form nomination english-ved

8/13/2019 Form Nomination English-Ved

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Form-A

LOK SABHA CANDIDATE DETAILS

(PERSONAL INFORMATION)

Name: ------------------------------------------------------------------------------------------------------------

Gender: -------------------------------- DOB --- ------------------------------

Phone(Mobile): ------------------------------------------------------------------

Phone (Landline): ----------------------------------------------------------------

Photo

E-mail:

Education Qualification: Year: ..

If Student then College Name: ---------------------------------------------------------------------------------------------------

Address: -------------------------------------------------------------------------------------------------------------------------------

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Whether you belong to any special category SC ST OBC

Details in electoral roll: S.no. .In part no.of the electoral roll for

.............................Assembly Constituency,

Note:Where ever the word used Family, It means Parents, Life Partner (Husband or Wife), and Children(If unmarried, then family means Parents only.)


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1. Your activity towards Janlokpal, Any other Andolan and Social Service etc. (Please give details onseparate sheet and enclosed with this form)

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2. Details of Family members:

S.no Name Relation Age Gender Occupation

3. Have you or your family member has been convicted for any offence or any case/FIR which has beenfiled. If yes please give the detail below& enclosed detail report along with this form.

S.no. Name of the PersonCase

No.

Detail of SectionDetail of

Case

In whichyear case

has beenstarted

Present

Situation


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4. Do you or any of your family memberarepart of any political party. If yes then mention.S.no.

Name of thePerson

Party Name Post From Up to

5. Do you or any of your family membersever contested in any election? If yes. Please Mention Below.S.no. Name

ContestedElection

YearPartyName

How much Votesyou got

How much moneyyou spent

Result

6. Do you or any of your family member are part of any social/revolutionary organization if yes. Pleasemention below.

S.no. NameName oforganization

Post From UptoMain activities oforganization

YourRole


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7. Source of Income (About self and family members).S. No. Name Average yearly income Source of income

8. Detail of property (About self and family members).S.no.

Name of propertyowner

Details ofproperty

Whenpurchased

Value at the time ofpurchase

Current marketvalue


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9. Why do you want to contest the election?---------------------------------------------------------------------------------------------------------------------------------------------

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10.Why should you be selected as candidate over other applicants?------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

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11. If you have not been selected as candidate. What will you do? Contest as independent candidate. Try to get ticket from some other party. Other (Please give details).

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12. Why do you think that you will win the election?---------------------------------------------------------------------------------------------------------------------------------------------------------------

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13. For decentralization of power, have you read the SWARAJ book? What is your opinion about that?---------------------------------------------------------------------------------------------------------------------------------------------------------------

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14.What strategies would you adopt to win the election? And how much expenses would be required? ---------------------------------------------------------------------------------------------------------------------------------------------------------------

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15. Do you have team apart from party volunteers? How many team members/volunteers, you have in eachassembly constituency?

Assembly constituency No. of members/volunteers

(List of members/volunteers with name and phone numbers has to be provided)


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List of 100 Proposing Voters from each Assembly constituency of respective Lok Sabha

We undersigned are the resident and voters of Assembly constituency and

we proposed the name of .

as the candidate of Aam Aadmi Party from . Lok Sabha.

S.No. Name Complete AddressAssembly

Constituency

Part No. &S.No. inVoter list

Phone

No.Signature

1

2

34

5

6

7

8

9

10

11

12

13

14

15

16

17

1819

20

21

22

23

24

25


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26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

5455

56

57


10/1210

58

59

60

61

62

63

64

65

66

67

68

69

7071

72

73

74

75

76

77

78

79

80

81

82

83

84

85

86

87

88

89


11/12

11

90

91

92

93

94

95

96

97

98

99

100

Note: - Your application shall be deemed rejected for giving wrong and incomplete information othe proposers.


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AFFIDAVIT Date: .

(To be submitted on Rs.10 Stamp Paper)

I.son/daughter/wife of ..

Resident of . ..

I take an oath to contest the election from Aam Aadmi Party for Lok Sabha

Constituency ..

I will follow the under given points after winning the election:

1. I will not take Red Beacon Car.2. Ill not take any unnecessary security. Security should be dedicated for Aam

Aadmi & not for their chosen candidate. Leader should not take any security

more than awaited to Aam Aadmi.

3. Ill not take any big bungalow & shall live like any other member of the society.4. I agree with the concept of Swaraj & that governance should be directly in the

hands of public & not in their chosen representatives. Ill give my full efforts to

bring such a law but till time such law is not passed, all the work in local area

shall be done in consultation with the local public.

5. Im committed towards Janlokpal bill & Electoral reforms. Ill putmy full effortsto bring such law/s at the earliest.

6. Govt should not acquire any land without the permission of public.Ill put myfull efforts to bring such law/s at the earliest.

7. I have gone through the ideology & principals of Aam Aadmi Party and have alsounderstood the same & fully believe in it. I have also read the candidate

selection process & fully agree with the same.

I above name deponent do hereby confirm the above contents are true and correct to

the best of my knowledge & belief & that nothing has been concealed.

Deponent

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