FORM2A

(See rule 4),

NOMINATION PAPE~
Election to the House of the People
Re~~nt$mp, size

\ (2M

pho) I
",1111
buCt
full fa~e view c",
'b'eatIfIcheJ.

~,\~~
STRI[(E OFF PART lOR PART II BELOW WHICHEVER IS NOT APPLICABLE
PART I
(To be used by-candidate set up by recognised _political patty)
.,
I nominate as, a candidate for election to the House of -the. People from
the , , Parliameataryconstituency.
'
,an
C , didat '
"~ nwe' ','" ,a fue,r'sf'rnoith er,'sib" usb-an d'~
F '_ ,
,s nanle .
. .. , ,..-,, ",'" "llispostal addr~.~s.::.: .. :. :' I.~:.: , : _: ; : ~.
His name is .entered at S'.No .. in 'Part' ,;"No....................... of -th~ 'electoral roll
for , 1(Assembly constituency comprised within) , Parliamentary
,- I, " ,
Constituency. , > .. •
My name is , :..,.. and it is entered at S.No in Part
No of the electoral roll for , i.: ;. (Ms~mbly constituency

comprised within) ' Parliamentary constituency.

Date , . Signature of Proposer

PARTU
(To be used by candidate NOT set up by recognised political party)

We hereby nominate .as candidate for election to the House of the People- from
the .... ~q.,..A.~.~A+a.-, ...Parliamentary Constitaency
,
ididat
Can a e s I name
- "A --~ -~ ,.jN- ...• (.~~~:r........
..J.~~I!'k1'A-< ,
/) ~ /' b~
,
'?b blis4'
Fa theer iI's/m,gtaeFj !~c.~ ~ S
name,.I}t.~a.a... ..IJd.htA .....His postal address.B.l.~.~:l.'../).N...~,/!.(!.-r,.K:;~~~i
,f) 1-.'1 ~ __lI
.'~~".r;'I~·.,·-·t<:··· .7.1
7Jrtn'''7 ~LI1A-h7,
, "L-r'7 - I

1
 / ·V/
His name, is entered at S.No.,..l.~~ .in Part No .•....lk.J.~ ofthe electoral roll for
...I..t3...4.i1~~ , Y(AssemblY constituency comprised within)
....... A.Q.J .. ;/J.el;~A~.~ , Patliamentary constituency.

We. declare th~twe are electors of the above Parliamentary Constituency andour names are
entered \)1
the electoral toll for that Parliamentary Constituency as indicated below and we
append ok· signatures' below in token of subscribing to this nomination.-e-

Particulars of the proposers: and their signatures

I
Elector Roll No. of Fun~Name Signature Date
Sl.no. Name of
, *1 fu
component Proposer
whic
Part No. of
I
Assembly S.No.m
to....
Constituency Electoral that part
,
, I
Roll
6' 7 gene
1 2 3 4 5
"'" mor
~~, I3/Sl,lIl1.. J)~ J ,~~S4. 1 ·-!f/·3·:4:>1'f
1.
2.
'-'~'k'1-;
-,.1/1-- l~~J
,>5''/
.,.'.*~ ~~ti( IIt'J.~~aq~ ~ ~).
3. Dat
4.
5. TSC
6. Ka:
anc
*SI
**'
N:
Cc
co
PARTm
I, the candidate mentioned in Part Wart n (Strike out which is not applicable) assent to
this nomination and hereby d~4tte-
(0) that I am a citizen of India and bave not acquired the citizenship of any foreign
State/¢6UJitIy . (J
(b) that 1 have completed. f.Q. ;~ years of age;
[STRIKE'OUT cCi) or c(ii) BELOW 'WHICHEVER IS NOT APP~ICABLE]
( C-)C')th
1 at I_ am set
," up at this e1"
,ect;J.Qn,y
b,.LL
U1~., , ,,/-1')"
' '" ,I.· , ..•

.party, which is.a recognised' Natlon~lp~lStAte Party in this. State and that the
. ~.' symbolreserved for the above partybe allotted to .me. ,"
OR' .
2

.... , • 0: ~
or (C,)~(-:~) u iLaam set'-,up at thi
11 that ms eT'ecnon /lA""~t$J
~', by thee ~IIJ< ~ •[~.L.._•..•(II-.}.,.!
.•••..••••...•• ~ J~liD"'WJ"ii11ll-'
':":.:~'.~J: ,.. r"(IJ.Cl {c
n} party, which is a registered-unrecognised political party/thar 1 am ~9Htestmg tlris:
e1ectj6n,..as ~ ineej3e:aaefit candidate. (Strike out which is not applieable) and thar
the symbols I have chosen, in ordet 'of preference, an~;-
(i).., ~li1.JL , (il) ..r.A~ (iii)_ 7J.it;,tk ~~ ~.
,(d) that my name and my father'si.GlQ~~ll5~tl'B:d's name have' beeti correctly spelt out
above in.... £:1.p.tY-.........(name of the language);
(e) that to, the best of my knowledge and belief, 1 am qualified and not also disqualified
for being chosen to fill theseat .inthe House.ef the-People.

·1. t:.loWUJer ec'1are' tha,t I am a mem

.....'" ~ de ' be r .0~fthe . ~~ H /1 ,. ,.... **r:
""a~et' /tribe
, .
which is .a seheduled **cast:~/tribeof the State of ;c .t./:~ _., in relation
to hIA.., (area) in, tll:at State.
1 also declare that I .have not been, and shall not be nominated as a candidate at the present
general election/the bye-elections being held simultaneously, to the House of the People from'
)/1 more than two Parliamentary CONstituencies.
si:s."
I~,J./f };~
lV"\:tIo Signature of Candidate
t ·3·t~ i
"Score out the words "assembly constituency comprised within" in the 'case of Jammu and
~'tf
,".3. I, Kashmir, Andaman and Nicobar Islands, Chandigarh, Dadra and Nagar Haveli, Daman and Diu
and Lakshadweep,
''''3''' , *Sco~eout th:is p~~~~pb. ifnot applicable.
U'~'f
Io.t **Score out the words not applicable.
;3~" N.B.-A -"recognised. pOlitical party" mean's a political PartY recognised by the 'Electi6n
Commission under the Election SYmbols (Reservati(,)R' and Allotment) Order, t968 in the S.f!ite
concerned.

PART IlIA
(To be filled by the candidate)
(1) Whether the candidate-
(i) has been eonvicted-
(a).of any offence(s' under sub-section (1); OF
(b) for contravep.ti.on otany laW &pecified in,sub';section,(2),
of section 8 of the Representation of the People Act, 1951 (43 .of 1951); or
(ii) has b~en con'l/:icted"forany :Q~heLoffence(s) fot w±ijch;he has. been
sentenced to imptis'Onment for two years or more.
3

,< •
 I
lof any
If the.answer is "Yes", the candidate shan fW:.nlshthe follo'Ying information:
IGoveri
l_tfYes
.- 'fit. s t .:'-~
( 1,")C as.er
e,i) Police station(s}
. ti1.0n 'report
ll1Lorma 1'(0;tNos
.' _1I.'t _ ' ."

:Nil
IVJ
.
OJ.

, .......
fWhethf
Distrions) " ,N t) ~. State(.S) ,.~f. ".., , .
ICarpOI
(Ui) Section(s) of the coneemed.Acus) and brief description of the· o{fence(sJ for which he
has been convicted .. , ; .." 'N.~ ; ; ' " . 1 Gaven
(Yesn
.
........_ ' ' '" / .
·".N.'.} , '.' _1 \,
','.' . l

-lfYe
(iv)Date(s) of eonvictienl s) ; f::; 1., .
ev) C(;mrt(s) which convicted the candidate 1:'J.~ , , .
(vi)Punis~ent(s) imposed [indicate period of imprisonment(s) .and/or quantum of ~ Whet
said I
fine(s)] , .!>l.~......•....
~lfyt
(yii) Dateis) of release fiol1l prison 1Y. ~L , ".
(viii)Was/were any appea1(s)l.reVi$ion(s) filed against above cenvietioru s) ;...
Ye·s(No
(ix) Date and partichlar.$·ofappea1(s)/appMcation~s)for revision filed _ , .
................. ,~ t1/J . 'lace: 1
)ate; .,
(x) Name oftbe ceurns) before which the ~ppeal(s)/iappH~ation(s) for revision filed .
•• •.•••• e " ••• _., •• -, tl.1J.. ; ..
(xi) Whether the said a:ppecd(s~hipplication(~) for revision has/have been disposed of or
,
is/are 'pending .....•... I
I. • 1
(xii) lithe said appeal(s)/atmUc3tio~(S) fQr revj~om has.1have been disposed of-- Serta
(a) Date(s) efdisposal. N.!l .
Ib-' N·tor 'f· d-' (-)
\' 1: a, eo or er & pas_e 'S' -d Nl! ' ..
{2) Whether the cimtliClafe is holding, any office ·ofprofit under the Government of India or State
.......
G'.O,ve
....--
4llUen-t?.. I.·~I....
I() _ (~T
.,.. .~ l.~O1.\
- -'l'
- If Y 6&,' deta ,we 0 ffi ce.h eId
l.g 0f·"1.., :I,UJ- " '.' .
Date
(3) .Whether the candidate has been declared insolv~nt by any Court? "~~~'" (~lNo)-
-If Ye$,_has he been discbarged from insolvency .. !:-Ilk:.....
(4}Whether the. candidate is under allegiance or adherence to any foreign
Cdub.try1 .. r1~·~.~o)
-If Y ~s,_give details -I!Y.•• 1: , '.": .,.... ..;..
(5) Whe.ther the candidate has been disqualified under sec.tion 8A of tne' said Act by an' order of
the Preside~t?.....!.~.Q~..... rtes/No) . ",

-If Yes, the period for which disqualified tj.fr .

(6) Whether the candidate was dismissed for corruption 01: for disloyalty while holding office
under the Government of India or the Government of any State? .. ~'l?..(¥dlNo)
-If Yes:,.the date of such dismissal. . IN.. J}~ "",
(7) Whether the c~didaw has any subsisting contract(s) with the ,Gover:nment eithex in
individual capacity or by truSt or partnership ,in which the candidate has a share. for supply

"
 of any goods to. that Government or fOJ: execution of works undertaken by that
Government?...p/,t:J ..... (¥esINo) .
•lfYes, with which Govemment and details of subsisting contract(s):•. I¥'~:":';":':"""M'"''''
I · · · ,·;···.···14·(}.· .. ·.. ·.. ·· .. ··.. ·,···, " - <." .•~.- .. ~ .. ,

............. . ether the candidate is a managing agent, or manager or Secretary of any company or
Corporation (other than a cooperative society) in the capital of which. the Central
for which he ,-, , (
Government or State Government has not less than twenty-five percent sliare?~o. ....
....., ..
................... (Yeshlo)
~lfYe$, with which Government,and the details thereof .. <co" ,•• IN.Ff.. , ..
, .
[Uantum of
~~~~~~'ili~'~didate has been disqualified by the Cominissiori under section lOA of the
said Act ..•.•. (YesINO)
$:......
-If yes, the date of disqualification N.ft. .
t .

., .
_r;~
Signature of Candidate

~d .

PART IV
ised of or . ~ .,._.J.. ..-,. _ -
(To be fll1edby, the Re~'( g Officer)
~erialNo. of nomination paper .... ,Db.).\w"J2..Ql~.
. nOmillatiQn
This _ .' .
was ~t . to me at my ornce
d elivered' ~ R() at ;lAa. ~ :.... QUf en )
n.. ~\\":>\f).t)~~
..
(date).by the .·canMdatelpropeser. (name of proposer .
a or State ........................... )

~
Returning Officer
Date - , ..

PARTV
foreign
~~ion ~f RetumiDg Officer Accept,ing or Rejecting the Nomin~tion ]!aper
r have examined this nomination paper in accerdanee with seenen 36 of the
Representation of the People Act. 1951(43 of 1951) and: decide as follows:-
'der of
t " .••• ,. II ~ "_,, ~ " ~ '" , ~ •• ; _" • '!' • • ~ , ..

• ••, " " " t .. "!' 0:' '! , ' "!" ' , t,. f··" .
•••••••• 10 ••••• "' ••• - "' '! •••••• ' ,

ace

ther in
Date................ Returning Officer
............................................. :.' (Perforation) ····.. ······ ·.. ··.. ··
supply s
 lARtVI
Receipt for NondnatIon Papef and Notice of~Scrutiny
(1fobe handed over to the person presentihg the Nomination Paper)
SerialNo. of nomination'paper : :.•
The nomination paper .of. ' '..;.- 8 candidate for election. from'
the.... P8iliamenta:ry' constituency was delivered to me at my office I
at (hour) on, (date) by the *cap.didate/proposer. All Domination papers
will be taken Up {or scrutiny at, (liour) on , (date) at. - .
............. (Place).

Date , Returning Officer

·Score out the word not applicable.

{,
i

"1

\.

6
 '''-
3111\S~1I OOISHA

FORM-26
(See rule-4A)

BEFORE THE NOTARY PUBLIC, BERHAMPUR, (OM) .

AFFIDAVIT
Affidavit by the candidate along with nomination paper before' the
f.eturrung Officer for election to Lok Sabha (Name of the House) from
Berhampur Parliament Contituency-20 (Name of the Constituency)
S PART-A
.,
~ 1, Somanath
Behera, Son of Prabhakar Bebera, aged about 40 years,
Resident of R ..C. Das Lane, Karnapalli, PO'Kamapalli, Berhampur, PS:B.N.Pur,
pistGanjam, Pin-760004, Odisha, a candidate at the above election, do hereby
solemnly affirm and state on oath as under:
! (1) I am a candidate set up by Socialist Unity Center of Indi~(Communist),
SUCI (Communist)

I (2) My name is enrolled in 133 Berhampur Assembly Constituency, Odisha

(Name of the constituency and the State), at Serial No.74'O in Part No. 155.
p.".~ th. .
Forma
,"idavtt "~.ttf t _

BHAGBAl1'~A1r~
NOTARY
~ERH"II .. _ ~"-_ ~
 ~
7r~Jast/ryOfficer
·':iD~l;/a, TI~dsllrv. BE!rhantl'"

RATA !<U. R
('TAr 'P VENDOR
;, ..., 'J. ~- B/~M
~1\/'l caUR I . ~
 2

(3) My contact telephone Number(s) is Cell: 9861536614 And my e-mail id is

: somanatb.india@gmail.com and my social media account(s) are
i) somanatb.india@gmail.comlfacebook
ii) 9861536614@Wbatsapp
(4) Details of Permanent Account Number (PAN) and Status of filing of
Income Tax return.

Sl. Names PAN The Financial year Total Income shown in

No. for which the last Income Tax return (in
income-tax return Rupees) for the last five
has been filed Financial Years(as on the
31st March)
~ ;

1. Self DUVPB1553H Nil Nil

Nil
N'1
.1
Nil
Nil
2. Spouse Ni I Ni I Nil
Subhasrnita Nil
Panigrahi Nil
Ni 1
Nil .

3. HUF(if the Nil Ni I Nil

Candidate IS
..v Nil
, Karta or
Nil
Coparcener)
Nit
N u
3. Dependent-l Nil Nil Ni 1
Anirban Nil
Goutam
Nil
Minor son
Nil

Ni 1 .
4. Dependent-2 Nil Nil Nil
Ni 1
, Ni 1
; '.
Nil
- Nil
.~or~~ Dependenl-3 Nil Nil N i.I
Nil
. If. ~~ . Nil
~G8A'SAH Nil
'ff.HAIIPilR (Gm~1 I. Forms~a'jJf
Lt.
bi_
, No" 0"1211991 .A -~mD"V ~:i#U NiI
,..... . ~.~J BHAGB~
fn~~ NOTARY
_.-n· ~"'Pl)~ tGM.)
 3

(5) Pending criminal cases

(i) The following criminal cases are pending against me:
Table
(a) FIR No. with NOT NOT NOT
name and APPLICABLE APPLICABLE APPLICABLE
address of Police
Station
concerned

Case No. with NOT NOT NOT·

(b) Name of the APPLICABLE APPLICABLE APPLICABLE
Court

(0) Section/a) of NOT NOT NOT

concerned APPLICABLE APPLICABLE ~PLICABLE
Acts/Codes
involvedtgive no.
of the Sections,
e.g.
Section of
lPC, etc.)

(d) Brief description NOT NOT NOT

of offence APPLICABLE APPLICABLE APPLICABLE
Whether charges NOT NOT NOT
have been APPLICABLE APPLICABLE APPLICABLE
(e) framed(mention
YES or NO)

(f) If answer NOT NOT NOT

against/e) above APPLICABLE APPLICABLE APPLICABLE
is YES, then give
the date on which
charges were
framed

(g) Whether any NOT

NOT NOT
AppeaI/Applica.ti APPLICABLE

40~~
It:~ -,.~ ~ :..
f ~e~e~;: against the
APPLICABLE APPLICABLE

/"* . B.::RItHAGgAN 14Hb~~

~
r,.~ ~ ~~~roceedings(Me~
t!tlon YES or NO)
I Q
!

...A.MPuR rCm J It ~
, Forms part o~
~ 0.t. Regd_}(o.ON211~; t:_-1Jir-----__J-------___L_~J>."mj~aa~mlf~~I.~.
_
'f"~
~.r:ttJ.bt-:,:::;t:i'-----j.
,~~ ....,.!,:' \S~v BHAG~~ SAHU
<,
._-",'
00"
~.-----
.~ NO'TARY
RERHAMPUR (GI\JI.}
 4

(6) Cases of conviction

(i) I declare that I have not been convicted for any criminal offence.
OR
(ii) Ihave.been
convicted for the offences mentioned below: NOT
APPLICABLE
Table
(a) Case No. NOT NOT NOT
APPLICABLE APPLICABLE APPLICABLE
(b) Name of the Court NOT NOT NOT
APPLICABLE APPLICABLE APPLICABLE
(c) Section(s)of NOT NOT NOT
concerned Acts/ APPLICABLE APPLICABLE APPLICABLE
, Codes involved(gjve
no. of the Sections,
e.g. Section. ,...... of
lPC, etc.)

(d) Brief description of NOT NOT NOT

offence for which APPLICABLE APPLICABLE AP.PLICABLE
convicted

(e) Dates of orders of NOT NOT NOT

conviction APPLICABLE APPLICABLE APPLICABLE
(f) Punishment imposed NOT NOT NOT
APPLICABLE APPLICABLE APPLICABLE
(g) Whether any Appeal NOT NOT NOT
has been filed APPLICABLE APPLICABLE APPLICABLE
against conviction
order(Mentioned
YES or No)

(h) If answer to(g) above NOT NOT

is YES. give details APPLICABLE
NOT
APPLICABLE APPLICABLE
and present status of
appeal

(6A)I have given full 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
/y~~;.. paragraphs(5) and (6).
/,"
0.
:.<~ ",
-//\- . A~
~.
,
. "H'
,>-t { ,
~:. C:~~~t.lPI)P(Grn,
•
GB,III t
Iil".1~
H'U *'~ ~.
t
\..
Forms part of th~
'ffjda~
" • \ '=-~a 'I' ON 'lJ1'~1
.- .\("1~
'
'1"(
•
-. '\,
,: ~ _/ c;~J
." A'"
BHAGBiI.i£)§~Z
.\~~.c >_ ': OO;_.~ NOTARY
... ~ ~ .
.-~- .", -

RERHAMPUR (OM.~
 5

(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 :

S.No .. Description Self Spouse HUF Depend Depende Depende
ent-I ot-2 nt-.3
(1) Cash in hand 5,000 NIL NIT.. NIL NIL NIL
<
I (ii) Details of deposit in lOB, Giri Road, NIL NIL NIL NIL NIL.
Bank Accounts Berhampur
(FDRs, Term Branch vjde SB
Deposits and all Ale
other types of No.048501000022
deposits including 440 (Ele.ction
saving 'accounts), purpose) as on
Deposits with 19.03.2019
Financial Rs.2,00O/-
Institutions, Non- SBI, MCC
Banking Financial!Branch,
Companies and Berhampur vide
Cooperative Afc No.34919551
Societies and the 294 as on
amount in each such 20.03.2019
deposit. Rs.5.000/-
(iii) Details of NIL NIL NIL NIL NIL NIL
investment m
.
" , Bonds,
debentures /
shares and units
ill companies /
Mutual funds and
other and the
amount
(iv) Details of NIL 'NIL NIL NIL NIL NIL
investment ill
NSS, Postal
Savings,
Insurance Policies
and investment in
any Financial
Instruments m
pm!t Office or
I
Insurance
Company and the
amount.
(v) Personal loans / NIL NIL NIL NIL NIL NIL
ivanee givento
. 'OTJ l~ y person or
.~ - ~ty including

*~ MAGSAI SAH
BERHAMPU (Gm., I
' company,
t etc., and
oth ~ receivables
2.11991 ~ "'h debtors and I

~~ amount. F< rms pa rt of tht'

pO~~ ."l idavit II.&.~.
~~ ~
BI~AG~
~.Oj._(
NS ~a'U
_I..- !T
I"I"_'
A...D
• " -
IV
RERHAMPUR (GM.,
 6

(vi) Motor vehicles / Baj aj Platina NIL NIL NIL NIL NIL
Aircraft I Yachts/ mlc 2 wheeler
Sbips(Detmls of bearing Regd,.
Make" NO.OD07J
registration 8297
Number etc. and
(Appro x,.
year of purchase
and amount) 25,000)
Jewellery, bullion NIL NIL Nil Nil Nil Nil
and valuable
I things(s) (give
(vii)
details of weight
and value)
(viti) Any other assets NIL NIL NIL NIL NIL NIL
such as values of
claims / interest
(.ix) Gross total Rs.37,000/,. NIL NIL NIL NIL NIL
Value
B. Details of Immovable Assets:

S.No. Description. Self Spouse HUF Dependent-I Dependent-z Dependent-J

(i) Agricultural NIL

Land NIL NiL NIt NIL NIL
Location/ s) Survey
Number(s)

Area (total NIL NIL NIL NIL NIL NIL

measurement in
acres)

Whether inherited NIL NIL. NIL NIL NIL

,• NIL
property (Yes or
No)

Date of purchase in NIL NIL NIL NIL NIL NIL

case cf'self-acquired
property.

Cost of Land (in NIL NIL NIL NIL NIL NIL

case of purchase at I

the time of
purchase)
,
o TJl ~ ~
Any investment on
the land by way of
.NIL NIL NIL NIL NIL NIL

I.HAGBM.: SA ~ .,
8ERHAMPUR fG .} .
Rsgd. No. ON Zl1! bI
* ~ evelopment
pnstmctlOO etc.
~pproximate current NIL NIL NIL NIL NIL NIL
_--' t?~~" market value
•. Irl\:'- . -
~OFO,"
-~.~.'
....
--
: . ~orm. Dan nfth.
.. ~m~avit kl .....
..[,{,J1 _

_f'{J-~ BHAGB~~AW0
NOT4RY
 7

S.No. Description Self Spouse HUF Dependent-I Dependent-2 Dependent~3

I

(Ii) Non- NIL NIL NIL NIL NIL NIL

Agdcultural
f
"
,-
Land

Locatiorus)
Survey
Number(s)

Area (total NIL NIL NIL NIL 'NIL NIL

measurement in
sq. ft.)

Whether inherited NIL NIL NIL NIL NIL NIL

property (Yes or
No)

Date of purchase NIL NIL NIL NIL NIL NIL

in case of self-
~ I 'acquired ,

property.

Cost of Land (in NIL NIL NIL NIL NIL NIL

case of purchase
at the time of
purchase)

Any investment NIL NIL NIL NIL NIL NIL

on the land by
way of
development
construction etc.

Approximate NIL
.
y
'current market
NIL NIL NIL NIL NIL
value
-.:..I-,

_!4~A

Form. pan of tl'M-

'"i~a~(M,(}!.JlOIQ
BHAGBAN SAHU
"OT,A RY
8ERHAMPUR (GM.)
 8

S.No. 'Description Self Spouse HUF Dependent- J Dependent-z Dependent-S

(iii) Commercial Building NIL NIL NIL NIL NIL NIL

(Including .
,

apartments )Location( s)
Survey Number(s)

Area (total NIL NIL NIL NIL NIL NIL

measurement in sq .ft.)

Built-up area (total NIL NIL NIL NIL NIL NIL

measurement in sq. ft.)

Whether inherited NIL NIL NIL NIL NIL NIL

propertyIYes or No)

Date of purchase in NIL NIL NIL NIL NIL NIL

case of self-acquired
property

Cost of property (in NIL NIL NIL NIL NIL NIL

case of purchase) at
the time of purchase

Any investment on the NIL NIL NIL NIL NIL NIL

.., ,
.land by way of
development,
construction etc.

I Approximate current NIL NIL NIL NIL NIL NIL

market value
, - ..

Forms pan of thtl

"fida~

~Ml1
E-HAG8~ SAHU
·OTARY
~~:~.t\MPUR
fC~t.
 9

S.No. Description Self Spouse HUF Dependent- Dependent-z Dependent-

[ 3

(iv) ReSidential Bnilding NIL N1L NIL NIL NIL NIL

(Including
apartments)
I Locationrs)

.Survey Number(s)

Area. (total NIL NIL NIL NIL NIL NIL

measurement in
sq.ft.)

Built-up area (total NIL NIL NIL NIL NIL NIL

measurement in
sq.ft.)

Whether inherited NIL NIL NIL NIL NIL NIL

property (Yes or No)

pate of purchase in NIL NIL NIL NIL NIL NIL

case of self-acquired
property

Cost of property (in NIL NIL :NIL NIL NIL NIL

case of purchase) at
the time of purchase

Any investment on NIL NIL NIL NIL NIL NIL

the land by way of
development,
construction etc.

Approximate current NIL NIL NIL NIL NIL NIL

market value
(v) Others/such as NIL NIL NIL NIL NIL NIL
.interest in property)

(vi) Total of current NIL NIL NIL NIL NIL NIL

~ market value of
• 0~~~o(V) above

HAGBA'·JA~ ~ ,
I BERHAM~Ufl(Gm.J )
\Regd. No. O~2/1991
* J
Forms part 0f thF'
&'ffid;lV~J4

BHAGBAN SAHU
2¥'..tOj.ao'l
,,_ ~:i
NOTARY
P"ER~l t\MPUR (Gl'..~.)
 10

(8) I give herein below the details of liabilities. / dues to public financial
Institutions and Government:

S,No. Description Self Spouse H1JF Dependent- Dependent-2 Dependent-S

1

0) Loan or dues to NIL NIL NIL

I
NIL NIL NIL
Bank / Financial
Institution(s)

Name of the Bank

or Financial
Institution,
Amount
I
outstanding,
Nature of Loan.

Loan or dues to NIL NIL NIL NIL NIL

any other
NIL
individuals.' entity
other than
mentioned above
Name(s) Amount
outstanding,
nature of loan

. Any other liability NIL NIL NIL NIL

.
NIL NIL

...
Grant total of N1L NIL NIL NIL
.
..:;":'.:......... liabilities
NIL NIL
~ " _.d~ ~
:~ ~~

Forms part of th" .

'ffida~
~,,,_g ,a.cI;
BHAGt::rAN SAHU
NOTARY
r.~r:t.
-_. ~"'PUR
1]\-'\lIft • (-t_~!,r.
\.0J
 11

(ii) Government (A) Has the Deponent been in occupation of v

Dues: .Nil accommodation provided by the Government at any YES/NO
Dues to time during the Iast tell years before the date of (pl.tick the
departments notification of the current election? Nil appropriate
dealing wi th (B)lf answer toeA) above is YES, the following alternative)
Government declarationmay be furnished namely.- Nil
accommodation (ij'The address of the ·Government.accommodation
............... Nil .
(ii)There is no dues payable 10 respect of above
Government accommodation, towards..
Nil (a)rent;NiI
(b)electricity charges.Nil
(c)water charges; Nil and
(d)telephone charges as on NiL. (date)

(iii) Dues to department NIL NIL NIL NIL NIL NIL

I dealing with
Government
transport(including
aircrafts and I

helicopters

(iv) Income Tax dues NIL NIL NIL NfL· NIL NIL
Self Spouse HUF Dependent-I Dependent-Z Dependent-S
.~

(v) GSTdues NIL NIL NIL NIL NIL NIL

(vi) Municipal/Property NIL NIL NIL NIL NIL NIL
tax dues

(vii) Any other dues NIL NIL NIL NIL NIL NIL
. (viii) Grand total of all NIL NIL NIL NIL NIL NIL
Government dues

(ix) Whether any other NIL NIL NIL NIL NIL NIL
liabilities are in
dispute, if so,
mention the
.. -.:t-~ ,.
amount...involved•
,.-:.;:::. ~. and the authority
.,/Y :~ 0 T~ .<)~ before which it is
ilk' ~ - -.of\"~
~HAG8AII SAHU . il
~~nding
I
i I"">
\J I
I :ERHAMPUR fG.• , )"*
'-Jd, No. ON ("'lal rl.
Forms part of thp

~~ 0.. ." v- ,I ~ffidav'it

~O_9,&O!r
~.

\. ~ '-..__ ~f"\-:>//
'\'"
c.1I' .
, I)r:- BHAGBAN SAHU
... • • ... t \.,) \J_ .."'-
<. I ":.:;":' ..:~\::~_"'_ "
NOTARY
pc~ ~?VlPIJR r~.
 12

(9) Details of Professton or occupation:

(a) Self : Social Worker
(b) Spouse : Student/Social Worker

(9A).Details ofsource(s) of income:

", (a) Self Nil .
(b) Spouse Nil .. '"
(c) Source of income, if any, ofdependents
I Nil

(9B)Contracls with appropriate Government and any public company or

companies:
(a) Details of contract entered by the candidate Nil.
(b) Details of contract entered into by the Spouse Nil ,
(c) Details of contract entered into by the dependents Nil , , .
(d) Details of contract entered into by the Hindu Undivided Family or trust in
which the candidate or spouse or :dependents have interest Nil '
(e) Details of contract entered into by Partnership Firms in which candidate or
spouse or dependents are partners , .. Nil .
(f) Details of contract entered into by private companies in which candidate or
'spouse or dependents have share.. , Nil , .

(10) My Education Qualification is as under:

Post· Graduate in Odia from Utkal University, Bani Bihar,

Bhubaneswar, Dist:Khordha Odisha .in the year 2002
PART-B
(11) ABSTRACT OF THE DETAILS GIVEN IN (l)TO (10).oF PART-A
1. Name of the Candidate Somanath Behera
.2. Full Postal Address R.C. Das Lane, Kamapalli,
PO:Kamapalli, Berhampur,
PS:B.N.Pur, Dist:Ganjam, Pin-
760004, Odisha
3. Number and name of the constituency 133Berh~mpur
.' and State. Assembly Constituency,
State-Odisha
4. Name of the Political Party which set Socialist Unity Center of
up the candidate (otherwise write India(Communist),
I 'independent)
SUCI
(Communist)
of pending criminal NIL

Forms part of thp

.l\ffjdavit~
/? ~&~/r
.JNYL.~ BHAGBAN'SAHU
NOTAR.V
 13
'~

7.- PAN of Year for which last Total Income

Income Tax return shown
filed

(a) Candidate DUVPB1553H NIL NIL

(b) Spouse NIL NIL NIL
(c)HUF NIL NIL NIL
(d) Dependents NIL NIL NIL
8 Details of Assets and Liabilities(including offshore assets) in Rupees
Description Self Spouse Dependents
A. Moveable Assets (Total Rs.37,OOO/- NIL Nil
~
value)
B. Immovable asset Nil Nil Nil
1. Purchase price of Nil Nil Nil
I
self-acquired
immovable
property

II Development I Nil Nil Nil

construction cost of
immovable
property after
purchase (if
applicable)
~
ill Approximate Nil Nil Nil
current market
price of Self-
acquired assets
I (Total value)

Inherited assets Nil

(Total value) I

~O_!~~
. ~.A
~ 'HA1i841SAlt
8EIIHAMPtm
~~No.ON:~J
... , . 911 ~.
*
I
Farms pan' 6l' lfif,

. ·OFOO\~~ ~1f1.'V~~

" BHAGBRlf~~H
NOTARY
'.' - '.JR (GM.)
 14

9. Lia bilities
(i) Government NIL NIL NIL
dues(Total)

(ii) Loans from Bank, Nil Nil Nil

Financial
Institutions and
others(T otal)

lO. Liabilities tbat are under dispute

(i) Government Nil Nil Nil

dues (Total)

(ii) Loans from Bank, Nil Nil Nil

Financial
Institutions and
others(Total )

U. Post Graduate in Odia from Utkal University , Bani Bihar,

Bhubaneswar, DistiKhordha Odisha in the year 2002.
..!

VERIFICATION
I, Somanath Behera, 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 hem 5 and 6 of part-A and B above;
(b) I, my spouse, or my dependents do not have any assets or liability, other
than those mentioned in item-? & 8 of Part-A and items-B, 9 and 10 of
Part-B above.
Verified at Berhampur(Om.) this the ... ~day of March 2019
., Identified by :
. M~~
~~ti-@f1
Advocate.
DECLARATION £~
T'h~ declarent have been ider.tified DEPONENT
oy ~ ~.;:-:;..........................•...•..
Ad·:e~.;"e ~ .... sclemnty aff'irmed
bfore me on this the ~~~ .." ..day
of J1.a.¥..~ 201'1)~/.~AM1PM
Contents having been reado~r ,
explained, the declarent who seemed to
have perfectly understood the contents
the theme of moving this affidavit.
No •••••• Af.f.r...~...
and _"'A. d? ..<i!.4/~ ..•.
O a t. • AIr. •• Y••
~M ~'me
\. ......
~9:'·.1y.f!lM.......
1
t.. 0 iN{-,Mfl
Serhampur (Gm.~