1 State: ………………………………….. Lok Sabha Applied for…………………….………….. Form-A LOK SABHA CANDIDATE DETAILS (PERSONAL INFORMATION) Name: ---------------------------------------------------------------------------------------------------------------- Gender: -------------------------------- D.O.B.: --- ------------------------------ Phone (Mobile): -------------------------------------------------------------------- Phone (Landline): ---------------------------------------------------------------- Photo E-mail: …………………………………………………………………………… Education Qualification: ……………………………………………………… Year: ………………………………………………………….. If Student then College 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.)
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State: ………………………………….. Lok Sabha Applied for…………………….………….. Form-A
If Student then College 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.)
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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)
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 Case No.
Detail of Section Detail of Case
In which year case has been started
Present Situation
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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 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 organization
Post From Upto Main activities of organization
Your Role
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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).
S.No. Name of property owner
Details of property
When purchased
Value at the time of purchase
Current market value
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9. Why do you want to contest the election? ---------------------------------------------------------------------------------------------------------------------------------------------