MyNetadocs.myneta.info/affidavits/rajsab09aff/692/Derek O Brien.pdfand the amount. with The New (b) LIC ofIndia Jeevan England Baptist. Shree Policy No. Hospital, Current 414091083

........~ ~~

~ q~:ql1 ~111C1 WEST BENGAL OBAB 947472I FORM 26

(See rule 4A)

Affidavit to be filed by the candidate alongwith nomination paper before thereturning officer for election to Council of States (RAJY A SABHA) from State ofWest Bengal constituencyI

II

PART-A

I .Derek O'Brien, son of Late Neil O'Brien. Aged 56 years, resident of 158, PrinceAnwar Shah Road, Kolkata: 700045), a candidate at the above election, do herebysolemnly affirm and state on oath as under-I

I (1) I am a candidate set up by All India Trinamool Congress

I

I£

I 2 6 JUL 20\1_

2

(2) My name is enrolled in 160- Rashbehari (General) Assembly Constituency, West Bengal (Nameof the constituency and the State), at Serial No 378 in Part No 232

(3) My contact telephone number(s) is /flfe 9830008000 and my e-mail id (if any) is [email protected] andmy social media account(s) (if any) are (i)Twitter: @quizderek (ii) Facebook: @MPDerekOBrien(iii) Instagram: @quizderek

(4) Details of Permanent Account Number (PAN) and status of filing ofIncome Tax return:

SI. No. Names PAN The financial year for Total income shownwhich the last Income- in Income-tax returnTax return has been (in Rupees)filed

I. Self- Derek AHIPB4526D 2016-2017 ~ 56,85,548/-O'Brien

2. Spouse- Tonuca US Citizen Not applicable Not applicableBasu

3. Dependent-l Not applicable Not applicable Not applicable4. Dependent-2 Not applicable Not applicable Not applicable5. Dependent-3 Not applicable Not applicable Not applicable

(5) I am not accused of any offence(s) punishable with imprisonment for two years or more in a pendingcase(s) in which a 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:-

(i) The following case(s) is/are pending against me in which charges have been framed by the court foran offence punishable with imprisonment for two years or more:

(a) Case/First Information Report No.! Nos. together with complete Not applicabledetails of concerned Police StationlDistrictlState

(b) Section(s) of the concerned Act(s) and short description of the Not applicableoffence(s) for which charged

(c) Name of the Court, Case No. and date of order taking Not applicablecognizance:(d) Court(s) which framed the charge(s) Not applicable(e) Date(s) on which the charge(s) was/were framed Not applicable

(t) Whether all or any of the proceeding(s) have been stayed by any Not applicableCourt( s) of competent jurisdiction

(ii) The following case(s) is fare pending against me in which cognizance has been taken by thecourt [other than the cases mentioned in item (i) above]:-

Name of the Court, Case No. and date of orderNot applicable(a) taking cognizance:

The details of cases where the court has taken

(b) cognizance, section(s) of the Act(s) and Not applicabledescription of the offence(s) for whichcognizance taken

(c) Details of Appeal(s)/Application(s) for revision Not applicable(if any) filed against the above order(s)

(6) I have not been convicted, of an offence(s) [other than any offence (s) referred toin sub-section (1) or sub-section (2), or covered in sub-section (3), of section8 of the Representation of the People Act, 1951 (43 of 1951)] and sentenced toimprisonment for one year or more.If the deponent is convicted and punished as aforesaid, he shall furnish the followinginformation:

In the following case(s), I have been convicted and sentenced to imprisonment by a court of law:

3

(a)The details of cases, section(s) of the concerned Act(s) and Nildescription of the offence(s) for which convicted

(b) Name of the Court, Case No. and date of order(s): Not applicable

(c) Punishment imposed Not applicable

(d)Whether any appeal was/has been filed against the conviction Not applicableorder. If so, details and the present status ofthe appeal:

(7) That I give herein below the details of the assets (moveable and immovable etc.) of myself, my spouseand all dependents:

A. Details of moveable assets:

Note: 1. Assets injoint name indicating the extent of joint ownership will also have to be given.Note: 2. In case of depositlInvestment, the details including Serial Number, Amount, date of deposit, the scheme,Name of the Bank/Institution and Branch are to be givenNote: 3. Value of Bonds/Share Debentures as per current market value in Stock exchange in respect of listedcompanies and as per books in case of non-listed companies should be given.Note: 4. Dependent here has the same meaning as assigned in Explanation (v) under section 75A of theRepresentation of the People Act, 1951.Note: 5 Details including amount is to be given separate lv in respect of each investment.S. Description Self (Derek O'Brien) Spouse (Tonuca DependNo Basu) ent-l

Notapplicable

Depend Depenent-2 dent-3Not Notapplica applicble able

(i) Cash in Hand Rs 41237/- as on July 22, US$ 800 Not2017 applica

ble

(ii) Details of Deposits (a) HDFC Bank Ltd, U.NBrahmachari StreetBranch, Savings Alc.Closing Balance on July22,2017Rs. 26,76,673.69(b) State Bank Of India,Parliament House Branch,Savings Alc. Closingbalance as on July 22,2017 Rs. 4,11,195.27(c) HOFC Bank Ltd,Prince Anwar Shah RoadBranch, Alc ( Jointly heldwith Mrs. Tonuca Basu,Closing Balance as onJuly 22, 2017 IS Rs.30,010.99Total:Rs. 31,17,879.95

(a) ChaseManhattan BankUS$ 31,032.37(b) Astoria Bank,US$ 13,487.86(c) Hong Kong andShanghai BankingCorporation,US$ 6700(d) Fidelity Bank,US$ 766.81(e) Citi BankUS$ 60,369.37Total:US$ 1,12,356.41

Notapplicable

NotappJicable

Notapplicable

of (a) Big Ideas IncInvestment In Private LimitedBonds, debentures /shares and units incompanies/ Mutualfunds and othersand the amount.

InBank Accounts (FDRs, TermDeposits and allother types ofDeposits includingsavings accounts),Deposits withFinancialInstitutions, Non-Banking FinancialCompanies andCooperativeSocieties and theamounts in eachsuch deposit

(iii) DetailsNil

Notapplicable

NotapplicableGreen Acres,

Ahiripukur 1stKolkata : 700019

23ELane.

Units Amount(Rs)

16090 Equity 95,990/-Shares

b) Derek O'Brien &Associates Pvt. Ltd,Green Acres, 23EAhiripukur 1st Lane.Kolkata: 700019Units Amount (Rs)3299990EquityShares

3,14,809.20

Total Rs. 4,10,799.2

4

iv) Details of (a) Details of Investment (a) Prudential Not Not Not

Investments m in Post Office Retirement: The applica applica appJic

NSS, Postal PPF Prudential ble ble able

Savings, Insurance Account Amount Rs. Company ofpolicies and with 21,06,2991 as America, 30investments in any Park on 31 st March Scranton Officefinancial instrument Street 2017 Park, Scranton, PAm Post office or Post 18507-1789Insurance Company Office Retirement Planand the amount. with The New

(b) LIC ofIndia Jeevan England Baptist .Shree Policy No. Hospital, Current414091083 Assured Sum Value:Rs. 5,00,0001- US$ 18, 922.63

(b) Charles(c) LIC ofIndia Bima Schwab, TotalBachat Policy No. Market Value US$494851837 Assured Sum 30,238.47Rs. 10,00,0001- (c) Chase, Account:

Non PrototypeTotal Rs. 36,06,299/- IRA, Account Total

US$ 27,199.06(d) Metlife,Account ValueUS$ 5,152.08(e) Fidelity BankRetirement AlcUS$ 19,502.13Total Value:US$ 1,01,014.37

Personal Not Not Not(v) Loansladvance Nil Nil applica applica applic

given to any person ble ble ableor entity includingfirm, company,Trust etc and otherreceivables fromdebtors and theamount.

(vi) Motor Vehiclesl Not Not NotAircraft.s/ Yachts/ Nil Nil applica applica applicShips (Details of ble ble ableMake, registrationnumber etc. year ofpurchase andamount)

(vii) Jewellery, bullion Not Not Notand valuable things Nil Nil applica applica applic(give details of ble ble ableweight and value)

(viii) Any other assets Painting worth Rs. Not Not Notsuch as value of 6,05,0001- Nil

applica applica applicclaims I interest Furniture and Fixture Rs. ble ble able

4,45,303/-(ix) Gross Total Value Rs. 82,26,518.15 US$ 2,14,170.78 Not Not Not

applica applica applicble ble able

~( ~ )

~ ICOIJrt <,~0- .•. OF \~~\\"-

5

B. Details of Immovable Assets:Note: 1. Properties in joint ownership indicating the extent of joint ownership will also have to be indicated.Note: 2. Each land or building or apartment should be mentioned separately in this format

S.No Description Self (Derek O'Brien) Spouse (Tonuca Basu) Depend Depe Dependent ndentent-l-2 -3

(i) Agricultural land Not Not NotLocation(s) Nil Nil applica applic applicSurvey number(s) ble able able

Area (total Not applicable Not applicable Not Not Notmeasurement in acres) applica applic applic

ble able able

Whether inherited Not applicable Not applicable Not Not Notproperty ( Yes or No) applica applic applic

ble able able

Date of purchase in Not applicable Not applicable Not Not Notcase of self -acquired applica applic applicproperty ble able able

Cost of Land ( in case Not applicable Not applicable Not Not Notof purchase) at the applica applic applictime of purchase ble able able

Any investment on the Not applicable Not applicable Not Not Notland by way of applica applic applicdevelopment, ble able ableconstructions etc.Approximate current Not applicable Not applicable Not Not Notmarket value applica applic applic

ble able able

(ii) Non Aericultural Land: Plot No 1064 or 1090 Not Not NotLocation(s) Nil at Prantik, Dist applica applic applicSurvey number(s) Birbhum, PS: Bolpur, ble able able

Pin: 731235

Area (total Not applicable Approx 12960 sq ft. Not Not Notmeasurement in sq. ft. applica applic applic

ble able able

Whether inherited Not applicable No Not Not Notproperty (Yes or No) applica applic applic

ble able able

Date of purchase in Not applicable In 2000 Not Not Notcase of self- acquired applica applic applicproperty ble able able

Cost of Land ( in case Not applicable Rs. 3,24,0001- Not Not Notof purchase) at the applica applic applictime of purchase ble able able

Any investment on the Not applicable Nil Not Not Notland by way of applica applic applicdevelopment, ble able ableconstructions etc.

Approximate current Not applicable Approx value Rs. Not Not Notmarket value 4,50,0001- applica applic applic

ble able able

6

(iii) Commercial Buildings Nil Nil Not Not Not(including apartments) applica applic applic

-Location(s) ble able able

-Survey number(s)Area (total Not applicable Not applicable Not Not Not

measurement in sq.ft.) applica applic applicble able able

Built up Area ( total Not applicable Not applicable Not Not Notmeasurement in sq. ft.) applica applic appIic

ble able able

Whether inherited Not applicable Not applicable Not Not Notproperty ( Yes or No) applica applic applic

ble able able

Date of purchase in Not applicable Not applicable Not Not Notcase of self- acquired applica applic applic

property ble able able

Cost of property ( in Not applicable Not applicable Not Not Notcase of purchase) at applica applic appIic

the time of purchase ble able able

Any investment on the Not applicable Not applicable Not Not Notproperty by way of appIica applic appIic

development, ble able able

constructions etc.Not Not Not

Approximate current Not applicable Not applicable applica appIic applicmarket value ble able able

(iv) Residential Buildings A self-acquired a) 15, Winthrop Not Not Not(including residential property at Road, Boston, MA, appIica appIic applicapartments): 158, Prince Anwar USA ble able able-Location(s) Shah Road, Kolkata: b) 219 14th street-Survey Number(s) 700045 along with a BrooklynNY 11215

two storied residentialbuilding sincedemolished.Land area approx. a)Approx 3500 Sq ft.

Not Not NotArea (total 7922 Sq.ft. appIica applic appIicmeasurement in sq. ft.) Building under b) Approx 3563 Sq ble able able

construction ft.

Not Not NotBuilt up Area (total Approx 6500 Sq. ft. a)Approx 3000 Sq ft. applica applic applicmeasurement in sq. ft.) b)Approx 3000 sq ft. ble able able

Not Not NotWhether inherited No No applica applic applicproperty ( Yes or No) ble able able

Date Of Purchase in Not Not Not

case of self-acquired July 25, 2007 a)Oct 1993 appIica applic applic

property b)June 2011 ble able able

Cost of property Cost of property along a) 50% ofUS$ Not Not Not(in case of purchase) at with the building was 475,000 (i.e. US$ applica applic appIicthe time of purchase) Rs. 3,00,00,0001- 287,5001- ) ble able able

stamp duty and legal b) Paid US$620,000fees was Rs. and took a loan from24,32,818/-. Total Rs. Chase Manhattan3,24,32,818/- Bank forUS$

920,000Any investment on the Not Not Not

-~

property by way of Rs. 56,54,616/- Nilapplica applic applic

~~~~development, ble able able

~ RN it;constructions etc.

I -J N ~I) a)50% ofUS$ Not Not Not<t: 9/92 Approximate current 100,00,00 ( i.e. US$ applica appIic appIic~ eN M'S/Court

~market value Rs. 4,50,00,0001- 5,00,000) ble able able

°0 ""vt OF \~\) b) US$ 15,40,000-

7

Others ( such as Not Not Not

(v) interest in property) Nil Nil applica applic applicble able able

Total current Not Not Not

(vi) market value of (i) Rs. 4,50,00,000/-Rs. 4,00,000/- Plus applica applic applic

to (v) aboveUS$ 20,40,000 ble able able

(8) I give herein below the details of liabilities/ dues to public financial institutions and government:-(Note: Please give separate details of name of bank, institution, entity or individual and amount for each item)

S. Depen Depe Depe

No Description Self Spouse dent-l ndent ndent-2 -3

(i) Loan or dues to Bank! Nil Loan ofUS$ 920,000 taken Not Not Notfinancial institution(s) from Chase Manhattan Bank applic appli appliName of Bank or for purchase of Residential able cable cablefinancial institution, property at 219 14th Street,Amount outstanding Brooklyn, NY 11215Nature of LoanLoans or dues to any Nil Nil Not Not Notother individuals/entity applic appli appliother than mentioned able cable cableaboveName(s), Amountoutstanding, nature ofloanAny other liability Nil Nil Not Not Not

applic appli appliable cable cable

Grand total Of Nil US$ 920,000 Not Not Notliabilities applic appli appli

able cable cable

(ii) Government dues: Nil Nil Not Not NotDues to departments applic appli applidealing with able cable cablegovernmentaccommodation

Dues to departments Nil Nil Not Not Notdealing with supply of applic appli appliwater able cable cable

Dues to departments Nil Nil Not Not Notdealing with supply of applic appli applielectricity able cable cable

Dues to departments Nil Nil Not Not Notdealing with supply of applic appli applitelephone/mobile able cable cable

Dues to departments Nil Nil Not Not Notdealing with applic appli appligovernment transport able cable cableincluding (aircraftsand helicopters)

Not Not NotIncome tax dues Nil Nil applic appli appli

<~~(W~~able cable cable

~ ./~ Not Not Notc R. aiti ~( -.J ot "Z Wealth tax dues Nil Nil applic appli appli~ CM319/~ G')} able cable cable••. 'Ivt'S ohG1 ICOlJrt f""~~OF\~\JV-

8

Not Not Not

Service tax dues Nil Nil applic appli appliable cable cable

Not Not NotMunicipall Property Nil Nil applic appli appliTax dues able cable cable

Not Not Not

Sales Tax dues Nil Nil applic appli appliable cable cable

Not Not Not

Any other dues Nil Nil applic appli appliable cable cable

Not Not Not

Grand total Of all Nilapplic appli appli

(iii) Nil able cable cableGovernment dues

(iv) Whether any other Not Not Notliabilities are in applic appli applidispute, if so, mention

Nilable cable cable

the amount involved Niland the authoritybefore which it ispending

(9) Details of profession or occupation:a. Self I am a professional quiz master, author, researcher, television host and CEO of a Pvt. Ltd. Companyb. Spouse My wife ( a US citizen) is a doctor who lives and practices in the US

(9A) Details of source(s) of income:a. Self Salary as CEO of a Pvt. Ltd. Company and Salary from Parliament as a Rajya Sabha MPb. Spouse Earnings from medical practice

(10) My educational qualification is as under: Bachelor of Arts from Scottish Church College, UniversityofCa\cutta in the year 1983.

(Give details of highest schoollUniversity education mentioning the full form of the certificate/diploma/degreecourse, name of the School /CollegelUniversity and the year in which the course was completed)

Part-B

(11) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A:

1 Name of the Candidate Sh. Derek O'Brien

2 Full postal address 158, Prince Anwar Shah Road,Kolkata: 700045

3 Number and name of the constituency and 160- Rashbehari (General) AssemblyState Constituency, West Bengal.

4Name of the political party which set up the All India Trinamool Congresscandidate ( otherwise write 'Independent')

(i) Total number of pending cases where-: charges have been framed by the Court for Nil_ V offences punishable with imprisonment for

~ 5. two years or more~-<... (ii) Total number of pending cases where the5;" ~ courus) have taken cognizance [other than NilI~ 37~~~ ~ the cases mentioned in item (i) above]

• CMM'S ;tIQ (COUrt <,~0- •. OFI~\)\~

9

Total number of cases in which convicted andsentenced to imprisonment for one year or

6. more [except for offences referred to in sub- Nilsections( I),(2) or (3) of section 8 ofRepresentation of the Peop le Act, 1951].

7 PAN of Year for which last Total Incomeincome tax return filed shown

(a) Candidate: AHIPB4526D 2016-2017 Rs 56,85,548/-Derek O'Brien

(b)Spouse: Tonuca Basu US Citizen Not applicable Not applicableNot applicable

(c) Dependents Not Applicable Not applicable Not applicable

8 Details of Assets and Liabilities in RupeesDescription Self Spouse Depen Depen Depe

Derek O'Brien Tonuca Basu dent-I dent-2 ndent-3

A Moveable Assets Rs. US$ Not Not Not(Total value) 82,26,518.15 2,14,170.78 applic applica appli

able ble cable

B Immoveable AssetI Purchase Price self- Total Rs. Rs 3,240001- Not Not Not

acquired immovable 3,24,32,818 Plus applic applica appliproperty US$ able ble cable

9,07,500I I DevelopmentlCons- Rs.56,54,616/- Nil Not Not Not

truction cost of applic applica appliImmovable Property able ble cableaft.er purchase(ifapplicable

I I I Approximate Current (a) Rs. Not Not Notmarket price- a) 400,0001- applic applica appli(a) self-acquired Rs.4,50,00,0001- Plus able ble cableassets(Total Value) US$

20,40,000(b) inherited assets(Total Value) (b)Nil (b) Nil

9 Liabilities

(i) Government dues Nil Nil Not Not Not(Total) applic applica appli

able ble cable

(ii) Loans from Banks, Nil US$ 920,000 Not Not NotFinancial Institutions applic applica appliand others ( Total) able ble cable

10 Liabilities that are under dispute

( i ) Government dues Not Not Not(Total) Nil Nil applic applica appli

able ble cable

( i i ) Loans from Bank, Not Not NotFinancial Institutions applic applica appliand Others (Total) Nil Nil able ble cable

11 Higher educational qualification.Bachelor of Arts from Scottish Church College, University of Calcutta in the year 1983(Give details of highest SchoollUniversity education mentioning the full form of the

'~~certificate/diploma/degree course, name of the School/College !University and the year in which,,'?- ~

I.... "t- the course was completed.).:::>c... 't.t 3 ~U CMM'SICourt;-* ~G0vr. O~ \~'V-

10

VERIFICATION

I, the deponent, above named, do hereby verify and declare that the contents of this affidavit are true and correct to the bestof my knowledge and belief and no part of it is false and nothing material has been concealed there from. I further declarethat:-

(a) there is no case of conviction or pending case against me other that those mentioned in items 5 and 6 of Part A and Babove:-

(b) I, my spouse, or my dependents do not have any asset or liability, other than those mentioned in items 7 and 8 of Part Aand items 8,9 and 10 of Part B above.

Verified at hd.~t.<?-o this th~;:e$.. , day of ~ 20"

Solemnly Affirm&

& Declared before me

~ R. N. MAITI

.2 6IJrrr 2011

R.N. MAlT'Notary

Govt. of IndiaReg. No. 379/9~

DEPONENT

Note: 1. Affidavit should be filed latest by 3.00 PM on the last date of filing nominations.

Note: 2. Affidavit should be sworn before an Oath Commissioner or Magistrate of the First Class or before a Notary

Public

Note:3. All columns should be filled up and no column to be left blank. If there is no information to furnish in

respect of any item, either "Nil" or "Not applicable", as the case may be, should be mentioned.

Note:4. The Affidavit should be either typed or written legibly and neatly.

· tI

Sl ......I: ~t1-

~ qf!(iPi ~JI!(1 WEST BENGALJ 08AB 947145

AFFIDAVIT

I Election to Council of States (RAJYASABHA) from State of West Bengal

Constituency

I .Derek Q'Brien, son of Late Neil Q'Brien. Aged 56 years, resident of 158,

Prince Anwar Shah Road, Kolkata: 700045, a candidate at the above

Election, do solemnly affirm and state on oath as under.-

-2-

(i) I have not been allotted an vernment accommodation at any time during theperiod of last ten year rior to the date of notification of the current election.

OR

(ii) I have been allotted govt. accommodation at 183, South Avenue, New Delhi:110011 during the period of last 10 years prior to the date of notification ofthe current election and there are no arrears of any dues to be paid towardsrent for the accommodation or any arrears to the agencies providingelectricity, water and telephone at the said accommodation as on 24.7.17 (thedate should be the last date of the 3rd month prior to the month in which theelection is announced)

(iii) "No dues certificate" from the agencies concerned are attached hereto

• RAJYASABHASECRETARIAT.

VERIFICATION

I, the deponent above named, do hereby verify and declare that the above statements arecorrect to the best of my knowledge, and no part of it is false.

Verified at Ko.J.~~~~ this the g,~.~.day of ~2017v-r: cr-----cr-' .

DEPONENT

Solemnly Affirm&

&: Declared before me

R.N. MAlT'Notary

Govt. of IndiaReg. No. 379192

R. N. MAITINotary

2 6 JUL 2011

~~PARLIAMENT OF INDIA

~ ~ (1R1ql~4

RAJYA SABHA SECRETARIAT~ ~"~~~ http://parliamentofindia.nic.int-~~"ICR~~,

~ ~-110001

Telegram: "PARISHAD"Fax :Telephone:Website : http://parliamentofindia.nic.inE-mail:Parliament Housel Annexe,New Delhi-llOOOl.

NO.RS.6712017/2018IMSA Dated the 24tIJ .l uly, 2017

PROVISIONAL CERTIFICATE

This is to certify that as per records of this Secretariat and the information furnished bythe allied agencies, nothing is due against Shri Derek O'Brien, Member Rajya Sabha as on dale.

Shri Derek O'Brien is due to retire as Member, Rajya Sabha on 18th August, 2017. Assitting Member, he is entitled to retain Government accommodation and Ri" tag. Final ccrti ficarcof No dues will be issued after his retirement and final settlement of' accounts.

(S.c. DIXIT)ADDITIO:\,AL DIRECTOR

Tel.: 23034540