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甫fi節鵞 器 R誡 憲蹴踏蕊ⅢI

PART_A

I滋iドi節難恐11灘1器靭

A237266Denorn,nqtron rOo

:観げ・nd° F

Form 26(See rul(.4.{)

I Afiidavit to be fited by the candidare alongwirL nomination paper bcfir

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ANCANA STATE at Scial No

My conta.t telephone nurnber(s) is 099667.r32g3,‐man id(ifany)is sllabbirshelk/2 yahoO.cO in

ili,:.I1:1li-r:",,*,. 1irrr"1i.. .r,"uti"r rheik(facebook)

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Rs.100

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卜Ｌ,●●●r ann∝ accuscd Or any oftcncく

9 pu面 shaЫc wiぬ imprlsOnmemおr"0元議 。rmOrc ln a pcnding casc(s)in which a chargc(s)has/havc bccn fralncd by thc cOurt(s)of

compctcntju● sdictiOn

Il'the deponenl is accused ofany such offence(s) he shalr fumish the followiDg inrbrmationi(i) The following case(s) is / ar

,t",,,"0 or,n""""ii'rJ.' '@ pending-a8ainsl me in which charges have beenmore:_ ence punishable with imprisonment fo-r two years or

(a)

NoT APPLIcABLE(b)

(C)

υl ArrLICABLE

pt,,iearron(s) lor revi ′:ず

'' g tt ordcrrsl ~…Y‐・′` 1｀ υ:APPLICABLE

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ヽPAヽ The financial ycar

for which the lastlncomc-Tax return

has becn filed

Total in(omeshorvn in hcome-tax return (in ')

１

５

二３

一４

壁L型■畳聾些望亜R BZJPS5120A 2014-15],52,860′‐

COCPMo901G 2014‐ 15 '2,86,1s0/-ヽIL NIL NILNIL

(5)1_a ,1`ヽ : ‐ 1

NIL NIL

菫換|

NOT APPL-ABLE-

NOT APPLICAB'E

ど1lil :卜 晟弄NoT APP,.AE.E騒=

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NOT APPLIcABLE

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lf the dcponent is convicted and punished as afbresaid, he shrll fumish the lbllowinginfi)nlrati(nr:

In the lbllowing cases, I have been convicted and sentenced to imprisonment by a court law:

(a) The detdils of cases section(s) of the Ac(s) and

dcscription ofthe offence(s) for which convicted NOT APPLICABLE(b) Name of the Court(s), Case No. and date(s) of

order(s): NOT APPLICABLE(C) Purishnrcnt irnposcd

NOT APPLICABLE(d) Whether any appeal was,4Es been filed against the

conviction order. lf so, details and the present

status ol the appeal:

NOT APPLiCABLE

(1) That I give herein below the details of the assets (movable and immovable etc',) ofmyself, my spouse and all dependents:

A. Details of movable rssets

Note: l. Assets in joint name indicating the extent ofjoint ownership will also have to be

given.

Note: 2. In case of deposit/lnvestment, the details including Serial Number' Amount, date of

dcposit. thc Schemc, Name ofthe Bank/lnstitution and Branch are to be given'

Note: J. Value ol Bonds/Share Debentu.es as per cun:ent market value in Stock exchange in

respcct of listcd companies and as per books in case of non-listed companies should be given'

Note: 4. Dependent here has the same meaning as assigned in Explanation (v) ulder section

75A of the Representation of the People Act, l95l .

Note: 5. Details including amourlt is to be given separatcly in respect ofeach investment'

争

SI No Dc!icription Sclf Spousc D-1 D-2 D-3

(1)( ush in IIand 10,000 15000

(H) Details ofdeposit in Bankaccounts (FDRS, TermDeposits and all othertlpes of dcposits iocludingsaving accounts), Depositsrvith Financial lnstitutions,Non-Banking FinancialCompanies and Co-operative societies and theamount in each suchdeposit

371‐

AXIS Ballk,

DILSUKHNACAR,SB A/c No235010100141536

13,221′‐

iCiC:Bank,Vanasthalipuram,SB AINo030401520638

NlL NIL ヽIL

そ ils ofinvestmenl in N:L Nll. NIL N:L ヽlL

リ

Bonds- debentures/sharesand units iI]companies/Mulual fundsaid othcrs and the amount(EOUITY SHARES)

SELF SPOUSE

(iV) Details of investmentin NSS. PostalSaving, lnsumncePolicies andinvestment in anyFinancial Instrumentsin Post otlice orlnsurunce Companyand the amount

｀49,000

1CICI Prudential

insurance policies,

Prcmium paid

99,000′‐

PunJab Mctlife

lnsurance prcmumoald

NIL NIL NIL NIL

(V) PersonalLoans/advance gvento any person orentity including firm,company, Trust etc.,and other receivablesfrom debtors and theamount.

ヽIL NIL NIL NIL NIL

(Vi) Motor Vehicles /Aircratis / Yachts /Ships (Details ofMake, Registrationnun'rber etc., year ofpurchasc and amount)

｀30,000

Passlon Pro

AP 29BC 1426

o● 10-2009

NIL NIL N:L NIL

(ヽ il) Jcwellery. bullion and

valuable thing(s)(give details ofweight and value)

｀90,000

35Cram ― COldornaments

NIL NIL ヽlL ヽlL

(Viii) Any other assets such

as value of claims /Interest

N:L lヽl´ N11´ NIL Nll.

(lX) Cross Total Value 2,78,800 28.221′‐ NIl. lヽL ヽ ‖

B. DETAILS OF IMMOVABLE ASSETS:

Note: l. Propertics in joint ownership indicating the extent ofjoint ownership will also have

to bc itdicatcd.

^_ote: 2. Each land or buildin8 or apartment should be mcntioned scParately in this format'

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Dcscription Sell Spousc D-1 D-2 D-3Aericultural LandLocation(s)

Survev nurnber(s)

N:L NIL NIL NIL NlL

Area (Totalmeaswemenl inacres)

NIL N‖ NIL NIL NIL

Whether inheritcdDroDertv (Yes or No)

N0 NO NIL NIL ヽlL

Date ofpurchase, irlcase ofselfacquiredDTODENY

NIL NIL NIL NIL NIL

Cost of Land (in case

ofpurchase) at thetime of puchase NIL NII

NIL NIL NIL

Alry investment onthe land, by way oldcvelopment.corlstrucliorl etc..

N:L NII NIL NIL NIL

Approximate CunentMarket Value ヽ:L Nll′

NIL IヽL NIL

N on-A e.iculturalLandLocation(s)

Survey numbe(s)

Plot N9.26,AbdullnpurVillagc, HayathNagar Mandal,Rangar€ddyDistrict, SurveyNo. l0i, to8 and109

NIL ヽ:L ヽ1し ヽ11

Arca(TOtal

mcasurcmcnt ln

so n、

201 Sq.lds

NIL

NIL lヽl NIL

whether inheritednrooertv (Yes or No)

Noヽo

ヽlL ヽlL ヽlL

Datc of purchasc, incase of sclf acquiredDroDerlv

2:‐ 06‐2010

ヽIl

NIL NIL NIL

Cost ofLand (in case

ofpurchase) at thetime ofpurchase

1,61,000′‐

NIL

NII. N:l′ Nll.

Any investment onthe land, by way ofdevelopment,construction etc.,

NIL NIL NIL NIL NIL

Approximate CurrentMrrkct Valuc

1,90,000′― NIL NIl´ Nll´

蜃 N:x149,NIL Nll. NIl′ ヽIL

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5

Location(s)

Survey number(s)

Village, NalgondaMandal andDistrictSurvey No, 3,15

and 346Arca(TOtal

mcasurcrncnt in

Sq lt) 166 66 sq、 ds NIL

N:L NIL NIL

Whether inheritedDroDertv (Ycs or No) N0 ヽo

NIL NIL NIL

Date ofpurchase, incase ofselfacquiredoroocrtv 27‐ 05‐ 2009 N‖´

NIL NIL NIL

Cost of Land (in case

ofpurchase) at thetime of purchase 70,500/‐ NH

NIL NIL NIL

Any investment onthe land, by way ofdevelopment,conshuction ctc., ヽ:L ヽ:L

NIL NIL NIL

Approximate CurrentMarket Value 90.0007-

NIL NIL NIL

CommercialBuildines(includingapariments)-Location(s)-Survev llumber(s) N:L N‖ .

NIL NIL ヽlL

Arca(TOtal

mcasurcmcllt in

So lt) NIL NIL

NIL NIL NIL

Bullt‐ up Arca(tOtal

mcasurcmcntinSo lt) ヽlL ヽ11.

NIL NIL NIL

Whether inheritedproDerty (Yes or No) No No

NIL NIL NIL

Date olpurchase, incase ofselfacqLriredproDerty NlL ヽ 11

NIL ヽIL NIL

Cost of Land (in cascof purchase) at thctime of purchasc NIL NIL

NIL IヽL ヽIL

Any investment onthe land, by way ofdevelopment,construction etc., ヽ:L NIL

NIL NIL NIL

Appl:lや‖閂 艘 ヽlL

NIL NII. NII

Rcsidcnti/.O7f NVLヽ NIL N【L NH NII.

＼t OFけ/

(@s / dues to public financial institutions and

govemmcnt:-

(Note: Please give separate details ofname ofbank, institution, entity or individual and

amount before each item)

Buildinss(includirgapartmcnts)-Locatior(s)-Survcy number(s)Arca(TOtal

mcasurcmcntinSo食 )

ヽIL NIL NIL NIL N:L

Bu‖t up Arca(tOtal

mctturcmcnt in

SQ It)

ヽlL N:L NIL NIL N:L

whethcr inh(jritedpropertv (Yes or No)

NIL ヽ:L NH NIL NIL

Datc of puК llasc,hl

cascoFsclfacquircdpropclly

ヽlL NIL Nll´ NII NIL

Cost of Land (in case

ofpurcl'use) at thetime ofpurchase ヽlL NIL

1ヽ1´ NIL NIL

Any investment onthe land, by way oidevelopment,construction etc.. IヽL ヽlL

N11. NIL NIL

Approximate CurrentMarket Value ヽlL ヽlL

NH NIL N:L

Others (such as

intcresl in Droperty) :ヽL NILNII NIL NIL

Total ofcurrentmarket value of(i) to(v) above lヽL NIL

NIL NIL NIL

Slヽ o Dcscription Sclf Spouse D-1 D-2 D-3

(1) Loan or dues to Bank /financial institution(s)Name ofthe Bank orfinarcial institution.Amount outstanding,Nature ol the loan

NIL

_NIL

NIL NIL NIL

Loa[ or dues to anyother individual /entity other thanmentioned aboveName(s), Amoulltoutstanding, nature of /

NIL

椰

N:1

ヽ

ヽlL NIL NlL

，ヽコン〃

判 ン躊

υ

LoanAllv othcr liabihtv NIL \Il. \tL NIL \lt-Grand total ofliabilities

NIL NI1, \IL NIL NIL

Govemment dues:Dues to departmentsdealing withgovemmentaccommodation

NIL Nt l. NIL NlL NIt,

Dues to departmentdealing with supply of

NIL \Il- NIL NIL NIL

Dues to departmentdealing with supply ofelectricitv

NIL NIL NIL NtL NIL

Dues to departmentdealing with supply ofteleDhones / mobiles

Nt t, NIL NIL N- lL NIL

Dues to depadmentdealing withgovemment transpoi(including aircraft andhelicopters)

\IL 1\lL NIL NIL NIL

lncome tux ducs NIL NII- NIL NII. NILWealth iax dues NIL

^"1LN-IL NIL \IL

Service tax dues NIL Nll. NIL \IL NIL

Municipal tax /ProDerty tax dues

)IIL \ I1- \IL NIL N lt-

Sales tax dues NIL NIL NIL NIL NIL

Any other dues NIL NIL N:L NIL NIL( iii) Grand total ofall

qovertunent duesNIL NI l- NIL lヽL )IL

(iV) whether any otherliabilities are indispute, ifso, mentionthe amount involvedand the authoritybcfore which it ispendjn,I

NIL NIL NIL NIL ヽlL

9) Dctails of profession or occupation

(a) Selt PRIVATE TEACHER(b) Spouse:PRMTE EMPLOYEE

My educational qualification is as under

M.A., B.Ed.,

8

9

PART-3

(ll) ABSTRACT OF THE DETAILS CIVEN IN(1)TO(10)OF PART― A:

|

|

1 Namc ofthe CaDdidate lヽr SlIElK SHABBIRヽ Full postal address H.N011‐ 21-1290,NTR

NACAR,SAR00RNACAR,RANCAREDDY DISTRICT‐500074

Number and Name cfthe constituency and State 50-Maheshwaram.Telangana State

1 Name ofthe Dolitical party which set up the Candidate IヽDEPEヽ DENT

ヽ (i) Total number ofpending cases where charges have been

framed by the Court for offences punishable with imprisonmentl'or two Years or more

NIL

(ii) Total number ofpending cases where the court(s) have

taken cognizance lother than the cases mentioned in item (i)abovel

NIL

6 Totul N.rmb.. ofcases in which canvicted and sentenced to

imprisonment fbr one year or more [except lbr offences referred

to in sub-scctions ( I ), (2) or (3) of section 8 ofRepresentationoflhe PeoDle Acl, l95ll

ヽlL

7 PAN Year forwhich lastIncome taxretum filed

TOtal

incomc

shown

(a)Candidatc BttPS5120ヽ「

Y2014‐ 15 3.52,860′・

(b) SDousc COCPヽ10901G 町 2014‐ 15 2.86.180′‐

(c) Dependentsヽ Dctails of Asscts and Liabilitics

Description Sclf Spousc D‐ 1 D‐2 D-3

A Movable Assets (TotalValue)

10,000′‐ 10,000′‐

B Immovable Assets1 Purchase price of

selfac4uiredimmovableproperty

N:L N:L NIL NIL N IL

ll Development /Constructioo costof immovableproperty afterpurchase (ifaoolicable)

NIL N:L

111

1

ヽ

ApproximateCurrent marketDricc of'-

ヽlL ヽlL NIL ヽ:L IヽL

ろ 「一「

`

r立黎 a)SClf NIL NIL NIL NIL NII´

|

|

|

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10

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ATTESTEDLtltt,Yu

tc covlnlxnx neooyB.Com.. LL.B.

ADVOCATE & NOTARYH.No: 1-6430/1. Zamisthanpu(\,trshai:rf, aC Frl,,C3i.bad-20

assets (TotalValuc)

(b) inherited assets(Total value)

9 Liabilitics

(i) Govemment Dues(Total)

NIL NIL NIL N"lL NIL

(11) Loans from Barrk,FinancialInstitutions andothcrs (Total)

s NIL

NILNIL NIL NIL

10 Liabilities lhat are under disputeCovemment Dues(Total)

NIL \IL NIL NIL NIL

Loans from Bank,FinancialInstitutions andothcrs (Total)

NIL r-lL a\-lL ヽlL NtL

Highest educational qualifi cation:

(Give details ofhighest school / university education mentioning the full folm ofthe certificate

/ diploma / degree course, name ofthe school / college / university and the year in which the

course uas completed.)

-

´、

　

　

　

一

フ

11

I'ERIFICATION

I, the deponent, above named, do hereby verify and declare that the cont€nts ofthis amdavit

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 thatt

a) There is no casc ofcooviction or pending case against me other than those mentioned

in items 5 and 6 ofPart 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 I ofPart a and items 8,9 and l0 ofPafi B above.

tllis the お■ day of

EDDY. LL B

/

違ぃdlyOtti:奥血n面。nsNotc:l Attdavn

Note: 2 Aflldavil should be sworn before afl Oath Commissioner or Magistrate of the First

Class or befbre a Notary Public

Notc:3 All colllnlns should bc flncd up and no columns to be lcft blank lf thcrc is m)

infol口 lation toヽ mish in rcsped of any itcln,eidlcr..Nil''or・ `Not Applicabld',as Jに casc

may bc,should bc mcntioned

Notc:4 Tllc affldavit sllould be cithcr typガ or wntcn lcglbly and ncatly

[FNo H‐ 11019(6)2012‐Lcg II]

Dr SANJAY SNGH,AddlSccy

Notc: Thc prlncipal rulcs wcrc publiShed vidc notiflcation nulnbcr S 0 859,datcd the 15th

ApH1 1961 and thc last alncndcd vidc notincaions_

Number S.O.72E(E), dated the E h May 2007

Number S.O. 425(E), dated the 23d February 2011

１

　

　

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