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1. Your activity towards Janlokpal, Any other Andolan and Social Service etc. (Please give details on
separate sheet and enclosed with this form)
Name
Relation
Age
Gender
Occupation
3. Have you or your family member has been convicted for any offence or any case/FIR which has been
filed. If yes please give the detail below& enclosed detail report along with this form.
Case
No.
Detail of Section
Detail of
Case
In which
year case
has been
started
Present
Situation
4. Do you or any of your family memberarepart of any political party. If yes then mention.
S.no.
Name of the
Person
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
Contested
Election
Year
Party
Name
Result
6. Do you or any of your family member are part of any social/revolutionary organization if yes. Please
mention below.
S.no. Name
Name of
organization
Post
From Upto
Main activities of
organization
Your
Role
Name
Source of income
Name of property
owner
Details of
property
When
purchased
Current market
value
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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 each
assembly constituency?
Assembly constituency
No. of members/volunteers
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 Address
Assembly
Constituency
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8
Phone
No.
Signature
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100
Note: - Your application shall be deemed rejected for giving wrong and incomplete information of
the proposers.
11
AFFIDAVIT
Date: .
Deponent
12