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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
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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
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NOT APPL-ABLE-
NOT APPLICAB'E
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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'
一 し
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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:
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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.)
-
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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
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