i,ll,

Dist. Warai~J2!, (Telanqana)

~(5) Cases of conviction : NOT APPLICABLE

(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 APPLICABLEagainst alternative (ii) below)

OR

(n) I have been convicted for the offences mentioned below: NOT APPLICABLE

(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. NOT APPLICABLE

(b) Name of the Court NOT APPLICABLE(c) Sections of Acts/Codes involved (give no. of the NOT APPLICABLE

Section, e.g. Section ....... of IPC, etc.),(d) Brief description of offence for which convicted NOT APPLICABLE(e) Dates of orders of conviction NOT APPLICABLE(I) Punishment imposed NOT APPLICABLE(g) Whether any Appeal has been filed against NOT APPLICABLE

conviction order (Mention YES OR NO)

(h) If answer to (g) above is YES, give details and NOT APPLICABLEpresent status of appeal

(6A) I have given full and up-to-date information to my political party about all pendingcriminal 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 NOTAPPLICABLE 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.,~U ,;";';f'il~~Additional sheet may be added if required./.;:.,"r 5. ~~~didate is responsible f~r suppl)'l~g all information in c~mpliance Of.I! '.... v.1hVtVA.~ l.;2.;~'bleSupreme Court's Judgment IIIW. P (C) No. 536 of 2011. «''T' ..~".;'r;'::',£:'Y'I '( * ~idVO'o, . M.A.. I' aU, l ii " A. ';. ,_;;._I: I ..:,.n, .:',.<~'- " j il ::;:3 2Dn $;S;-;a..--<;__ -

~ ~ 'e;;,~,,;",!;Y '*;/ 15.=5) T. S.. NIVA 5, M.A., u.a,. ~.J'4'l::--;~V ADVOCATE & NOTARY

~~_Q~~ . KESAMUDRAM,Ol;;t.Waranga!; (Te!anqana)

(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 begiven.

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 begiven.

Note: 3.Value of Bonds/Share Debentures as per the current market value in StockExchange in respect of listed companies and as per books in case of non-listedcompanies should be given.

Note: 4. 'Dependent' means parents, sorus), daughter(s) of the candidate or spouse andany other person related to the candidate whether by blood or marriage, whohave no separate means of income and who are dependent on the candidate fortheir livelihood.

Note: 5. Details including amount is to be given separately in respect of eachinvestment

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 otherbody or institution abroad, and details of all assets and liabilities inforeign countries';

S. Description Self Spouse HUFDepen Depen DepenNo. dent-l dent-2 t-3

(i) Cash in hand Rs.15,OOO/- Rs.lO,OOO/- [NIL NIL NILNIL

(ii) Details of deposit in I.Account l.A/c.No.O 163 101000Bank accounts No.73030221342 27217 A.B. Gudur

(FDRs, Term APGVB Gudur Branch Rs.2,726/-Rs.I,009/-

Deposits and allother types of 2.A/c.No.0 16310 1000

deposits including 38152 A.B. GudurRs.5,908/- NIL NIL NIL NILsaving accounts),

Deposits withFinancialInstitutions, Non-Banking FinancialCompanies

T. SRINIVAS, M.A., LUJ.,ADVOCATE & NOTARY

KESAM UDRArvI,

-(iii) Details of

investment in; Bonds,

Debentures/Shares NIL NIL NIL NIL NIL NILand units IIIcompanies/MutualFunds and othersand the amount.

(iv) Details ofinvestment in NSS,Postal Saving,Insurance Policies

NIL NILand investment InNIL NIL NIL NILany Financial

instruments in Postoffice or InsuranceCompany and theamount -(v) Personalloans/advance givento any person orentity includingfirm, company, Nil Nil NIL NIL NIL NILTrust etc. and otherreceivables fromdebtors and theamount.

(vi) MotorVehicles/ Aircrafts/Yachts/Ships

NIL(Details of Make,NIL NIL NIL NILregistration number. NIL

etc. year ofpurchase andamountl

(vii) Jewellery, bullion 2 Tulas ornamentsand valuable Rs.70,OOOI-thing(s) (give NIL NIL NIL NIL NILdetails of weightand valuti

(viii) Any other assets suchas value of Nil Nil NIL NIL NIL NILclaims/interest

(ix) Gross Total value Rs.21,917/- Rs.82,726/-NIL NIL NIL NIL

6

T. RINIVAS, M.A., LLB.,ADVOCATE & NOTARY

KESAM~;DRAM.Dist. War<:ng;:,i, (T,,;z:lgana)

B. Details of Immovable assets:

Note: 1. Properties in joint ownership indicating the extent of joint ownership will alsohave 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. Description Self Spouse HUF Depen Depend DependNo dent-t ent-2 ent-3

(i) Agricultural Law! NIL NIL

Location( s) NIL NIL NIL NILSurveynumber(s)Area (total NIL NILmeasurement in NIL NIL NIL NILacres)Whether inherited NIL NILproperty NIL NIL NIL NIL(Yes or No)

Date of purchase in NIL NIL

case of self - NIL NIL NIL NILacquired propertyCost of Land (in NIL NILcase of purchase)

NIL NIL NIL NILat the time ofpurchaseAny Investment on No Nilthe land by way of

NIL NIL NIL NILdevelopment,construction etc.Approximate Current NIL NILmarket value NIL NIL NIL NIL

(ii) Non-A2Ticultural Land NIL NIL

Location(s)NIL NIL NIL NILSurvey

number(s)

Area (total NILmeasurement in sq. ft.) NIL NIL NIL NIL

Whether inherited NIL No

property NIL NIL NIL NIL-,. (Yes or No)

4~

~WiChasein NIL NIL

V ca 0 If- 7 NIL NIL NIL NILSf? IAI~cqui ,.)', operty ...., ,nn.,.-'''''.''·~.FtI0 \",-a<n .t".1.J it LJ..J::---~*' 'Adl'o MA.·I J "', I '. ~ ~ 53c§~-----Clile & ,,;.~-JJ.. t I; - ~Tela.. """" f! ,,/ I T. S'RINIVAS, M.A., l'. 11~'dna; '.('-'. .11 * I l.B.•

ADVOCATE s: NOTARY

Cost of Land (in NIL NIL rcase of purchase)NIL NIL NIL NILat the time of

purchaseAny Investment on Nil Nilthe land by way ofdevelopment, NIL NIL NIL NILconstructionetc.Approximate NIL NILcurrent market NIL NIL NIL NILvalue

(iii) Commercial Nil NilBuildinz:;s

(includingNIL NIL NIL NILapartments)

-Location(s)-Survey number(s)Area (total Nil Nilmeasurement in sq. NIL NIL NIL NILft.)Built-up Area Nil Nil(total

NIL NIL NIL NILmeasurement insq. ft.)Whether inherited Nil Nilproperty

NIL NIL NIL NIL(Yes or No)

Date of purchase in Nil Nilcase of self - NIL NIL NIL NILacquired propertyCost of property (in Nil Nilcase of purchase) at

NIL NIL NIL NiLthe time ofpurchaseAny Investment on Nil Nilthe property by wayof development, NIL NIL NIL NILconstructi 0netc.Approximate Nil Nilcurrent market NIL NIL NIL NILvalue

(iv) Residential I) House No.,5-60/2 situated at NILBuildinz:;s Marrimitta village, Gudur Mandai,

Mahabubabad district.(includingNIL NIL NILapartments) : NIL

~

~--..::: _~-Location(s)A ~:a~ey number(s)

~~

~~otal measuring 1350 Sq.fts, 8 NIL

S me e-,\ ent in sq. NIL NIL NIL NILRIN aftl,r\ \ ?"" ~', I:Arr' ·rrJ:.?p~-~':;n_"~ ) ... J _:-~. \':

i/, At" ' I it·0,.,.... • - - I J., i I: ~~2b:J5)___ ~ .....l.-dt' \ 1~,\·.~.:.lrlTelaI \;,:,!~~:~:.'P. .I.~ X • d T. S1fINIVAS, M.A., Ll.B..~.-.'I

ADVOCATE & NOTARYKESArA UDRAfiI,

Built up Area (Total 800 S.Ft ~HLmeasurement in sq. NIL NIL NIL NIL

, ft.)Whether inherited Yes Noproperty NIL NIL NIL NIL(Yes or No)

Date of purchase in NO NILcase of self - NIL NIL NIL NILacquired propertyCost of property (in ~IL NILcase of purchase) at

NIL NiL NILthe time of NILpurchaseAny Investment on Rs.l,OO,OOOI- Nilthe land by way ofdevelopment, NIL NIL NfL NILconstructionetc.Approximate Rs.4,50,OOO1- NILcurrent market NIL NIL NIL NILvalue

(v) Others (such as ~il Nilinterest in NIL NIL NIL NILproperty)

(vi) Total of current Rs.4,50,OOOI- NILmarket value of (i) to NIL NIL NIL NIL(v) above

It 91J(

\

..~(\\

(4) I give herein below the details ofliabilities!dues to public financial institutions andgovernment: -

(Note: Please give separate details of name of bank, institution, entity or individualand amount before each item)

S. Description Self Spouse HUF Dependent-l Depend Dependent-3No. ent-2(i) Loan or dues to

Bank/FinancialInstitution(s)

Name of Bank or NILFinancial Institution, NIL NIL NIL NIL NILAmount outstanding,Nature ofloan

Loan or dues to anyother individuals! entityother than mentionedabove.

Name(s), Amount NIL NIL NIL NIL NIL NILoutstanding, nature ofloan

Any other liability NO NIL NIL NIL NIL NIL

Grand total of liabilities NIL NIL NIL NIL NIL NIL

10

E S'""'ED't"ATT 1

~T. SRINiVAS, M.A., U.S..ADVOCATE & NOTARY

KESAivlUDRAM,• . c-r- , )D'St. \Naranq.:::!, \ {!2iangana

ii) r Government Dues:

Dues to departmentsdealing withGovernmentaccommodation

(iii)Dues to department dealingwith Government transport(including aircrafts andhelicopters)

(A)Has the Deponent been in occupation ofaccommodation provided by the Government atany time during the last ten years before the dateof notification of the current election?

(B) If answer to (A) above is YES, the followingdeclaration may be furnished namely:-

(i) The address of the Governmentaccommodation:

(ii) There is no dues payable in respect ofabove 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 thethird month prior to the month in whichthe election IS notified or any datethereafter].

Note- 'No Dues Certificate' from theagencies concerned in respect of rent,electricity charges, water charges andtelephone charges for the aboveGovernment accommodation should besubmitted.

Self

NIL NIL NIL

NO

Dependent-3

NIL

NIL NIL NILl NIL

(iv) Income Tax dues(v) GST dues

Spouse HUF Dependent-l Dependent-2

NIL NIL NIL NIL NIL

NIL

NIL

~--+-----------+----+I-----+----+--'-----+----------f----'---­(vii) ., "..Any other duesI ~~~~\ I-~.i·,,·. , )~(r1 ""'''\ Ii_.~".

(vi) Municipal/Property taxdues

allNIL NIL

~l>'NILr1'f.srt ~L

"1\'\,,, .~~-"-StlIN!I"u", ~s , ;i:~. i 'Ii f'i.~, M.A., Ll.B.,ADVOCATE s. NOTARY

KESAM UDRAM.Dist.Warangal. (Teiangana)

NIL NIL NIL NIL NIL

NIL NIL NIL NIL NIL

NIL NIL NIL NIL NIL

NIL

NIL

---------------_. __

. Whether any other(ix) liabilities.are in dispute, if

'so, mention the amountNIL NIL NILinvolved and the authority NIL NIL NIL

before which it is pending.

(5) Details of profession or occupation:

(a) Self

(b) Spouse

: AGRICULTURE

: AGRICULTURE COOLIE

(9A) Details ofsource(s) of income:(a) Self : AGRICULTURE

: AGRICULTURE COOLIE(b) Spouse

(C)Source of income, if any, of dependents: NO

(9B) Contracts with appropriate Government and any public company or companies

(a) details of contracts entered by the candidate- NIL.

(b) details of contracts entered into by spouse- NIL

(c) details of contracts entered into by dependents- NIL.

(d) details of contracts entered into by Hindu Undivided Family or trust in which thecandidate or spouse or dependents have interest- NIL

(e) details of contracts, entered into by Partnership Firms in which candidate orspouse or dependents are partners - NIL.

(f) details of contracts, entered into by private companies in which candidate orspouse or dependents have share- NIL.

(6) My educational qualification is as under:

VII class, U.P.S Hanamkonada 1992(Give details of highest School! University education mentioning the full form of thecertificate! diploma! degree course, name of the School !College/ University and theyear in which the course was completed.)

i~~o-r~~.I~ ~/r e /1 0~ '-d'~!~I,;'~:r~~'~,w • Ir),)y,.' 1" ~}f P\\ "'f...... I,. (_flJa .._ ,._ 1/\\ ',..{\ "Oiq' 1Il r.\\'< (I , /''~~n . 'i\ /""."""•4i'lJ 1)'P ~\}1 .--;/

~~::-:,:~~,~?~.~;:?

12

T. SRINIVAS, M.A., Ll.S ..ADVOCATE 8, NOTARY

KESAMUDRAM.D' --, .'\I' ~I (T • )1:.1..Ii <3, anqa s \ ,elcmgana

I

PART-B

(11). ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A:

l. Name of the candidate Shri .CHELPURI VENKANNA

2. Full postal address H.No. 5-60/2, MARRIMITTA (V), GUDURMANDAL, MAHABUBABAl) DISTRICT506134

3. Number and name of the 102-MAHABUBABAD (ST) LAC, TELANGANAconstituency and State STATE, AT SERIAL No.579 PART No: 19

4. Name of the political party which set INDEPENDENTup the candidate (otherwise write'Independent' )

5. Total number of pending criminal cases NIL

6. Total Number of cases in which NILconvicted

7. PAN of Year for which last Total Income ShownIncome Tax Returnfiled

(a) Candidate PAN NOT NIL NILiALLOTTED

(b) Spouse PAN NOT NIL NILALLOTTED

(C)HUF NIL NIL NIL(d) Dependent 1 NIL NIL NIL(e) Dependent 2 NIL NIL NIL

8. Details of Assets and Liabilities (including offshore assets) in rupees

Description Self Spouse IHUF Dependent-l Dependent-2 Dependent-3

A. Moveable Rs.21,917/- Rs.12,726Assets (Total NIL NIL NIL NILvalue)

B. ImmovableNIL NILAssets NIL NIL

I Purchase Price INIL INILof self-acquiredimmovable NIL NIL NIL NILproperty

II Development!const ructioncost of

~~

~ §able NIL NIL NIL NIL NIL NIL[11 ~ after

~~~lf 13l'~) nA"-"'~"'1<' :£;;1 1tl''j)'O

1.. ~\, .t... , ... ..,I..._,. ~.·.;irt/lV/VA \""" \j ~ ..-. S 1"'''';;

~~~ 210202-Af!I'OC8.t M.,q. LL.!3 ' 'Ii -- ,-7 .fJ{: 'I, " # ':' S ~, l!1N IVA~ Ii! A lelctn " " (·1'A f( y. j it Q - A ~ l' ijI _ .':} i .".,·gal) ._ ~ Ij" IfJdi' d, " i ADVOCATE 8! NOTA·'l.l.~t~~, Id, I;

l.B..RY

KESAMUDRAM,Dist.Warangai, (Telangana)

---------------------------------- - - - -------------------------------------------

III ApproximateCurrentMarket

. Price

(a) Self-acquired

INfLassets NIL NIL NIL NIL(Total NIL

Value)

(b) Inheritedassets RsA,50,OOOI·(TotalValue)

9. Liabilities(i) Government

dues (Total) NIL NIL NIL NIL NIL NIL

(ii) Loans fromBank,FinancialInstitutionsand NIL NIL NIL NIL NIL NIL

others (Total)10. Liabilities that are under dispute

(i) Governmentdues (Total) NIL NIL NIL NIL NIL NIL

(ii) Loans fromBank,FinancialInstitutions and NIL NIL NIL NIL NIL NILothers (Total)

11. Highest educational qualification:

VII class, V.P.S Hanamkonada 1992

(Give details of highest School /University education mentioning the full form of thecertificate/ diploma! degree course, name of the School /College/ University and the year inwhich the course was completed.)

~A;T:~t'I.............L '

T s~;n"':.n\:r?, -: ~ JI It {>t. Ii' ~ • .r.. ~ ... ~ J\ r;__.~i!' ..H~i L .0.,

ADVOCATE 8: NOTARYKESAfv1 uo RAM.

Dirt. Warangal, (Telanqana)14

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents ofthis affidavit are true and correct to the best of my knowledge and belief and no partof it is false and nothing material has been concealed there from. I further declarethat:-

(a) there is no case of conviction or pending case against me other than thosementioned 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 thosementioned in items 7 and 8 of Part A and items 8, 9 and 10 of Part B above.

( 14th) Day of May, 2019.

DEPONENT

Note: l.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 ofthe First Class or before a Notary Public.

Note: 3. All columns should be filled up and no column to be left blank. If thereis no information to furnish in respect of any item, either "Nil" or "Notapplicable", 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 theAffidavit should bear on each page the stamp of the Notary or Oath

r • ~commiSSioner or Magistrate before whom the J\ ffidav it is sworn.

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