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IN-PY31012~356R20-Mar:-?Ql9 1,1:5! AMIMPACC (SH)/ pyshimp17/ SARAM1P¥-PUSUBIN-PYPYSHIMP1750906429713~21,ftS MOTHILAL "":,

Description of Document .'CO

Property Description .,.Consideration Price (Rs.) -T

Article 4 AffidavitAFFIDAVITo(Zero)S MOTHILALFirst Party

Second PartyStamp Duty Paid ByStamp Duty Amount(Rs.)

~ELECTION COMMISSION OF INDtA ~ONDICHERRYS MOTHILAL20(Twenty only)

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[See rule 4A] II

AFFIDAVITTO BEFILEDBYTHECANDIDATEALONGWITH I;NOMINATIONPAPER BEFORETHE RETURNINGOFFICER FOR

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~~ ~ . ' -1:"'1'.r.;e:.~~ty of thl~StampCertificateshouldbe verifiedat ..www.shcilestamp.com-.Anydiscrepancyinthedelailson thisCertificateand as WII::..w"1iP"Cavailableon thewebsderendersIt IOvahd.

2. Theonusof checkingthe legitimacyis on Iheusersof the certificate.3. In caseof anydiscrepancypleaseinformtit",CompetentAuthority.

ELECTION TO HOUSE OF THE PEOPLE FROM PUDUCHERRYCONSTITUENCY (NAME OF THE CONSTITUENCY)

2

PART-A

I, S.MOTHILAL, son of Somasundaram, aged 40 years, resident of No. 10, 15thCross, Avvai Nagar, Lawspet, Puducherry - 605008 (mention full postal address), a

candidate at the above election, do hereby solemnly affirm and state on oath as under:-

(1) I am a candidate set up by COMMUNIST PARTY OF INDIA (MARXIST _

LENINIST) (LIBERATION) ("name of the political party').

(2) My name is enrolled in 9 THAIT ANCHAVADY IN UNION TERRITORY OF

PONDICHERRY (Name of the constituency and the State) at Serial No. 419 inPart No. 13.

(3) My contact telephone number(s) is 9345574855 and my email id (if any) islal.pondy@gmail.com and my social media account(s) ( if any) are

(i) 9345574855 (Whatsapp)

(ii) ................................

(iii) ...............................

(4) Details of Permanent Account Number (PAN) and status of filling of Income Taxreturn:

SI. Names PAN The financial Total IncomeNo. year from Shown in Income

which the last Tax return (Inincome tax Rupees) for thereturn has last Five financialbeen filed. years completed

(as on 31st March)1. Self ANJPM0601R NIL (i) NIL

S. MOTHILALN\l_ (ii) NILNil (iiDNIL_",n t (iv) NIL

IV" (v) NIL2. Spouse EOBPM6046D NIL (i) NIL

MALARVIZHI ~Nil (ii) NIL1\1"1 L- (iiDNILrut' (ivlNILN\, (v) NIL

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3. HUF (If the Candidate is NIL NIL (i) NILKarta or Coparcener)NIL .....,"- tN\L-

.,\ t\I\ , (ii) NILNH ....,.. (iii) NIL,,-rlL. Nu (iv) NILN\\..-- Nh. (v) NIL

4. Defendant - I "No PAN NIL (i) NILMukilan Ull allotted"NIL ,

N\\._ Nt l (ii) NILNh__ "" (iii) NIL

"" - .r. , (iv) NIL"''' MI (v) NIL

5. Defendant - 2 "No PAN NIL (i) NILNila Lal allotted"NIL

f'l' 1'-- MI.-- (ii) NIL.." t rJ\'-"' (iii) NILN\I.. w\'-- (iv) NIL"'''- N\'-- (v) NIL

6. Defendant - 3 NIL NIL (i) NILNIL

N'L. N\'-- (ii) NIL..,.1 \ NI\. (iii) NIL""L. ..n... (iv) NILNt ""IL- (v) NIL

Note: It is mandatory for PAN holder to mention PAN and in case of no PAN, it shouldbe clearly stated "No PAN allotted".

(5) Pendingcriminal cases(i) I declare that there is no ding criminal case against me. ~(Tick this alternative if there is n eri inal case pending against the Candidate and writeNOTAPPLICABLE against alte tve (ii) below)

(OR)(ii) The following criminal cases are pending against me. ""'"(If there are pending criminal cases against the candidate, then tick this alternative andscore off alternative (i) above, and give details of all pending cases in the Tablebelow)

TABLE

(a) FIR No. with name and address Crime No. 136/2011, Station House Officer,of Police Station concerned Auroville Police Station, Villupuram District,

Tamilnadu(b) Case No. with Name of the Crime No. 136/2011, Judicial Magistrate Court,

Court Vanur(c) Section(s) of concerned IPC 147, IPC 148, IPC 294(B), IPC 427, IPC

Acts/Codes involved (give no. of 448, 506(ii)the Section, e.g., Section ..of IPC, etc.)

(d) Brief description of offence Trespass and destruction and mutilation ofproperty.

(e) Whether charges have been Noframed (mention YES or NO)

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(f) If answer against (e) above is Not ApplicableYES, then give the date onwhich charoes were framed

(g) Whether any Appeal/Application NOfor revision has been filedagainst the proceedings(Mention YES or NO)

(6) Cases of conviction(i) I declare that I have not been convicted for any criminal offence. (v')(Tick this alternative, if the candidate has not been convicted and write NOTAPPLICABLE against alternative (ii) below)

(OR)(ii) I have been convicted for the offences mentioned below: (Not Applicable)(If the candidate has been convicted, then tick this alternative and score off altemative(i) above, and give details in the Table below)

Table

(a) Case No. NOT APPLICABLE(b) Name of the Court NOT APPLICABLE(c)

Sections of Acts/Codes involved (give no. NOT APPLICABLEof the Section, e.g., Section ............. ofIPC, etc.)

(d) Brief description of offence for which NOT APPLICABLEconvicted

(e)Dates of orders of conviction NOT APPLICABLE

(f) Punishment imposed NOT APPLICABLE(g)

Whether any Appeal has been filed against NOT APPLICABLEconviction order (Mention YES or No)

(h)If answer Jo (g) above is YES, give details NOT APPLICABLEand present status of appeal

(6A) I have given full and up-to-date information to my political party about all pendingcriminal cases against me and about all.cases of conviction as given in paragraphs (5)and (6). y.Rll, ~'(~-<- 0\. '[candidates to whom this Item is not applicable should clearly write NOT APPLICABLEINVIEW 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 againsteach item.

3. Details should be given in reverse chronological order, t.e., the latest case to bementioned first and backwards in the order of dates for the other cases.

4. Additional sheet may be added if required.

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5. Candidate is responsible for supplying all information in compliance ofHon'ble Supreme Court's judgment inW.P (C) No. 536 of 2011.

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

A. Details of movable assets: Note:

1. Assets in joint name indicating the extent of joint ownership will also have to begiven.

2. In case of deposit/Investment, the details including Serial Number, Amount, date

of deposit, the scheme, Name of the Bank/Institution and Branch are to be given

3. Value of BondS/Share Debentures as per current market value in Stock

exchange in respect of listed companies and as per books in case of non-listedcompanies should be given.

4. 'Dependent' means parents, son(s}, daughter(s} of the candidate or spouse and

any other person related to the candidate whether by blood or marriage, who have no

separate means of income and who are dependent on the candidate for their livelihood.

5. Details including amount is to be given separately in respect of each investment

6. Details should include the interest in or ownership of offshore assets

Explanation : For the purpose of this Form, the expression "offshore assets"includes details of all deposits or investments in Foreign banks and any otherbody or institution abroad, and details of all assets and liabilities in foreigncountries

51. Description Self Spouse HUF Depend Oepende DependentNo. ent-1 nt-2 -3(i) Cash in hand RS.280 NIL Not NIL NIL Not

Applicabl Applicablee

(ii) Details of deposit in Indian Bank Karur Vysia NIL NIL NIL NotBank accounts SB Account Bank Applicable(FDRs, Term SB AccountDeposits and all other Rs.9359/-types of deposits

State bank Rs.10,979/-including saving

of Indiaaccounts), Depositswith Financial SB AccountInstitutions, Non-

Rs.3982/-Banking FinancialCompanies and PondicherryCooperative societies Stateand the amount in Co.operativeeach such deposit. bank

SBAccount

RS.9212/-

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(iii) Details of investment NIL NIL NIL NIL NIL NOTin Bonds,APPLICABLEdebentureS/shares

and units incompanies/Mutualfunds and others andthe amount

(iv) Details of investment TATA AlA NIL NIL NIL NIL NOTin NSS, Postal Life PolicyAPPLICABLESaving, Insurance Rs.100000/-policies and

investment in anyFinancial instrumentsin Post office orInsuranceCompanyand the amount.

(v) Personal NIL NIL NIL NIL NIL NOTloans/advancegivenAPPLICABLEto any person or

entity including firm,company, Trust etc.,and other receivablesfrom debtors and theamount.

(vi) Motor Motor Cycle NIL NIL NIL NIL NOTVehicles/Aircrafts / RoyalAPPLICABLEYachts/Ships (Details Enfiled

of Make, registrationPY-05-Enumber etc., year of

purchaseand 3526amount)

Rs.120000/-Hyundai Car

PY01 CH

3967Rs.6000001-

(vii) Jewellery, bullion and 40 Grams 92 Grams NIL NIL NIL NOTvaluable thing(s)Gold Gold APPLICABLE(give details of weightOrnaments Ornamentsand value)Value ValueRs.80000/- Rs.1,84ooo/-

(viii) Any other assets NIL NIL NIL NIL NIL NOTsuch as value ofAPPLICABLEclaims / interest

(ix) Gross Total Value RS,900000 Rs.184000 NIL NIL NIL NOT

APPLICABLE

B. Details of Immovable Assets :Note :1. Properties in joint ownership indicating the extent of joint ownership will alsohave to be indicated.

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2. Each land or building or apartment should be mentioned separately in this format.3. Details Should include the interest in or ownership of offshore assets.

Sl. Description Self Spouse HUF Dependen Dependen DependentNo. t-1 t-2 -3

(i) Agricultural Land Thailapuram NO NO NO NO NotLocation(s) Survey number(s) Villupuram Applicable

DistrictSurveyNO.81n

Area (total measurement in 0.16.0 Ares NO NO NO NO Notacres) Applicable

Whether inherited property (Yes YES NO NO NO NO Notor No) Applicable

Date of purchase in case of self- 27.8.2013 NO NO NO NO Notacquired property Applicable

Cost of Land (in case of Rs.62000 NO NO NO NO Notpurchase) at the time of Applicablepurchase

Any investment on the land by NO NO NO NO NO Notway of development. Applicableconstruction etc.

Approximate current market 7,00,000 NO NO NO NO Notvalue Applicable

(ii) Non-Agricultural Land: . NO NO NO NO NO NotLocation(s)Survey number(s) Applicable

Area (total measurement in NO NO NO NO NO Notsq.ft.) Applicable

Whether inherited property (Yes NO NO NO NO NO Notor No)

Applicable

Date of purchase in case of self- NO NO NO NO NO Notacquired property Applicable

Cost of Land ~n case of NO NO NO NO NO Notpurchase) at the time of

Applicablepurchase

Any investment on the land by NO NO NO NO NO Notway of development. Applicableconstruction etc.

Approximate current market NO NO NO NO NO NotvalueApplicable

(iii) Commercial Buildings NO NO NO NO NO Not(including apartments)

Applicable-Location(s) -Survey number(s)

Area (total measurement in NO NO NO NO NO Notsq.ft.) Applicable

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51. Description Self Spouse HUF Dependent-1 Dependent-2 Dependent-3No

Built-up Area (total NO NO NO NO NO NOTmeasurement in sq.ft.)APPLICABLE

Whether inherited property (Yes NO NO NO NO NO NOTor No)APPLICABLE

Date of purchase in case of self- NO NO NO NO NO NOTacquired propertyAPPLICABLE

Cost of property (in case of NO NO NO NO NO NOTpurchase) at the time of APPLICABLEpurchase

Any investment on the property NO NO NO NO NO NOTby way of development, APPLICABLEconstruction etc.

Approximate current market NO NO NO NO NO NOTvalueAPPLICABLE

(iv) Residential Buildings NO NO NO NO NO NOT(including apartments):- APPLICABLELocation(s)-Survey number(s)

Area (total measurement in sq.ft.) NO NO NO NO NO NOTAPPLICABLE

Built up area (Total NO NO NO NO NO NOTmeasurement in sq.ft.) APPLICABLE

Whether inherited property (Yes NO NO NO NO NO NOTor No) APPLICABLE

Date of purchase in case of self- NO NO NO NO NO NOTacquired property APPLICABLE

Cost of property (in case of NO NO NO NO NO NOTpurchase) at the time of APPLICABLEpurchase

Any investment on the land by NO NO NO NO NO NOTway of development,APPLICABLEconstruction etc.

Approximate current market NO NO NO NO NO NOTvalueAPPLICABLE

(v) Others (such as interest in NO NO NO NO NO NOTproperty)APPLICABLE

(vi) Total of current market value of NO NO NO NO NO NOT(i) to (v) aboveAPPLICABLE

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(8) give herein below the details of liabilities/dues to public financialinstitutions and government:

(Note: Please give separate details of name of bank, institution, entity or individual andamount before each item)Sl.No

Description Spouse HUF Dependent-1 Dependent-2 Dependent-3Self

(i) Loan or dues to Bank! financial Rs.50000institutlon(s)

Name of the Bank or financialInstitution, Amount outstanding.Nature of Loan

NIL NIL NIL NIL Not

Applicable

Loan or dues to any otherindividuals/entity other thanmentioned above

Name(s), Amount outstanding,nature of loan

PSC Bank

BajajFinance

Rs.150000

NIL NIL NIL NIL NIL Not

Applicable

Any other liability NIL NIL NIL NIL NIL Not

Applicable

Grand total of liabilities Rs, NIL NIL NIL NIL Not

ApplicableGovernment dues: Dues to(ii)Departments dealing with (A) Has the Deponent been in occupation ofGovernment accommodation accommodation provided by the Government at any time

during the last ten years before the date of notification ofthe current election?

200000

(8) If answer to (A) above is YES, the followingdeclaration may be furnished namely: -(i) The address of the Government accommodation:

NIL

(ii) There is no dues payable in respect of aboveGovernment accommodation, towards-

(a) rent:

(b) electricity charges;

(c) water charges; and

(d) telephone charges as on .(date)

[the date should be the last date of the third month prior tothe month in which the election is notified or any datethereafter].Note - 'No Dues Certificate' from the agenciesconcerned in respect of rent, electricity charges, watercharges and telephone charges for the aboveGovernment accommodation should be submitted.

NIL

NIL

NIL

NIL

NO

(iii) Dues to department dealingwith Government transport(including aircrafts andhelicopters)

NIL

Self Spouse HUF Dependent-1 Dependent-2 Dependent-3

(iv) Income tax dues NIL NIL NIL NIL NIL Not

Applicable

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(v) GST Dues NIL NIL NIL NIL NIL Not

Applicable

(vi) MunicipaVPropertytax dues NIL NIL NIL NIL NIL Not

Applicable

(vii) Any other dues NIL NIL NIL NIL NIL Not

Applicable

(viii) Grand total of all GovernmentNIL NIL NIL NIL NIL Notdues

Applicable"(ix) ) Whether any other liabilities are

NIL NIL NIL NIL NIL Notin dispute, if so, mention theamount involved and the

Applicableauthority before which it isIpending.

(9) Details of profession or occupation:(a) Self Self Employed(b) Spouse House wife(9A) Details of sources of income:

(a) Self Rs. 1,80,000/- per annum through self employment(b) Spouse: Nil(c) Source of income, if any, of dependents NIL

(98) Contractswith appropriate Government and any public company or companies:(a) details of contracts entered by the candidate NIL(b) details of contracts entered into by spouse NIL(c) details of contracts entered into by dependents NIL.(d) details of contracts entered into by Hindu Undivided Family or trust in which the

candidate or spouse or dependents have interest: NIL(e) details of contracts, entered into by Partnership Firms in which candidate or spouse

or dependents are partners.. NIL(f) Details of contracts entered into by private companies in which candidate or

spouse or dependents have share NIL(10) My educational qualification is as under

Secondary School Leaving Certificate (SSLC) Dr. Ambedkar Government HigherSecondary School, Pulichapallam,and ITI from Government ITI, Cuddalore(Give details of highest SchooVUniversityeducation mentioning the full form of

the certificate/diploma/degree course, name of the School/College/University and theyear in which the course was completed.

PART-B11. ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A

1. Name of the candidate Sh. S.MOTHILAL

2. Full postal address No.471, Bharathy Street,Puducherry - 605001.

3. Number and name of the Puducherry, Union Territory of Puducherryconstituency and State

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4. Name of the political party Communist Party of India (Marxist-Lenist ) (Liberation)which set up thecandidate (otherwise write'Independent')

5. Total number of pending Only Onecriminal cases

6. Total number of cases in Not Applicablewhich convicted

7 PAN of Year for which last Total incomeIncome Tax return filed shown

(a) Candidate ANJPM0301R Not filed Not Applicable

(b) Spouse EOBPM6046D Not filed Not Applicable

(c) HUF NIL NIL NIL

(d) Dependent NIL NIL NIL

8. Details of Assets and Liabilities (including offshore assets) in RupeesDescription Self Spouse HUF Depende Oepende Oependent-

nt-1 nt-2 3A. Moveable Assets (Total Rs. Rs. NIL NIL Nil Not

value) 9000001- 184000/- Applicable

B. Immovable Assets :

I. Purchase Price of self- Rs.62000/- NIL NIL NIL NIL Notacquired immovable Applicableproperty

II. DevelopmenU Not Not Not Not Not Notconstruction Applicable Applicable Applicable Applicable Applicable Applicable

cost of immovable

property after purchase (ifapplicable)

III. Approximate Current Rs. Not Not Not Not Not

market price-(a) self- 700000/- Applicable Applicable Applicable Applicable Applicableacquired assets (TotalValue) (b) inherited assetsI(Total Value)

9. Liabilities :.

(i) Govemment dues (Total) NIL NIL NIL NIL NIL NIL

(ii) Loans from Bank. PSC Bank NIL NIL NIL NIL NILRs.50000

Financial Institutions and Bajajothers (Total) Finance

Rs.150000

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10. Liabilities that are under dispute:

(i) Government dues (Total) NIL NIL NIL NIL NIL NotApplicable

(ii) Loans from Bank, NIL NIL NIL NIL NIL NotApplicable

Financial Institutions and NIL NIL NIL NIL NIL NotApplicable

others (Total)

11. Highest educational qualification :

Secondary School Leaving Certificate (SSLC) Dr. Ambedkar GovernmentHigher Secondary School, Pulichapallam, (1993-1994)and ITI from Government ITI, Cuddalore (1994-1995)

Give details of highest SchooVUniversityeducation mentioning the full form of thecertificate/Diploma. Degree course, name of the school, college, university and the year in which thecoursewas completed)

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of this

affidavit 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 that

(a) there is no case of conviction or pending case against me other than those

mentioned in items 5 and 6 of Part 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 8 of Part A and items 8, 9 and 10 of Part B above.

Verified at Puducherry this the 21st day of March 2019