Dependent2 NA Ni : Ai) ” an) ; aan pe » tid | Nel fs - Ni) Nil | iv) Ny) | 2 wid Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it should bbe clearly stated “No PAN allotted”, (S) Pending criminal eases (i) I declare that there is no pending criminal case against me. (Tiek this alternative if there no criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ji) below) oR Gi) The following criminal eases are pending against me: (if there are pending criminal eases against the candi score off alternative (i) above, and give detail te, then tick this alternative and is of all pending eases in the Table below) FIR No. with an: and address of vu ual Na Police Station i concerned ; Grdecst, Kure ee(6) Cases of conviction () 1 declare that 1 have not been convicted for any criminal offence. (Tick this alternitive, if the candidate has not been convicted and write NOT APPLICABLE against alternative (ji) below) OR (ii) I have been convieted for the offences mentioned below: (if the candidate has been convicted, then tick this alternative and score off alternative (i above, and give details in the Table below) Table @ Case No. aa Wa @ Name of the Court Ni A © Sections of ‘Acts/Codes involved \l \ (eive no. of the) Ni Nx) Section, ex. Section....... of IPC, ete). @ Brief description of offence for which} — }),| Nil Na convicted oO Dates of orders of convietion N) Ni\ Nil © Punishment imposed [4 not NA ® Whether any Appeal has been filed | 4); ) WN.) (Ve)or No) a If answer to (@) above is YES, give nil Ni\ Na details and present status of appeal (GA) T have given fall and up-to-date information to my political party about all pending criminal 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 NOT APPLICABLE 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.c., the latest case to be mentioned first and backwards in the order of dates for the other eases. 4. Additional sheet may be added if required. 5. Candidate is responsible for supplying all information in compliance of Hon’ble Supreme Court's judgment in W, P (C) No. 536 of 2011. (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 dicating the extent of joint ownership will also have to be given. 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 be given. Note: 3.Value of Bonds/Share Debentures as per the current market value in Stock Exchange respect of listed companies and as per books in case of non-listed companies should be given, Note: 4. Dependent” means parents, son other person related to the candid: Separate means-of-income and why gy livelihoodNote: 5. Details including Not institution countries Explanation,- For the purpose of this details of all deposits or investment 6. Details should include the interest in or ownership of offshore assets. ‘amount is to be given separately in respect of each investment Form, the expression “offshore assets” includes, Foreign banks and any other body or broad, and details of all assets and liabilities in foreign Deseription Ser pouse HUF [Dependent-T [Dependent-2| Dependent-3 Cashin hand Wsaeide Nd Na Wil Nl Details of deposit in Bank accounts (FDRs, Term Deposits and all other types of deposits including saving accounts), Deposits with Financial Institutions, Non-Banking Financial Companies and Cooperative societies and the amount in each such deposit Nis N? Na Na iii) Details of investment in Bonds, Debentures/Shares and units in companies/Mutual Funds and others and the amount. A onl iv) Details of investment_in NSS, Postal Saving, Insurance Policies and investment in any Financial instruments in Post office or Insurance Company and the amount ta wi NM)Personal Toans/advanee given to any person or J entity including — firm, company, ‘Trust ete, and other receivables from debtors and the amount wi Motor Vehicles/Aireralis? z No No No No Yachts/Ships (Details of f Make, registration number, ete, year of purchase and amount) ity Jewellery, bullion and FEGIAGS ICS 2o'3 ee.cee l= No Ne No valuable" thing(s) (give details of weight and value) ‘Any other assets such as Ne ieee | Gross Total value value of claims/interest No Ne Wo B. Details of Immovable asset Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have 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, f No. \ Descript Self Spouse HUF Dependent-1 ependent-3 gvicultural Land Location(s) een) Na NA Ni) Na Survey number(s) wit ‘Area (otal measurement |) in acres) 0) td) Nay Nd i = = a = MotMED eon KERALA STATIS LE KERALA, INDIAWhether inherited properly (Yes or No) Wa Date of purchase in case of self = acquired property |i) fyi) Cost of Land (in case of purchase) at the timeof yc) purchase Any Investment on the land byway of | . development, constuction |W. AN | yr N) Ne Wa ete. ‘Approximate Current ‘market value ST vo No 0) Non-Agi nw Wa Ni and Location(s) een Survey number(s) MT fay W: ‘Area (total measurement insq. ft.) hel | tal | wa ‘Whether inherited property alan |p ; ‘ (Yes or No) Ish TNA) tu NA \ Date of purchase in case of self - acquired property |\\y) | (Je) Na WA we) Nd ‘Cost of Land (in case of purchase) at the time of fod purchase hail | ‘Any Investment on the land by way of development, construction | {U:\] {\\ NV ele ‘Approximate current market value Ww iy) | Comm Wa NA Wa WA Ws Gincluding apartments) Location(s) Ww} he | hor Ws Wi “Survey number(s) A. MOHAMMED 9 NOTARY KERALA STATE KERALA, INDIA‘Area (total measurement in sq. ft.) Wil} Qi ) Wi) Built-up Area (total ‘measurement in sq.ft.) WA) Ww Ni Na ‘Whether inherited property (Yes or No) WA} Nd Ni Date of purchase in case of self- acquired property |j\3\ } {\)i\ Nt Cost oF property Gn ease of purchase) at the time of | purchase ft] i ‘Any Investment on the property by way of development, construction |\x\|_ Ni ete. ‘Approximate current market value ay} WA Wi Nil Ny) Residential Buildings Gncluding apartments): Location (s) S341 ~Survey number(s) BA Nv Na hs ‘Area (Total measurement in sq. ft) eas a WA Na WA NA Built up Area (Total measurement in sq. ft.) |&""]"_ ti, Nd Nil Nal ‘Whether inherited property (Yes or No) Nil Na Ni Date of purchase in case of self — acquired property Na Na Na Cost of property (in case of purchase) at the time of purchase wil ‘Any Invesiment on the Jand by way of 3 development, construction |‘. ete. Nel ‘Approximate current market valueOthers (such as interest in Ni) Ni Na) Na Na Na Nl Na property) Total of current market value of (i) to (v) above (8) I give herein below the details of liabilities/dues to public financial institutions and government: (Note: Please give separate details of name of bank, institution, entity or individual and amount before each item) Description Self Spouse] HUF ependent-1pependent-2 ependent-3 Loan or dues to nancial nfs Na wd Wa Ws Name of Bank or Financial —_Institution, Amount outstanding, Nature of loan Loan or dues to any other —_individuals/ entity other than mentioned above. hie | WA | Na NA NA NA Name(s), Amount outstanding, nature of Joan ‘Any other liability Grand (otal of liabilities ee ae —S— EZ orsssnn NOTARY KERALA STATE KERALA, INDIAfi) | Government Dues; (A)Has the Deponent been in occupation of Dues to departments accommodation provided by the Government at dealing, with any time during the last ten years before the Government date of notification of the current election | accommodation (B)If answer to (A) above is YES, the following dcclaration may be furnished namely: () The address. of the Government accommodation nh (3) There ts no dues payable in respect of above Government accommodation, towards. (a) tent, (b) electricity charges: (c) water charges, and (4) telephone charges. as on (ate) Ithe date should be the last date of the third month prior to the month in which the election is notified or any date thereafter] Note- "No Dues Certificate’ from the agencies concerned in respect of rent, electneity charges, water charges and telephone charges for the above Government accommodation should be submitted. ni) pies cesar cea vith Govemment transport feo airerafis and) p) |) f_ welicopters)/ Self (iv) [income Tax dues Spouse | HUF Dependent-1 [Dependeni-2 Dependent-3 NPN} ful | fod pd wi) | GST dues WN} par} pad Na | Ml Ni vi) [| Municipal/Property tax dues Wf wal} okt f Na | il J) wifi] Ma ft | td | a (viii) | Grand total of all Government dues Wi oot os Ni) WJ) Wi) Whether any other x) | liabilities are in dispute, if so, mention the amount . yy invoived and the | NV | WA |) NA \):) Ws) N authority before which it is pending, (wit) | Any other dues (9) Details of profession or occupation: (@) Self..... Maser. (b) Spouse ......\) (9A) Details of source(s) of income: (a) Self... Maser, (b) Spouse... Wile (©) Source of income, if any, of dependents...) (9B) Contracts with appropriate Government and any public company or companies (a) details of contracts entered by the candidate Daily: Wages (b) details of contract entered into by spouse ..AJs\ a mon AMeD 2 ‘KERALA STATEcandidate or spouse or dependents have interest .....{hil...... (©) details of contracts, entered into by Partnership Firms in which candidate or spouse or dependents are partners .......f))\seeeeseene (0 details of contracts, entered into by ate companies in which candidate or Ns spouse or dependents have share ........ De purtmewt of Ge eval Gd utattén, Kerala State cs details of highest Scho Iniversity education mentioning the full form of the (Gi ¢ course, name of the School /College/ University and the year certificate! diploma’ degr in which the course was completed.) A. MOHAMMED NOTARY KERALA STATE. KERALA, INDIA aPART-B an. ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART - A: Tr Name of the candidate ThSmtKum— Sadeogh Kuwmar.G B. Full postal address a RA ont E lees po) Kall are B Number and name of the constituency and State Nilawbus- 95 i Name of the political party which 5 Le set up the candidate (otherwise Sedalist \hoate del (S50? write Independent’) 5 Total number of pending criminal | )-) cases ‘ 6 Total Number of cases in which | 444 convicted i [7. PAN of Year for which last Total Income Shown Income Tax Retum filed fa) Candidate Berm as gel Na Zak, Crowsll {o) Spouse Na cy HUF Nil (d) Dependent ay ‘Details of Assets and Lial jes (including offshore assets) in rupees: Description, self [Spouse HUF [Dependent-1 [Dependent-2 |Dependent-3 A. Moveable Assets (Total value) asks | wel | Na MN) Nd Na B. Immovable Assets | Resile.tul Telba| Nt] Ni ) Nd Ni Purchase Price of \ self-acquired ae w A immovable af | OA] NA NS Naf Na) property : lil | Development/const ruction cost of NA immovable eee tee Ni purchase dr |, ¥ ct applicable) 4 4j—%‘Approximate Current Market Price assets (Total Value) (b) Inherited assets (Total Value) (a) Self-acquired 6\* \.\ Wi Ys Ws) Liabilities @ Government dues (Total) Wi ») Ww! Wi i) Loans from Bank, Financial Institutions and others (Total) i | ied xs NY WA Liabilities that are under dispute @ Government dues (Total) vi) Sy ws Ww) ii) Loans from Bank, Financial Institutions "and | jy) others (Total) ys NS Wi Na (Give details of highest was completed.) Highest Saito jalification: S ITTD,, De parsmen ewera) Cducarion ceva\ s Sha PEcnool "ave education nosing ‘the full form of the certificate/ diploma’ degree course, name of the School /College/ University and the year in which the course ‘age L- £6, Cecondany Schoo | Leavin 5 Conds frcate