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"'~v,t~-t *}} ANNEXURE IX-C .. 161~~~~~~l (CHAPTER V, PARA-7.21 G.O. ~o-:."199"..•. ;y~ "'/ ~>,'i; FORM 26 9SEE RULE 4A) t.Jt..'W 2~'1'!I~ffida. vit.to b..e furnished by...t.he 9ancllt1ate.bE:ffo..r~th(p&turning Off.icer forJ 'JL. i L.fl~) \...L\Xv\),L If).•~ "H"~ "'If: '~Qelection to .;-..~ .. :..NP:....C}{\.<k fj••..'.~.(name of the House)'rrom .\~~M/ v,.A...A

Constituency (name of the constituency)

I, .....S...:.V.i,i~)4-<.fA,.r(lD.91£tL.. so'nld~ughterlwife of .;..0.~.~!~~..p~~ ,-Co_

iJ LfiJ t .; §I", '" l' t./)1Il ..• lt~ ...Ill! I • ,'~

B aged about lb years, resIdent of / ;..I.(v!:. f;;:,·:t.J.,.~ndfdat ,f"-i\I at the above election, do hereby solemnly affirm/state on oath as under:- \

. 1} I Milam not accused of any offence(s) punishable with imprisonment for~)". two years or more in a pending case(s) in which a charge(s) has/have been

framed by the court( s) of competent jurisdiction.

If the deponent is accused of any such offence(s) he shall furnish the following

R info rm.ation: L J crv,,,, ""..\f\.•••' .~.. (j).7 If-I .. · I/;11 ~(I .••.fb, \, ~ ••

,~ AMAHICKAM.8.A" a ~" D2 .. (/'. If ~~ ."'''

~.M,K. RAJOCArE & NOTARY. tj!;) /, C ,,// ~ 6"_ !II''\,I AOV. Cnef/iSr Street ~W 0

23-Ap;J:<dTTAI ~626 101 .J)4:nw~1,\? hP·...'l. ~"I. "RU. ,.-._lIiIIAr OfstriCI '\,7 ..9"" V;fUUJ-~

..2..

~.~~ ':2 .• \\

...•..-..> ...; ..lL~; •.•..••. 1\1»"" ~ '3 .f] ;:::1 .t1Q:~--\\." {)&\O ••••••.~.:~'.' .'..\\_,.rr•••• l1I(i) Case/First information reports No/Nos NJ, , .(ii) Police station(s) N.R (District(s) l\l.J. .

State(s) .

(Hi)Section(s) of the concerned Act(s) and short description of the offence(s) for which

the candidate has been charged ~:-1.~: .

(iv) Court(s) which framed the charge(s) 1\1.\1. .'1

(v) Date(s) on which the charge(s) l\I.I.l .

(vi) Whether all or any of the proceeding(s) have been stayed by any court(s) for

competent jurisdiction

...................................................... \~..~ .

2. I have ~/have not been convicted of an offence(s) (other than any offences)

referred to in sub-section (1) or sub-section (2) or covered in sub-section(s), of

section 8 of the Representation of the People Act, 1951 (43 of 1951) and

sentenced to imprisonment for one year or more.

If the deponent is convicted and punished as aforesaid, he shall furnished the

following information:

(i) Case/First information reports No.lNos \\I.~ .

(ii) Count(s) which punished ; i:.J:J l4S..'1.61(Hi) Police Station(s) ..\\J ...lt (District(S)""';.O •.... :;.;,;~q..'\..g9fJ, ' , ' , ~ .. ~ ..

(State(s) N.\t ~1i1J(iv) Section(s) of the concerned Act(s) and short description of the

offence(s) for which the candidate has been charged l\J.~ .

(v) Date(s) on which the sentence(s) was/were pronounced N!J .

(vi) Whether the sentence(s) has/have been stayed by any court(s) of

competent jurisdiction N.:~ ·..··· ···Jl7/zf··· ..'iil ·iI.Place .1l.A.•••f\,~~i~~tF~·::::::··::;~;~;;·:~3::iAil·~~fI:~~;;~VERI FICATION

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

this affidavit are true and correct to the best of my knowledge and belief, no part of it is \

false and nothing material has been concealed therein.

* ~f ••~t .R",,\>.pU\~A.tt...,/ this A~.A<i.. day :1tJ:J;;b ~'4~.~.\\ Sign~"'Oldepon.ntAI . -'M~* . MANICKAM. 8.A.. 8l ao&em~ Aff1;rDMMlUIG

'9vR.. ~ ••-~.t- ..•~ S.M,I(, RJ\JA A fIE & NOTARY sipllld'befc1Ie ~ ~.~ .•..",,~,~ AOV()() c;nettiar Street M AltlWU~ -I

\: ~. 'k ~.'7:..•.~.,.t(.•••. 23~OTiAf' ~ 'Of,y.JO\,M'\ (JVW-\-"~-"""t)'S. :tP if...•,~u. AR ._ ...- .••••AtIfI,()II,triOI ~tY\\\ \ \~ ~ ';.~~ ..... ~~~- \1 6~

~~re't\l:·: e columns in this Form which are not applicable to the deponent may bestruck off."

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