dr shaista neelofar - State Election Commission

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--.::---_.:..:::;- ·- -S1atutory A

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Certificate No. Certificate Issued Date

Account Reference

Unique Doc. Reference

Purchased by

Description of Document

Property Description

Consideration Price (As.)

First Party

Second Party

Stamp Duty Paid By Stamp Duty Amount(Rs.)

INDIA NON JUDICIAL

Government of National Capital Territory of Delhi

e-Stamp

IN-DL66180976075043P 01-Apr-2017 04:12 PM

IMPACC (IV)/ dl753203/ DELHI/ DL-DLH

SUBIN-DLDL75320332981219791119P

DA SHAISTA NEELOFAR

Article 4 Affidavit

Not Applicable

0 (Zero)

DR SHAISTA NEELOFAA

Not Applicable

DR SHAISTA NEELOFAR

10 (Ten only)

..

FORM-21 [See Rule 18(2)]

Affidavit to be furnished by the candidate before the returning officer for election to the No~ Delhi/South Deihl/ East Deihl Municipal Corporation from2 I Ma-b'o,, Mcv<blb. and name of the Ward)

I, lh·.S.b.9.tS.tP....N.t~~~n/dau~hter/wife of f'1,r.:,H~L~...f.l.Kht.%ged about...5..0...years, resident ofH•.No...21i.!1.,M.. ; ..···candidate at,the above ~l~ctio,Q, do he,reby s.olemnly affirms/state on o:Jthasunder:, ~ru.1 $hQn\<DA ~a,2-G\,1\ gt~ ~ Ue..lt-\t - llO OO(

1. I am not accused of any offence(s) punishable wtth imprisonment for two years or more in a pending case(s) In which 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 information:-

{ij Case/First information report No./Nos .............N.IJ............................... .. (ii) Police station(s) ...~.:.~...Dlstritt(s)....N.:.&..... State(s)... ...N.::.(t ...... .. (iii) Section(s) of the concerned Ac;t(s) and short description of t,he offence(s) for which the

candidate has been charged ............................... N.'...~........................... . (iv) Court(s) which framed the charge(s) .................N .~..t.\......................... (v) Date{s) on which the charge(s) was/were framed .........N . .'...I\......................... (vi) ~hether all or any cf the proceeding(s) have been stayed by any court(s) of competent

jurisdiction...... ............N.;..~................ ......... ...... ................

2. I have been/have not been convicted of an offence(s) [other than any offence(s) referred to in sub-section (1) or sub-section (2) or covered in sub-section (3), of section 8 of the Representation of the People Ac,, 1951 (43 of 1951)1 and sentenced imprisonment for one Year or more.

If the deponent is convicted and punished as aforesaid, he shall furnish the following Information:

(i) (ii) (iii) (iv)

VERIFICATION

I, t ~'&.llatnetl-lU'li-'nent, do hereby verify and declare that the contents of the affidavit are true and co • of my knowledge and belief, no part of it is false and nothing material has been concealedi'lt~i"iPfrr""

Verified at... ... .D.e..l.lJ/......... ... .............this.......Q3.....................day of ......l:rp:-r.t./..................:20..l.1....,....

TJ:0 ·Signature of deponent

Note: The columns in this form which tlh n~n. to t~deponent may be struck off.

j\llGIPRRN0 - 2378/SEC/2016-20.000 F r!\\SOT \' PUBLIC ~~< ~¥ DELlll (11\il)lA) <J

-. 1'R Z 1

INDIA NON JUDICIAL

Certificate No.

Certificate Issued Date

Account Reference

Unique Doc. Reference

Purchased by

Description of Document

Property Description

Consideration Price (Rs.)

First Party

Second Party

Stamp Duty Paid By

Stamp Duty Amount(Rs.)

e-Stamp

IN-DL66618813085556P 03-Apr-2017 01 :25 PM

IMPACC (IV)/ dl729203/ DELHI/ DL-DLH

SUBIN-DLDL72920333840579133981 P

SHAISTA NEELOFAR

Article 4 Affidavit

Not Applicable

0 (Zero)

SHAISTA NEELOFAR

Not Applicable

SHAISTA NEELOFAR 10 (Ten only)

..••. ·-··-···-· •.••... ___ ··--·--··· ....•.. ___ .Please write or type below lh1$ ltne.••....•... ___ . ____ ..••..•.... . ..... . ____ .... .

Statutory Alort:

1 !~'~n~Jl~~p~~~t1,i ~~~!1u7~:~;;e,~!~~.:~~fc.shoulu Ur. \--Cnfied .11 W't.~\· ~lKJ1h•.:ilntl1t1 'Ill I "''· 11 ,l~IJlJ, ltrf"¾ 11111 11 · ' it tits, '. It ' ·•·I ,,, ,, I ~ ~

2 The onus or checl,lng tho leg,umac-, "' oo the JSers of the cen,r,::ate 3. fn Cd$4:1of :i1ty rlw,,,np,JHt~y f•klirlht lf lfotrn UrH Comv,u1enLAult1011ty

AFFIDAVIT

I, Dr. Shaista Neelofar aged about 50 years w/o Mr. Habib Akhtar R/O

2284, Gali Shankar Bazar Sita Ram, Delhi-110006, do hereby solemnly

declare and affirm as hereunder:

1. That I state that I am contesting the Delhi Municipal Corporations

elections from the ward no. N-87, which is reserved for ladies.

2. That I declare that being a lady I am contesting elections for Swaraj

India from the above mentioned seat.

JW~~ Deponent

Verification: !9 3_ APR zO17 Verified at Delhi on this .~ -=- • . . . . - - day of April 2017 that the

contents of my affidavit are true and correct to my knowledge and nothing

material has been conceal there from.

V~biAf Deponent

~

I

•••.••••.••••.••••.•• ••••••••••.•.••• • . •.••.•.Please write or type below this line •••• ••••••••••• •••• •••••• __ ..•••.••• ••••.••••.

\•

Certificate No.

Certificate Issued Date

Account Reference

Unique Doc. Reference

Purchased by

Description of Document

Property Description

Consideration Price (Rs.)

First Party

Second Party

Stamp Duty Paid By

Stamp Duty Amount(Rs.)

INDIA NON JUDICIAL

Government of National Capital Territ~ry_of !?.elhi

e-Stamp

IN-DL66181188385495P 01-Apr-2017 04:12 PM

IMPACC (IV)/ dl753203/ DELHI/ DL-DLH

SUBIN-DLDL75320332980990086777P

DR SHAISTA NEELOFAR

Article 4 Affidavit

Not Applicable

0 (Zero)

DR SHAISTA NEELOFAR

Not Applicable

DR SHAISTA NEELOFAR

10 (Ten only)

S1ah1lory A lort.

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.

FORMZZ [See Rule 18(2)]

AFFIDAVIT TO BE FURNISHED BY THE CANDIDATE ALONGWITH NOMINATION PAPER BEFORE THE RETURNING OFFICER

- ~or Election to the Nort~i/South Delhi/Ec:tst Delhi Municipal Corporation of Delhi.

. From .N.::.i.~.,....2.J.,.J:1.~h:.a.....t1a.bo,L (No. and name of the Ward)

1 .lh.:..S.ha/sio....~.e.d,Qf!?_n/da~ghter/w'l(of M:r...):f.~i.b.....f.\Kh.t.~...... aged· ......5..0......years, · resid~nt of ..;)..'li~r--·4·o.L....S.t\Q.r.d{~,.:&a:2m..Sd:ri..Ro.c.o... (mention full' postal address), a •candidate at thl:! above election, do hereby solemnly affirm and state on oath as under:-(Strii<e out whictrever is iibt applicable).

(1) I am a candidate set up by .Sw.~..f~............ (name ~f the political party)/am contesting as an lndep~ndelit candt/Jate. U ,

(2) Detail of PAN and status of ffllng on Income tax retum:

S.No. Name

1. Self

2. 3. Depr?ndent 1 4. Dependent 2

5. Dependent 3 .<.':...... N I L

Permanent The flnanclal Account Numbl!r .,,.a, for whkh (PAN) the last lnc~me

tax return has been 1 ·

Tdtal Income shown in Income tlix return (In

. rupees)

(3) The followlne ,..ases(s) ls/ctre pehdlng against me In which-cognizance has been takeh by the court:-

S.No. Offence Description (a) The detailsof cases where the court has taken cognizance, Sections

of the Act and description of the offence for which cognizance taken:

N\L

:OU2 Name of th~ court, case no. and date oforder taking cogni.uJnce: "-\I I ~c Detail of App-~al{s)/Application(s) for revision (if any) filed against

the above order(s} NIL

(4) Cases in which: have ~n convicted be a court of law (other than those referred to in form 'A')\ (a) The de-rail$ of cases, Sections of the ;\ct a·nd description of the offence

for which convictf~d. N IL (b) . Name of the Court(s), Case No. and date(s) of order(s): NI L (c) Punishmerit im ~d· -----'--'---:-, _ _::...;_~-----+--_~N~l!!!_L__--l

'--'-'---'-- ---·

.,,,,<4'-- .

SNJC.• I •·· •1·• I \.r••t y ,"\+f i

DELh.' ~~CD. l~.155~

,.

(5) That I cive herein below the details of the assets (movable and immovable etc.) Of

myself, my spouse and all dependents:

A. Detail of movable assets: (Note:

1. Assets in joint name indicating the extent of joint ownership will also have to be given. 2. In case of deposit/Investment, the details includlns Serial Number, Amount, Date of

Deposit, the Scheme, Name of Bank/Institution and Branch are to be given. , 3. Value of Bonds/Shere/Debentures-as- per,the cum:nt market. value in Stock Exchange in

respect of listed companies and as per books in case of non-listed companies should be

given. 4. Dependent, here means a person, substantially dependent on the lncol'{le of the

candidate. 5. Details Including amount is to l:?e given separately in respect of each lnvastrnent.)

S.No Description

i) Cash in hand ~ O1-(ii) Detail of Deposits m Bank

accounts (FDRs, Term Deposits and all other types of deposits including saving-accounts), Deposits with Financial Institutions, Non Banking Financial Companies and Cooperative societies and the amount In each such

de osit. (111) Detail of Investment In

Bonds, Debentures/share and units in

companies/Mutual Funds and other:s and the amount.

(iv} Details of investment in NSS, Postal savings, Insurance Policies and Investment In any Financial Institution in Post office or Insurance Company and the amount.

(v) Personal loans/advance given to any person or entity including firm, Company, Trust etc. and

m

<1:, •.✓,I6 7

~ ~ '·· 0 - ~VT.

1.

-2-.; .St. Mo............ •i'{F \lN NOTARY f·<:1 .

Depend DependSelf ent-2i,Jt-1

tJIL rJI L ~JI L

NILNILNlL t'.\lL

NILNIL

Depend ent-3

NIL

NIL ,,,.

-l I

• l

(vi) Motor Vehicles/ Aircrafts/ Yachts/Ships (detail of Make, Registration No. etc, Year of Purchase and amount.)

tJ ll tJ lL tJ\L tJ \L Nt L

(vii) Jewelry, bullion and valuable thing (give details of weight and value)

10f~Af ~\?.. . )..1 "a_nr.t .

~

(viii) Any other assets such as value ofClaims/interest.

II

tJ\L t-Jll Nil NIL t,Jll

(ix) Gross Total value :) :>(,I n11/,... I

B. Detail of Immovable assets: (Note: 1. Properties in joint ownership indicating the ,extent of joint ownership will alsq have to

be indicated. 2. Eac.h land or buildingor apartment should be mentioned separately in this format.)

S.No. Description Self Dependent-3Spouse Oependent-1 Dependent-2 .

(i) AgrlgJl!ural Land

t-J · I\~ ·A Nll NIL NIL .-Location(s) -Survey number(s) Area (Total

NILNll Nil NANAmeasurement , in acres) -

Whether inherited NIL NILNIL NA NAproperty (Yes or NO) Date of purchase in tJANill-Jll NANIL.case of self acquired property Cost c,f Land .(in case of purchase) at µAf'J IL NANil..~ Nil the time of~~_rl purchase Any .lnvestnient c.r, the i->l'ld by {'JI L t-JANIL Nf\NILway, f devek>pment, coi:as:tructton etc.

~T,(.) . . ' tiliR.~.J ~1 ·J

DELHI

-3-

I.

r,

I

· Appr0>:imate Current tJIL N\L NIL tvA NA I market value

(ii) ~ &,rf~Ultu[!I Y!l!I NIL NIL NA NA -Lo.catioh(s) t-J \L -Survey number(s) Area (Total

tJllmeasurement NIL NIL NT-\ NA in sq.ft.) Whether inherited NIL NIL. NIL NA NA

-' prape11V (Yesor NO) Date of purchase In case of self NIL NIL N\L NA- NA-acquired property

Cost of Land (in case of

N\L NA NApurchas~} at tJ\t NH. the time of purchase ,. . . Any lnvestmen; on the land by tJll NA NA-way of N\L NlL, development, construction etc. Approximate

NA NACurrent NlL NH... NI~ market value

(iii) C2mmerctal Building (including N}L tJlt.. tJlL. NA NA-apartments) -Location(s) I

-Survey number(s) Built up area (Total ~l\.. NlL N,L 1'l A- NA measurement

I , in sq. ft.) - ~ I--~ a t>.,y "'\Q/ ..... ,-lt J~~(''11::

_

~:;;.~~0 17 ········:·: . ,!\,l' ... y'

~- -~ -:r.•• .,..•·~/ r<-,E-0 I:) ~ ~'<:;--~ ,~-:} . ·::- k ~ 6....1),_?- ' "' ~~- ~

. ~ \ I . ~ ~ . . 0ovr. o<-<

Whether·

inherited

NA

N\t,.

NlL

NA-

NIL tJ IL property (Yes or NO) ·

Date of p.;rch;;.se in case of self tJ ll t0 lL NIL acquired property

Cost of property (in case of purchase) at the time of pµrchas~ Any !nvestmer'lt on

· the property

by way of development~ construction etc.

Approximate N l L Nil NlLCurrent

market value

(iv) Residential Buildings (including NANILapartments,) "1 l L N lL. -Location(s)

. -Survey number(s)

Area (Total measurement N\l-NIL.. N tL Ii

in sq. ft.) ·Built up Area (Total NIL measurement

, ...~•::;i~> in sq. ft.) _;\;;, Whether --;---t---t------1------+---__J

inherited property (Yes or NO) Date of purchase in NAcase ofself acquired property

St ~O·•·••;_;::;•\~~C \\~ t..\.01P--t •1

,

Cost of property (in case of purchase} at the time of purchase Any Investment on

tJ\ L· NlL \'JIL Nf\ NA

the land by way of development, construction

tJ IL Nil NIL NA 1'J A

(v)

etc. Approximate Current market value Other {such as interest in property)

t\l l L

N ll

tJIL

NlL

tJ IL

NtL

NA

NA

f'JA

N A-

(vi) Total of Current Market Value of (i} to (v)

NfL- NIL f'J.I L,,. NA- NA

(6) 1give herein below the details of liabilities/duesIto public financial institutions and govemment:­(Note: Please give separate details of name of Bank, Institution, entity or Individual and amount for each item)

S.No. Description Self Spouse(s) 0ependent-1 Dependent-2 Dependent-3 (i) Loan or dues to

Bank/Financial lnstitutlonjs) Name of Bank or Fl Amount outstanding Nature of loan

Nll NlL

loan or dues to any

. Individual/Entity otherthan mentioned In (I) above. Name(s) Amount outstanding Nature of loan

NlL NA Nh

(fr) .

n (if) Government rDues

Dues to departments 1'.J\L ~IL "-' I L N f\ NA dealing with government accommodation

Dues to . .

departments NIL NIL tJ\ L t0A ~H\

dealing with supply ofwater · ,

Dues to departments

tJlt. NOdealing with .' N'l NI t. NA. supply of el'ectricity

Dues to •,

departr•ents

tJ l L tJA "'~deallng with t-J t L tJl L supply of . telephones/ ~

mobiles Dues to departr.;ents . dealin,g with ~ll tJ tl tJ IL tJ A tJAgovernment tran~port (including aircrafts and h~licopt~rs) Income Tax Dues NlL t-J.IL tJtL NA tJA Wealth Tax Dues "-'II ...._,, L ulL . NA- NA..

,.,..•::(: Service Tax Dues . .. ,-. \ V Municipal/,,.,[\'O\.:

Property Tax Dues Sales Tax Due~ Any other Dues Grand Total of all Govt. Dues

Details of profession o~occupatior ili a. Selt...8.ll!:1.$..4 ••• :f.t~~•to:a. O'nVI. b. Spouse...Mtro. -................ . My educational qualification is as under:· ~ UM6 (Give details of highest School/Universitv education with full fonn ofthe DLJ

' certificate/dip!oma/degree course)

(7)

(8)

(Name of the School/College/University and the year in with the course was compl~ted.)

r,· .l l.

(S) ABSTRACT or fHE DETAILS GIVEN IN (1) TO (8} ABOVE:

6.

(b) Total Numbers of Pending cases where the court(s) t,-/ ' A have taken cognizance PAN of Year for which last Total Income

Candidate Spouse:

...

income Tax_ Return ·filed

5- '101'

Shown

7 Details of Assets and liabilities in rupee

J

A.

8.

8.

9

Description Self

Moveable Asset·(Total value)

Immovable Asset

(i) Purchase Price and Development Cost of Immovable Property (Total Value)

ii) .. Approximate Current Mark.et Prlce ofAsset (Total Value) Liabilities -Government Dues (Total)

loans from Bank, Financial Institutions and others (total)

Spouse

?,S~Obl

Howe

lo1GT5,0tr ,-~pp--f• NI \.

..._ , \ l

NIL

Dependent~! Depender:it-11 ,_

-

.

N \ \..

' .

N\ l, . .

Dependent-Ill

-

Highest educational qualification:

(Give details ofSchool/University education w!th full form ofthe certificate/diploma/degree course) (Name of the School/College/ University-and the year in which the course was completed.) g ut4S h 0-,,, o.- lJ'l'\1 \.I wit..,. .

J VfRIFACTION

!VIGIPRRND-23 0TA . U'l3L lC DEL.Ul (INOIA)

..~.3 APii 201/·