ABSTRACT STATEMENT OF ELECTION EXPENSES

PART-I

l Name of Candidate s//Snt./Kn.A ?,-lyl,rr. A^rk \ o

Number and name of Constituency g c.tWgavU, H.?'E

,l' Name of State/Union Teritory ASSA r'

IVNature of Election(Please mention whether General Election To

State Assembly/Lok Sobha/Bye-election)

LoK)qbhg",

Date of declaration of result ajYName and Address of the Election Agent

fNc-\.q\e}\ Vtv r.t'.0,.

Nzt r " "ytd s^b11atl,. A35rt t^

vlllf candidate is set up by a political party, Please mention the

name of the political partY

trnrsus-\ BN N\r-tvr0N t>frL

vlll Whether the party is a recognized political party Yes/No N D

Date:

Place:

,soo f -

rt"vuL\ SJ\<''-'Signature of the candidate

Name: 4 f Vn fbO Sffl pt R

PART-Il: ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE OF CANDIDATE

Total Election

expenditure(3)+(4)+(s)

Amt. Incurred/authorised by

Political Party(in Rs.)

Amt. Incurred/authorised by

others (in Rs.)

Expenses in public meeting, rally, procession etc.:-

l. aiExpenses in public meeting, rally, procession etc. (i.e.:other

than the ones with Star Campaigners of the Political Party,

(Enclose as per Schedule-1)

l. b: Expenditure in public meeting rally, procession etc. with the

Star Campaigner(s) (i.e. other than those for general party

propaganda (Enclose as per Schedule-2)

Campaign materials otherthan those used in the public

meeting, rally, procession etc. mentioned in Sl. No. I above

(Enclose as per Schedule-3)8! oo/-

Campaign, through print and electronic media including cable

network, bulk SMS or internet and Social media (Enclose as per

Schedule-4)Ilao [,-

Expenditure on Campaign vehicle(s), used by candidate (Enclose

as per Schedule-5)

Expenses of campaign workers/ agents (Enclose as per

Any other campaign expenditure

Ir.l0.oit@+t s) .Qe_

QSec-*t- 1"fo"i.t( )

Expenses incurred on publishing of declaratiorr regarding

F"*Ln 9+ tn'(

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frry

Schedules 1. to 9: Details of Etections Funds and Expenditure of Candidate

Schedule-1xpenses in public meeting, rally, procession etc i.e. other than those with Star Campaigners of the Political Par v)

Sl. No. Nature of ExpenditureTotal Amount

in Rs.

Source of Expenditure

Amt. incurred/Authorise By

Candidate/agent

Amt. incurred/ by

Political Party withname

Amt. incurred

by others

1 2 5 4 5 6

1 Vehicles for transporting visitors NIL NI, NIL NILErecting Stage, Pandal & Furniture,

Fixtures, Poles etc.

3 Arches & Barricades etc.

A Flowers/ garlands

5Hiring Loud speakers, MicroPhone,

amplifiers, comparers etc,

6Posters, hand bills, pamphlets, Banners,

Cut-outs, hoardings

Beverages like tea, Water, cold drink,juice etc.

8Digital TV- boards display, Projector

display, tickers boards, 3D disPlay

9

Expenses on celebrities, payment to

musicians, other artists remuneration

E LL.

10lllumination items like serial lights,

boards etc.

11

Expenses on transport,Helicopter/aircraft/vehicles/boats etc.

charges ( for self, celebrity or any othercampaigner other than Star

Campaigner)

N tt- Nr L \ tr- NIL

72 Power consumption/generator charges

IJ Rent for Venue

.A Guards & security charges

I5

Boarding & lodging expenses of sellcelebrity, party functionary or any

other campaigner including Star

Campaigner

1-6

Other expenses

TotalNl L Nl L Nl L IV'L

p4 9;v,-5

4?"/'/k'>r 5^: l'-i

in public meeting rally, procession etc with the Star Campaigner(s) as appo rtioned to cand idate (i e other than those for

Amount of Expenditure on public meeting rally,

procession etc. with the Star Campaigner(s) apportioned

to the candidate ( As other than for general party

ProPaganda) in Rs.

Name of the Star

Campaigner(s) &of Party

Date and Venue

oetails of expenditure on campaign materials, like handbills, ItTll',":t,oitl:ll;llif '1.:t:,:.:n""tt' cut-outs' gates & arches'

video and cassettes, cDs/DVDs, Loud speakers, amplifiers, digital rV/ board display, 3D display etc' for candidate's election

campaign (i.e. : other than those covered in Schedule-1 & 2)

Remarks, if anY

Sources of ExPenditure

Total Amount inRs.

tNature of ExPenses

6ooo [-D,lA, fa t (os{e/

2qoof-Leolle-\-

8!oof--ppu/.'h $J l*'<

Detail of expenditureoncampaignthroughprintandelectronicmediaincluding cablenetwork,bulksMSorinternetorsocial media'news

itemslTV/Radio channet etc., including paid news so decided by MCMC or vouluntarily admitted by the candidate'The details should

include the expenditure incurred on all such news item appearing in privately owned news paper/TV/Radio channel etc'

Sources of ExpenditureTotal Amount

in Rs.

cot.r(s)t(4)

Name and address o

agency, reporter,

stringer, comPanY or

any person to whom

charges/ commission

etc. paid/ payable, ifany

Name and address o

media provider(print/ electronic /SMS/ Voice/ cable

TV, social media etc')

Nature of medium

(electronic/ print)

and duration

Amt. By

candidate/agent

A?,"r'tan gJ H

DOtails of expenditure on campaign through print and electronic media including cable net work,bulk SMS or internet or social media'news

items/Tv/Radio channel etc., including the paid news so decided by MCMC or vouluntarily admitted by the candidate The details should

include the expenditure incurred on all such news items appearing in news papers/Tv/Radio channels,owned by the candidate or by the

party sponsoring the candidate

TotalAmountin Rs.

col. (3)+(a)

Name and address

agency, reporter,

stflnger, company or

any person to whom

charges/ commission

etc. paid/ payable, ifany

Name and address

media provider(print/ eledronic /SMs/ Voice/ cable

W, social media etc.)

Nature of medium(electronic/ Print)

and duration

pp".*4 SJ 4

Schedule4A

5t.

No.

50urce5

Amt. By

candidate/aSenr

Amt. By

)olitical Party

t 2 3 4 5 6 7 8

1 NIL N tt' NIL l'/lL NIL NIL NIL2

3

4

5

6

7

8

9\

10

11

72

r{lL NIL N 'L

NIL NIL NIL N)L

14

15

16-\\\.\___-.\

17

18

19

20

Total NIL NIL NIL NIL

Schedirl-5

Details of expenditure on campaign vehicle (s) and poll expenditure on vehicle (s) for candidate's election campaign

Sl No.

Regn. No. ofVehicle & Type

of vehicle

Hiring Charges of Vehicle

No of days

for which

useo

Total amt.incurred/

authorisedIn Rs.

Source of expenditure

Rate for hiringof Vehicle/

maintenance

Fuel

charges (lfnot

covered

unoer

hiring )

Drivers

charges (lfnot covered

unoer

hiring)

Amt. bycandidate/

agenr

Amt. by

Poljtical Party

Amt. by

otners

7 2 3a 3b 3c 4 5 6 7 8

L

4rs-23-\* 61LL lloo It oo l-

2

3

4

5

6

7

8

9

10

11

72

I4

lo

L7

18

Totalt/ oof*

t.{,1

In\4

f\r{\

\

Details of expenditure on campaign workers / agents and on candidates' booths (Kiosks) outside polling ,t"tion;G[Gi'lTvoter's slio

Date and Venue

Kiosks ) set up for

/r?.'t/4 S;t--;

Details of Amount of own fund used for the election campaign

DD/Cheque no. etc with details of draweebank

Q+,', ooa f .

tt;. 3.1,

-l-; te-;

Details of Lump sum amount received from the party (ies) in cash or cheque or DD or by Account Transfer

DD/Cheque no. etc with details ofdrawee bank

f tL-

9.- J.-s'e'p*./rr1

Schedule-9

Details of lumpsum amount received from any person/companyfirm/associations/body of persons etc as loan , gift or donatioretc

Sl No. Name and address Date Cash

DD/Cheque no. etcwith details ofdrawee bank

Mentionwhether

loan,gift ordonation etc.

TotalAmount in

Rs.

Remarks

1, 2 3 4 5 6 7 8

1NIL NIL rn )L NIL

2

3

4

5

6 NIL N]U N)L^J/L

7 \

8

9

10

\

t7

72

Total N\L NIL NIL N'L

Atuj'^ Si '^-

t

Schedule-10*Details,of expenditure incurred on publishing criminal antecedents, if any in newspaper and TV Channel

Sl No. Newspaper Television

Mode of payment(Electronic/Chequ

e/DD/Cash)(Pl. specify)

Name of newspaperDate of

publishing

Expenses

that may

have been

incurred(in Rs.)

Name ofChannel

Date &Time of

insertion/telecast

Expenses

that may

have been

incurred(in Rs.)

1, 2 3 4 5 6 7 8I2 tl

^tl l- n] lt, t\il,1 ^ll /

3 \nl I u' lV t"-' lvtL/ f v r- tY r

4

5

6

7R

9

10

L1

Total N\L Tltb N1L NlL N1,?-

Note:1. In Schedule 5:-(a) Copy of the order containing list of all vehicles for which permit issued by the Returning Officer to beenclosed.(b) lf the vehicle is owned by the candidate/his relative/agent are used for election purpose, notionalcost of hire of all such vehicles, except one vehicle if owned and usedby the candidate, notional cost offuel and drivers salary for such vehicle, shall be included in total amount of expenditure in above table.2. In all schedules if any expenditure on goods and services,provided by the political party ; or providedby any person/company/farm/associations/body of person etc.on behalf of the candidate,then thenotional market value of such goods or services are to be indicated,in respective columns.

3. In Part-lll the Lump- sum amount of fund received from the political party or others or the candidate'sown funds,should be mentioned date wise. In all such cases such amounts are required to be firstdeposited in the Bank account ofthe candidate,opened for election expenses.4. Each page ofthe Abstract Statement should be signed by the candidate.

* In persuance of Hon'ble Supreme Court Judgment dated 25.09.2018 in WP(C ) No. 536 of 2011.

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I

ACKN O W L, E,DGEMENT FORM

To,

THE RETURNING OFFICER

13 Dibrugarh HPC

Dibrugarh, Assam

Sir,

r acknowredge receipt orvour retter No9. 9.lf :^:!'*:"'*#:tr'rur",] .... arong

with its enclosures contaittittg. anrong other documents, a Register bearing serial

No........K.. fbr mai'taini'g o1'my accounts of election expenses.

2. I have noted the requirements of law for maintenance of account of election expenses and

lodging of true copy of that account with the District Election Officer / Returning Officer.

Yours faithfully,

fi7v^*1 >';E;(Signature of Candidate with date)

* Strike offwhichever is inapplicablc..

AC KNO W i. E DG EMENT (To be filled up by O1fice)

The account of the erecri.'experses in respect or......f,rr.. ..fr.p.wr.h.w. fu^klg(Constituency) restrlt of which was cleclare ,l

"" .*..].1.t[.T.!.1.......... (Date) has been filed by him

/ on his behalf on -.n.l.A'l.nlf ... 1nut.) and has been received by me rociay th. ....1.4..R...

(Date) ,f ...W.....(Month; ..U.!.L. ..... (year)

District Election Officer

Offrce Seal

Disrrict 146l,lnl1

serial No. .....F.,J.5.,,..._-

FsTsiTrQ Rs. 100,

D 55559 6

PART - IV

AFFIDAVIT

Affidavit of shri r w r gs Apurba saikia, (s/o, w,p/',) Late Nilsaikia I Shri Apurba Sair<ia Son / wrdgugfrfer of Lare Nir saikia age 44years, resident ot' [Jo'ai Katarikhan Gaon, p.o. Teok, p.s. Teok,.DistrictAssam do hereby solemnly and sincerely state and declare as under :-

( I ) That I was a contesting canclidate at the general election / bye election to theHouse of the Peoplc / Legislative Assernbly of l3 Dibrugarh frorn Dibrugarhparliamentary lasscnrbli constituency, the resurt of which was declared on23 May 2019.

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AM1

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(2) That I/My election asent l<ept a separate and_ rrect accc'runt of all expenditure

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incurred / authorised by rne/ rny election agent in connection with the above

election betweenr*cord*:.*$-/t;:?"; on which r was nominated) and/the date of declaration ol'the result thereof, both days inclusive.

(3) fhat the said account was maintained in the Register furnished by the

Returning Oflicer for the purpose and the said Register itself is annexed

hereto with the supporting vouchers/ bills mentioned in the said account.

(4) That the accoltr-tt of ntv election expenditure as annexed hereto includes all

items of elccliort cxpc-rrditure incurred or authorised by me or by election

agent, the political party which sponsored me, other associations/ body ofpersons and other individuals supporting me, in connection with the election,

and nothing has been concealed or withheld / suppressed therefrom (other

then thc expcllsc ott travcl of leaders' covered by Explanations I and,2under

section 77 (r) of the Representation of the people Act, r 95 l ).

(5) That the Abstract Staternent of Election Expenses annexed as Annexure II tothe said accoLlnt also includes all expenditure incurred or authorised by me,

my election agetlt. the political party which sponsored rne, other associations

/ body of persons ancl other individuals supporting ffie, in connection with

ru*i$St*s

the election.

ffi$w(6) That the statemenls in the fbrgoing paragraphs ( l) to (5) are true to the best of

my knou'leclge and 'crief.

that nothing is false and notrring material has beenconcealed.

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AP "'J'^ 92i\ " r

DEPONENT

Solemnly uF,.,r,.d / sown by Shri Apurba Saikia at Tinsukia this the l Tth day ofJune, 2019 before me.

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