State: ………………………………….. Lok Sabha Applied for…………………….………….. Form-A L O K S A B H A CAND I D A T E DETA I L S (PERSONAL INFORMATION) Name: ----------------------------------------------------------------- ----------------------------------------------- Gender: -------------------------------- D.O.B.: --- ------------------------------ Phone (Mobile): ---------------------------------------------- ---------------------- Phone (Landline): ---------------------------------------------- ------------------ E-mail: …………………………………………………………………………… Photo Education Qualification: ……………………………………………………… Year: ………………………………………………………….. If Student then College Name: ------------------------------------------------------------------------ --------------------------- Address:
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State: ………………………………….. Lok Sabha Applied for…………………….………….. Form-A
3. Have you or your family member ever been convicted for any offence or any Case/FIR’s pending. If yes please give the detail below& enclosed detail report along with this form.
S.no. Name of the Person CaseNo. Detail of Section Detail of
Case
In which year case has been started
PresentSituation
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4. Do you or any of your family member are part of any political party. If yes then mention.
S.no. Name of thePerson 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 ContestedElection Year Party
NameHow 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 organization Post From Upto Main activities of
organizationYourRole
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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).
15. Do you have a team apart from party volunteers? How many team members/volunteers you have in each VidhanSabha?
Vidhan Sabha No. of members/volunteers
(List of members/volunteers with name and phone numbers has to be provided)
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A F FI D AV I 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. I’ll 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. I’ll 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. I’ll 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. I’m committed towards Janlokpal bill & Electoral reforms. I’ll put my full efforts to bring suchlaw/s at the earliest.
6. Govt. should not acquire any land without the permission of public. I’ll put my full efforts tobring 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
List of 100 Proposing Voters from E A C H V I DH A N S A BHA 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. Name Complete Address Vidhan SabhaPart No. & S.No. in Voter list