State: ..

Lok Sabha Applied for...

Form-A

LOK SABHA CANDIDATE

DETAILS
(PERSONAL
INFORMATION)
Name:
---------------------------------------------------------------------------------------------------------------Gender: -------------------------------- D.O.B.: ---

Photo

-----------------------------Phone (Mobile):
-------------------------------------------------------------------- Phone
(Landline): ---------------------------------------------------------------E-mail:

Education

Qualification:

..

If

Student

then

College

---------------------------------------------------------------------------------------------------

Year:
Name:
Address:

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Whether you belong to any special category SC ST

OBC
Details in electoral roll: S.no. In

part

no.

Vidhan
Sabha
...Lok
Sabha...
Note: Where ever the word used Family, It means Parents, spouse (Husband or Wife) and
Children (If unmarried, then family means Parents only.)

1. Your activity towards Janlokpal, Any other Andolan and Social Service etc. (Please give
details on separate sheet and enclosed with this form)
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2. Details of Family members:
S.n
o

Name

Relation

Age

Gender

Occupation

3. Have you or your family member ever been convicted for any offence or any Case/FIRs
pending. If yes please give the detail below& enclosed detail report along with this form.
Case
S.no. Name of the Person No.

Detail of Section

Detail of
Case

In which
year
case has
been
started

Present
Situation

4. Do you or any of your family member are part of any political party. If yes then mention.
S.no.

Name of the
Person

Party Name

Post

From

Up to

5. Have you or any of your family members ever contested in any election? If yes. Please Mention
Below.
S.no. Name

Contested
Election

Year

Party
Name

How much
Votes you got

How much
money you spent

Result

6. Are you or any of your family members a part of any social/revolutionary organization if yes.
Please mention below.
S.no. Name

Name of
organizatio
n

Post

From Upto

Main activities
of organization

Your
Role

7. Source of Income (About self and family members).

S. No. Name

Average yearly income

Source of income

8. Detail of property (About self and family members).

S.No Name of
property owner
.

Details
of
property

When
purchase
d

Value at the time

of purchase

Current market
value

9. Why do you want to contest the election?

-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

--------------------------------------------------------------------------------------------------------------------------------------------

10. Why should you be selected as candidate over other applicants?

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------11. If you have not been selected as candidate. What will you do?
Contest as independent candidate.
Try to get ticket from some other party.
Other (Please give details)
.

......
5

12. Why do you think that you will win the election?
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

13. For decentralization of power, have you read the SWARAJ book? What is your opinion about
that?
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

14. What strategies would you adopt to win the election? And how much expenses would be
required?
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

15. Do you have a team apart from party volunteers? How many team members/volunteers you have in each
Vidhan
Sabha?
Vidhan Sabha

No. of members/volunteers

(List of members/volunteers with name and phone numbers has to be provided)

AFFIDAVI
T
(To be submitted on Rs.10 Stamp
Paper)

Date:
.

I.son/daughter/wife of
Resident of
...
.. I take an oath to contest the election from Aam
Aadmi Party for
Lok Sabha

..
I will follow the under given points after winning the election:
1. I will not take Red Beacon Car.
2. Ill not take any unnecessary security. Security should be dedicated for Aam Aadmi
& not for their chosen candidate. Leader should not take any security more than
awaited to Aam Aadmi.
3. Ill not take any big bungalow & shall live like any other member of the society.
4. I agree with the concept of Swaraj & that governance should be directly in the hands
of public
& not in their chosen representatives. Ill give my full efforts to bring such a law but
till time such law is not passed, all the work in local area shall be done in
consultation with the local public.
5. Im committed towards Janlokpal bill & Electoral reforms. Ill put my full efforts to bring
such
law/s
at
the
earliest.
6. Govt. should not acquire any land without the permission of public. Ill put my full
efforts to
bring such law/s at the
earliest.
7. I have gone through the ideology & principals of Aam Aadmi Party and have also
understood the same & fully believe in it. I have also read the candidate selection
process & fully agree with the same.

I above name deponent do hereby confirm the above contents are true and correct to the
best of my knowledge & belief & that nothing has been concealed.

Deponent

1
0

List of 100 Proposing Voters from EACH VIDHAN SABHA of respective

Lok Sabha
(E.g. if there are 8 Assembly Constituencies in a Lok Sabha then 800 proposing voters
are mandatory)

We undersigned are the resident and voters of Vidhan

Sabha

and

we

proposed

the

name

of

as

the

candidate

of

Aam

Aadmi

Party

from

.Lok Sabha.
S.No
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Name

Complete Address

Vidhan
Sabha

Part No.
& S.No. in
Voter list

Phone
No.

Signature

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100
Note: - Your application shall be deemed rejected for giving wrong and
incomplete information of the proposers.

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