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FORM 28
I /
(See rule a)
NOMINATIONPAPER
Election to the Legislative Assembly of West Bengal (State)

STRIKE OFFPARTIOR PARTIIBELOW WHICHEVERIS NOT APPLICABLE

PART I
(To be used by candidate set up by recogn izndpolitical party)

I nominate as a candidate for election to the tegislative Assembly from

the 70. Rejinagar Assembly Constituency.
Candidate's name RABIUL ALAM CHOWDHURY Father's/ffi
name Late ISARAFIL CHOWDHURY His postal address Vill+P.O - Mirzapur. p-S-
Beldanga Dist. - Murshidabad. W.B. Pin 742133. His name is enterd at Sl.No 46 in
-
Part No 75 of the electoral roll for 70-Rejinagar Assembly constituency.

My name is MD SIRAJUL ISLAM and it is entered at Sl.No l3l in Part No l2l of the
electoral roll for the 70-Rejinagar Assembly constituency.

Date at /e 4 i, r 2l Signature of the Proposer

PART II
nominate as candidate for election to the Legislative Assembly from
... Constituency.
-.........Assembly
Candidate's name :.:.. Fathef#mother'sl
husband's His postal address
.. ... . His name is entered
at Sl. No. in Part No electoral roll
for......... ..........Assembly constituency.
t\|*rare that we are electors of this Assembly constituency and our names are entered in
the e\al rott for this Assembly constituency as indicated betow and we append our
signatures b\ token of subscribing to this nomination:-
Particulars of thelroposers and their signatures
sl. Elector Roll \ of Full name Signature Dde
No. Proposer \
Part No. of S. No. h-
Electoral that part
Roll
I Z 3 4 5 6
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

N.B-- There should be ten electors of the constituency as proposers.

PART III
I, the candidate mentioned in partllPad{Shike out which is not applicable)assent to this
nomination and hereby declare that-
(a) I am a citizen of India and have n9t acquired the citizenship
of any foreign State;
(b) That I have completed 6l years of age;
ISTRIKEOUT c(i) OR c(ii) BELOW WHrClrEVERrs NoT APPLTCABLEI
(c) (i)I am set up at this election by the All India Trinamool Congress partJl
which is
recognized National Partylstate Parry in this State arO thut tlre
the above party be allotted to me.
wmUol fo, ,*ord
(ii) Not Applicable party, which is a registered
uffecogniznd, contesting this election as an independent
candidate.(Strike out which}
)and that the symbols I have chosen, in
order of preference, are:-

(d)Mvnameandmyfather's/ffiname-havebeencorrectIy.speItoutabovein
English (name ofthe language);and
(e) That to the best of my knowledge and belief, I am qualified
and not also disqualified for
being chosen to fill the seat in the Legislative AssenLty of this
State.
+I further declare that
**caste/tribe ofthe
t am a member of the **Caste/tribe which is
a scheduled
stateof.-.-.- .in reration 1o......-.....................(area) in that State.
 I also declare that I have not besn, and shall not be nominated
as a candidate at the present
general election/the b1ee}e#iens being held simultaneously, to the legislative Assembly
West Bengal of (State) from more than two Assembly constituencies.

(c'.[l -"( dtlc,,r.'\ e/* 'e-Q,]"" ' \

Signature of Candidate J
t Scme od this if not applioable.
ft Score ql ttre worrds not ryplicable.
N.B.-A' rccognized political porty" meaos apolitical party recognized by the Electim Cmrmissim unda the Election
Spbols(Reservaticn and Allohent) Chder, I g6Sinthestateconcerned

PART IIIA
(To be filled by the candidate)

( 1) Whether the candidare-

(i) has been convicted-
(a) of any offence(s)under sub-section ( l ); or
(b) For contravention of any law specified in sub-section (2)
of section 8 of the Representation of the people Act, 1951 Y€s'Ihlo
(43 of 195 1); or
(ii) has been convicted for any other offence(s) for which he has
been sentenced to imprisonment for two years or more.
I
If the answer is "Yes", the candidate shall furnish the follo*it g information

(i) Case/First information report No.A{os. .

.. Not Applicable..
(ii) Police station(s) .
... ..Not Applicable... ... Distrii(s) ... ...Not Applicabte... ... .
State(s) ... Not Appticabte..
(iii) Section(s) of the concerned Ac(s) and brief description of the offence{sfior which he
has been convicted ... . .. ... Not Applicable .
(iv) Date(s) of conviction(s). . . . . . Not Applicabte .
(v) court(s) which convicted the candidate ... Not Appticable .
(vi) Punishment(s) imposed [indicate period of imprisonmint(s) andlor quantam of
fine(s)l ... Not Appticabte ... .
(vii) Date(s) of release from prison. .. Not Applicable .
(viii) Was/were any appeal(s/revision(s) filed against above conviction(s)..No.,.yes/No
(ix) Date and particulars of the appeal(s/application(j for revision
(*) Name of the court(s) before which the appeal(s/application(sfor revision
filed. Not Appticable
(*i) Whether the said appeal(s)iapplication(s)for revision hasArave been disposed of or
is/are pending ... Not Applicabte .
(xii) If the said appeal(s/application(s)for revision has/have been disposed of-
 (a) Dat{s) of disposal n$ot Appticabte .
(b) Nature of ordeds) passed ... Not Appticable
(2) Whether the candidate is holding any office of profit under the Government of lndia or
State Government? No (\fe#hlo)
-If Yes, details of the office held ... NotApplicable ..-...
(3) Whether the candidate has been declared insolvent by any Court? No. (Yes/tlo)
-If Yes, has he been discharged from insolvency. . . .. . Not Appticable ...
(4) Whether the candidate is under allegiance or adherence to any foreign
country?......No.......(*sAIo)
-If Yes, grve details. .. Not Appticabte ...
(5) Whether the candidate has been disqualified under section SAof the said Act by an
order of the President?...No. (yesA[o)
-If Yes, the period for which disqualified... ... Nor Appticable ...
(6) Whether the candidate was dismissed for comrption or for disloyalty rvhile holding
office under the Government of India or the Government of any State?..,..No.
(Y+s/I{o)
-If Yes, the date of such dismissal .. . Not Applicabte ...

(7) Whether the candidate has any subsisting contract(s) with the Government either in
individual capacity or by trust or partnership in which the candidate has a share for
supply of any goods to that Government or for execution of works undertaken by that
Government?...No.. .....(YesNo)
-If Yes, with which Government and details of subsisting confiac(s),,. . .. Not
Appliebte ...
(8) Whether the candidate is a managing agent, or manager or Secretary of any sompany
or Corporation(other than a cooperative society) in the capital of which the
Central/Govemment or State Government has not Iess than twenty-five percent
share?.....No.........(Yes/no)
-If Yes, with which Government and the details there of. . . Not ApplleHe
(9) Whether the candidate has been disqualified by the Commission under sectionl0Aof
the said Act... .No... (yesA{o)
-If yes, the date of disqualification . . . Not Applicable . . .

place: f3evh.a^y .
(^l-;*l J r,"^ Q,[.'--,{t^...'1
Date: o(-o q_ZoLl
4
Signature ofthe candidate J
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Regn Nn'i'112007
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---...-
AFFIDAVIT TO 8E FILED BY THE CANDIDATE ALONGWITH NOMITTIATION PAPER BEFORE

THE RETUR]{|NG OFFTCER FOR ETECnONTO WEST BEilgAt IECIpIATUE ASSEMBTY

aAittrllee oF mE HolrSEFnoM TqREJltlAglR OOIISIITUEIIICY (NAME OF THE

ii,r D RAh(ffi/rt lililffi t[ ;;**u Et{cY}

r,roinnY PUBLtc
Reqn No' 8112007 PART A
eovi.. of VJest Beggal
DK tJiurshidabdU I MBIUL AIAM CHOWDHURY t'son/dauehtefifuife of tatp ISABAFIL CIQWDHUBY Aged

H O! years, resident of Vill .+P.Q Beldansa., D.is,t.-.MufshidSbad .W.8.

=Mirzpour..,P.5-
Pin:742133, (mention full postal address), a candidate at the above election, do hereby
I
solemnly affirm and state on oath as under:-

I
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(1) I am a candidate set up by ALL INDIA TRINAMOOL CONGRESS (AlTCl

(**name of the political partyll** .

(**strike out whichever is not applicable)

(21 My name is enrolled in 70-RUINAGAR, WEST BENGAL (Name of the Constituency and the state),

at Serial No 46 in Part No 75

(3) My contact tetephone number(s) is/a+e gZfSOZfAES and my e-mait id (if any) is

[email protected] and my social media account(s) (if any) lr/are

( i) www.facebook.com/Rabi uI Ala m Chowd h u rv-M lA
(iiltwitter.com/na biu I nlffi
(iiil ..................No1 Applicable.............

(4) Details of Permanent Account Number (PAN) and status of filing of lncome tax rehrrn:

sl. Names PAN The financial Total income shown in income Tax
No- year for which Return (in Rupees! for the last five
the last income Financial years completed (as on
tax return has 3l't March)
been filed ,\
,l
1. I Not Applicable ,A,
4,t
rrr
Self (ii) Not Applicable \-
AYMPC62O4C Not Applicable (iiil Not Appllcable E
a
RabiulAlam (iv) Not Applicable 'r)
Chowdhury (v) Not Applicable /)
2. (i) Not Applicable
Spouse (ii) Not Applieble
No PAN Not Applicable (iii) Not Applicahte
Amina Begum Allotted (iv) Not Applicable
(v) Not Applicable
3. HUF (lf Candidate (i Not Applicable
is Not (ii) Not Applitzble
Karta/Coparcener) Applicable Not Applicable ( iii) Not Applicable
(iv) Not Applicable
(v) Not Applicable
4. Dependent 1 (i) Not Applicable
( ii) Not Applicable
Fordousi No PAN Not Applicable ( iii) Not Applkzble
(Mother) Allotted (iv) Not Applicable
(v) Not Applicable
5. Dependent 2 (i) Not Applicable
BMrPC5910q (ii) Not Applicable
Sakil Anam Not Applicable ( iii) Not Applicable
Chowdhury (iv) Not Applicable
(Son) (v) Not Appllcable
6 Dependent 3... (i) Not Applicable
( ii) Not Applicable
Not Applicable Not Not Applicable (iii) Not Applitzble
Applicable (iv) Not Applicable
(v) Not Appticable

*%SP" ".."8f'
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Go,,r nf U.'eSt Bengal
f ir ii'iu:'shidabad

Note: lt is mandatory for PAN holder to mention PAN and in case of no PAN. it should be cleady stated

"No PAN allotted".

(sl Pending criminal cases

(il I CeCare that there ie ne pendinE eriminal ease against me. (Tick this alternative if there is no
criminal case pending against the Candidate and write NOT APPLICABLE against dEnatiue (iil
belowl
OR

r' $l The following criminal cases are pending against me:

(lf there are pending criminal cases against the candidate, tfien tick this dterndve md score
off alternaUve (i) above, and give details of all pending cases in the Table belowl
Table

(a) FIR No. with name and FtR No.30UOg

address of Police Station Date 11-08-09 of
concerned Beldanga Police
Station, Beldanga Not applicable Not applicable Not applicable
, Murshidabad.
(W.B)

(b) Case No. with Name of the

Court Beldanga P.S.
Case !
,)
No.301/2009 and
GR Not applicable Not applicable Not applicable
No.2253/2009
J.M 2nd Court
Berhampore,
Murshidabad
(W.B}

(cl

Section(s) of
concerned Section.
Acts/Codes involved (give 3231324134
no. of the Section, e.g. of lndian Penal Not applicable Not applicable l{otapplicable
Code
Section ....... of lPC, etc.).

(d) voluntarily
causing
hurt(s323),
Voluntarily
causing hurt by Not applicable Not applicable Not applicable
Brief description of offence dangerous
weapons(s324),
voluntarily
causing grievous
hurt.(s3251
common
intention (s-34)

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t

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Regrr iu " t1/2007
GOvt Lri ';;* ,t Bengal
Ih iYiu:'r;niciabad

(e! Whether charges have been YES Not applicable Not applicable Not applicable
framed (mention YES or NO)
(f) lf answer against (e) above Cognizance was
is YES, then give the date on taken on Not applicable Not applicable Not applicable
which charges were framed t]-/o&lz00e
G) Whether any Appeal/
Application for revision has
been filed against the Not applicable Not applicable Not applicable Not applicable
proceedings (Mention YES
or NO)

(61 Cases of conviction

{ lal I declare that I have not been convicted for any criminal offence. (Tick this alternatftrcr af the
candidate has not been conviced and write NOT APPLICABLE against alternative (iil belwl
OR

(iil I have been convicted for the offences mentioned below: NOT APPUCABLE

(lf the candidate has been convicted, then tick this alternative and score oilf dternative(ll
above, and give details in the Table below|
Table

(a) Case No. Not Applicable Not Applicable Not Applicable

(bl Name of the Court Not Applicable Not Applicable Not Applicable
(c! Sections of Acts/Codes
involved (give no. of the Not Applicable Not Applicable Not Applicable
Section, e.g. Section
of IPG etc.).
(d) Brief description of
offence for which Not Applicable Not Applicable Not Applicable
convicted
(e) Dates of orders of Not Applicable Not Applicable Not Applicable
conviction
(fl Punishment imposed Not Applicable Not Applicable Not Applicable

(e) Whether any Appeal has

been filed against Not Applicable Not Applicable Not Applicable
conviction order (Mention
YES or NOI
(h) lf answer to (g) above is
YES, glve detalls and Not Appllcable Not Appllcable Not ApBlieable
present status of appeal

(6Al 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 paragraphs (5) and(61.

I candidates to whom this ltem is not applicable should cleady write NOT APPUCABI^E lt[ VIEW
OF ENTRIES lN S(il and 6(ll, abovel
Note:
1. Details strould be entered clearly and legibly in BO1D letters.
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3. Iletails should be giYerr in revense chronological order, i.e., the latest cilse to be mentioned first
and backwards in the order of dates for the other r;lses.

4. Additional sheet may be added if required.

5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme Court's
judgment in W. P (Cl No. 536 of 2011.

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

A lletails of movable assets :

Note: 1. Assets in joint name indicating the extent of joint ownership will also have to be givm-
Note:2. ln case of deposit/lnvestment the details including Serial Number, Amoun! date of deposit,
the scheme, Name of Bank/lnstitution and Branch are to be given.

Note: 3. Value of Bondsfihare Debentures as per the current market value in Stock Exchalge in respect

of listed companies and as per books in case of non-listed companies should be givm
Note:4. 'Dependent' means parents, son(s), daughter(s) of the candidate or spouse and any other
person related to the candidate whether by blood or marriage, who have no separate means of

income and who are dependent on the candidate for their livelihood,

Note: 5. Details including amount is to be given separately in respect of each investment.

Note: 5. Details should include the interest in or ownership of offshore assets.

,#ter
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NOTARY PUBL IC
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Elglanation,- For. the purpose of this Form, the expression "ofhhore assets" includes, deails of all
deposits or investments in Foreign banks and any other body or institution abroad, and

details of all assets and liabilities in foreign countries';

s. Description Self Spouse HUF Dependent Dependent Dependent-

No, -l -[ lil
(il Cash in hand Rs 5000/- Not Not Not Not Not
Applicable Appli Applicable Applieable Applieable
cable
(ii) Details of 1.S.B.r SB A/C
deposit in 3279452L942 P.N.B.
Bank accounts Beldanga Branch Debkunda
(FDRs, Term Balance as on date Branch SB
Deposits and Rs.3672tl- Alc
all other types 2. S.B.l Salary A/C 670500010
of deposits No.32863042293, 0074101
including Kolkata High Court Rs,11530/-
saving S.P.B. Branch
accountsl, Balance as on date Not Not Not Not
Deposits with Rs.48208/- Appli Applicable Applicable Applicable
Financial 3. Bandhan Bank cable
lnstitutions, SB A/C
Non-Banking 5016001to78272,
Financial Beldanga,
Companies Branch, Balance as
and on date Rs22L44l-
Cooperative 4. Axis Bank S.B
societies and Alc
the amount in 9170100542s1119,
each such Beldanga Branch,
Deposit date as on date Rs
eLzs&l-
5. Bandhan Bank,
SB A/C No
5021011859565,
Beldanga Branch,
Balance as on date
Rs.2fi)00/-
(Election Purpose)
(iii) Details of
investment in
Bonds,
Debentures/S
hares and Not Not Not Not Not
units tn Not Applicable Applicable Appli Applicable Applicable Applicable
companies/M cable
utual Funds
and others
and the
amount.

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(.v! Details of L-r.c.

investment in 1) P. No. Lt.c
NSS, Postal 447658054
Saving, (28/Ot/zo]. 1) P. No.
lnsurance 4) 4?9t83872
Policies and Rs. Not Not {28l02l2o,.2l Not
investment in Not Applicable 10oo0o/- Appli Applicable Rs. Applicable
any Financia! 2) P No. cable L,Z',OWl-
instruments in 4291706t3
Post office or (28lL0/aOL
lnsurance 1)
Company and Rs.
the amount 310,000/-
(v) Personal
loans/
advance given
to any person
or entity Not Not Not Not Not
including firm, Not Applicable Applicable Appli Applicable Applicable Applicable
company, cable
Trust etc. and
other
receivables
from debtors
and the
amount.
(vi) Motor
Vehicles/
Aircrafts/Yach
ts/Ships Not Not Not Not Not
(Details of Not Applicable Applicable Appli Applicable Applicable Applicable
Make, cable
registration
number. etc.
year of
purchase and
amount)
(vii) Jewellery
bullion and Gold 100
valuable Gold 15 gm gm Not
thing(s) (give Rs.67500/- Rs. Appli Not Not Not
details of (Approx) 4,50,000/- cable Applicable Applicable Applicable
weight and (Approx)
value)
(viii) Any other
assets such as Not
value of Not Applicable Not Appli Not Not Not
claims/interes Applicable cable Applicable Applicable Applicable
t
(ixl Gross Total Rs. Not Not Rs. Not
Value RS. ZgotStl= g71530l= Appli Applicable !,25rffil- Applicable
cable

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B. Details of lmmovaHe 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
Note: 3. Details should include the interest in or ownership of offshoie assets.

s. Description Self Spouse HUF Dependent-l Dependent-ll Dependent-

No. ilt
(i) Asricultural land JL NO.65,
Location(s) Mouza - Char
Survey number(s! Mirzapur Not Not Not I{ot
Khatian -L279 Not Applicable Applic Applicable Applicable Applicable
NO.60,
JL able
Mouza - Barua
Khatian -76t4
Area (total Not
measurement in 7.?:OLG Acre Not Applicable Applic Not Not Not
acresl able Aoolicable Aoolicable Aoolicable
Whether Not
inherited Yes Not Applicable Applic Not Not Not
property (Yes or able Applicable Applicable Applicable
Ne)
Date of purchase Not
in case of self- Not Applicable Not Applicable Applic Not Not Not
acquired able Applicable Applicable Applicable
property
Cost of Land (in Not
case of purchase) Not Applicable Not Applicable Applic Not Not Not
at the time of able Applicable Applicable Applicable
purchase

Any lnvestment
on the land by Not Not Not ilot
way of Not Applicable Not Applicable Applic Applicable Applicable Applicable
development, able
construction etc.
Approximate Not
Current Rs.8O0O,ffiAl Not Applicable Applic Not Not Not
market value able Applicable Applicable Applicable
(ii) Non-Arricultural
Land JL NO 65,
Location(s) Mouza- Char Not Not JL No. 60 Not
Survey number(s) Mirzapur Not Applicable Applic Applicable Mouza - Applicable
Khatian No. able Barua
LZ79 Plot No 2485
Area (total Not
measurement in 10454.4 5q.ft. Not Applicable Applic Not 13068 sq. ft. Not
sq. ft.) able Applicable Applicable
Whether Not
inherited Applic Not Yes Not
property (Yes or Yes Not Applicable able Applicable Donated by Applicable
l$e) Close
Relative

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Date of purchase Not

in case of self- Not Applicable Not Applicable Applic Not Not Not
acquired able Applicable Applicable Applieable
property
Cost of Land (in Not
case of purchase) Not Applicable Not Applicable Applic Not Not Irlot
at the time of able Applicable Applicable Applicable
purchase
Any lnvestment Not Applicable Not Applicable Not Not Not Not
on the land by Applic Applicable Applicable Applicable
way of able
development,
construction etc.
Approximate Not Not Rs. Not
Current Rs. 5,50,0ff) Not Applicable Applic Applicable 10,00,000/- Applicable
market value able
(iii) f.ommercial
Buildinss
(including Not Not Not Not
apartments) Not Applicable Not Applicable Applic Applicable Applicable Applicable
-Location(s) able
-Survey
number(s)
Area (total
measurement in Not Not Not Not
acres) Not Applicable Not Applicable Applic Applicable Applicable Applicable
able

Built-up Area Not

(total Applic Not Not Not
measurement in Not Applicable Not Applicable able Applicable Applicable Applicable
sq.ft.)
Whether
inherited Not Applicable Not Applicable Not Not Not Not
propemy (Yes or Appllc Applleable Appllcable Appllcable
No) able
Date of purchase Not
in case of self- Not Applicable Not Applicable Applic Not Not Not
acquired able Applicable Applicable Applicable
property
Cost of Land (in Not
case of purchase) Not Applicable Not Applicable Applic Not Not Not
at the time of able Applicable Applicable Applicable
purchase
Any lnvestment Not
on the land by Applic Not Not Not
way of Not Applicable Not Applicable able Applicable Applicable Applicable
development,
construction etc.
Approximate
Current
market value Not Not Not Not
Not Applicable Not Applicable Applic Applicable Applicable Applicable
able

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(iv) Residential
Buildings JL NO 64
(including Mouza- Not Not Not Not
apartments) M!RZAPUR Not Applicable Applic Applicable Applicable Applicable
-Location(s) (lnherited) able
-Survey
number(s)
Area (total Not Not Not Not
measurement in 720o Sq.ft. Not Applicable Applic Applicable Applicable Applicable
sqft) able
Built-up Area 4000 Sq. ft- Not
(total Not Applicable Applic Not Not t{ot
measurement in able Applicable Applicable Applicable
sq.ft.)
Whether Not
inherited Yes Not Applicable Applic Not Not Not
property (Yes or able Applicable Applicable Applk:able
I'le)
Date of purchase
in case of self-
acquired Not Not Not Not
property Not Applicable Not Applicable Applic Applicable Applicable Applicable
able

Cost of Property Not Not Not Not

(in case of Not Applicable Not Applicable Applic Applicable Applicable Applk:able
purchase) at the able
time of purchase
Any lnvestment
on the land by Not Not Not Not
way of Not Applicable Not Applicable Applic Applicable Applicable Applicable
development able
construction etc.
Approximate Not Not Not Not
Current Rs 35,00,000 Not Applicable Applic Applicable Applicable Applicable
market value able
(vl Others (such as Not Not Not l{ot
interest in Not Applicable Not Applicable Applic Applicable Applicable Applicable
property) able
(vi) Total of current Not
market Rs. Not Applicable Applic Not Rs. Not
value of (i) to (v) \2A,5A,o{m,l- able Applicable 10,00,0001- Applicable
above

r4,'&v1v;* [1",*r
va 14 *{v &h'"[A'^ c['*U'-1
TC Safiur Rah*an Biswas
Advocats
Berhampore Court
wB,s45/2010

10
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 ffir'alvl
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(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

before each item)

s. Description Self Spouse HUF Dependent Dependent Dependent

Ne. -t -ll -[r
(i) Loan or dues
to
Bank/Financi
al
institntion(s)

Name of
Bank or Not Not Not Not Not Not
Financial Applicable Applicable Applicable Applicable Applicable Applicable
lnstitution
,Amount
outstanding,
Nature of
loan

Loan or dues
to any other
individuals/e
ntity other
than
mentioned Not Not Not Not Not Not
above. Applicable Applicable Applicable Applicable Applicable Applicable

Name(s),
Amount
outstanding,
nature of
loan
Any other
liability Not Not Not Not Not Not
Applicable Applicable Applicable Applicable Applicable Applicable
Grand total
of liabilities

Not Not Not Not Not Not

Applicable Applicable Applicable Applicable Applicable Applicable

,$P ..oFl gtswar

R!,]iX.*\ 0^n iA.-A^ rsa

,c$h'q$*H"ffiffiP 11
 rc g7,7tt a-aq

w I g'/ |
iWit#, Alrii
iIOTA R' C JU iC
tegn l{,., r tt2007
Govt. of Wesr B.'rgal
DK tlurshideoad

(ii) Govemment (A) Has the Deponent been in occupation of accommodation

Dues; provided by the Government at any time during the last ten
Dues to years before the date of notification of the current election? YES/Ne
departments (B) lf answer to (A) above is YES, the following declaration may be (Pl. tick the
dealing with furnished namely:- appropriat
Government (il The address of the Government accommodation: e
Accommodat State Legislatot's Hostel.Room No ill. 2no l(YD Strect. alternative
ion Kol-16 l
(ii) There is no dues payable in respect of above Government
accommodate on, towards- YE5
{a) rent; NIL
(b) eledricity charges; NIL
(c) water charges; and NIL
(d) telephone charges as on 03/03 /zAZLGate) Not
Applicable
[the date should be the last date of the third month prior to
the month in which the election is notified or any date
thereafterl .
Note- 'No Dues Certificate' from the agencies concerned in
respect of rent electricity charges, water charges and
telephone charges for the above Government
accommodation should be submitted.

(i ii) Dues to
department
dealing with Not
Government Not Applicable Applicable
transport(incl
uding
aircrafts and
helicopters)
Self Spouse HUF Dependent Dependent- Dependent
-l il -ilt
(iv) lncome Tax Not Not Not
dues Applicable Applicable Applicable Not Not Not
Applicable Applicable Applicable
(v) GST dues Not Not Not
Applicable Applicable Applicable Not Not Not
Applicable Applicable Applicable
(vi) Municipal/Pr Not Not Not
operty tax Applicable Applicable Applicable Not Not ilot
dues Applicable Applicable Applicable
(vii) Any other Not Not Not
dues Applicable Applicable Applicable Not Not Not
Applicable Applicable Applicable
(viii Grand total
) of all
Government
dues Not Not Not Not Not Not
Applicable Applicable Applicable Applicable Applicable Applicable

(-h*\ n[.,^ $v'oJt6

$ ,'.ffi't 'Lz
 "'lH#y'{jyltr*$
IgrARy pilB'i_,c
.l*:l
L:.9, Ig,- B'1'tzaaz
y::i'eilll
K luurst,iOaOi j
)

(ix! Whether any

other
liabilities are
in dispute, if
so, mention Not Not Not Not Not Not
the amount Applicable Applicable Applicable Applicable Applicable nplicable
involved and
the authority
before which
it is pending.

(91 Details of fofiesslon c occupation:

(a) Self Cultivation & Social Worker .
(b) Spouse House Wife .

(9A) Details of source(s) of income:

(a) Self Cultivation & Honorarium of M.LA.
(bl Spouse Not Applicable.
(c) Source of incomg if any, of dependents - Not Applicable
(98) Contracts with appropriate Government and any public company or companies
(a) details of contracts entered by the candidate -Not Applicable
(b) details of contracts entered into by spouse-Not Applicable.
(c) details of contracts entered into by dependents -Not Applicable
(d) details of contracts entered into by Hindu Undivided Family or trust in which the candidate or
spouse or dependents have interest- Not Applicable

(el details of contracts, entered into by Partnership Firms in which candidate or spouse or
dependents are partners- Not Applicable
(f) details of contracts, entered into by private companies in which candidate or spouse or
dependents have share-Not Applicable
(101 My educadqral qualiftcdon is as under:
Bachelor of C,ommerce passed from Beldansa S.R.F Collese under Calcutta Unhrcrt'tv Year of
1983

(Give details of highest School I University education mentioning the full form of the certificate/
diplomal degree course, name of the School /College/ University and the year in which tfre cotlrse was
completed.)

,r.,n'f#tr^w
e\r\.t *t o\^^ e)"'^,,nA'M%
rdd- satiu r nrhmtl#il|;
gernarrrPore Ccld
- vrmfiLy2oro
13
 ,rggg{fffun
{f,uo,/
fxulroi,r
Igrolv ;iiijr,"d,ur
[-".gil{g,_ N\'rzoot
o3llt;l.I::r'f'j?ni,
DK rvtursr,iJrlliw

PART-B

(111. ABSTRACT OF THE DETATTS GIVEN rN (11TO (10) OF PART- A:

1. Name of the candidate Sh./Smt+tCum. RABIUL AIAM CHOWDHURY

2. Full postal address Vill + P.O - Mirzapur, P.S - Beldanga ,
Murshidabad,742L33
3. Number and name of the constituency 7G Rejinagar, General Assembly ConstiEency, West
and State Bengal
4. Name of the political pafiy which set All lndia Trinamool Congress
up the candidate (othenrise write
'lndependent')
5. Total number of pendinB criminal cases Total l(One) Case Pending
5. Total Number of cases in which Not Applicable
convicted
7. PAN of Year for which last lncome Tax Total lncome Shown
Return filed
(a) Candidate AYMPC62O4C Not Applicable Not Apslicable
(b) Spouse No Pan Not Applicable Not Applicable
Allotted
(c) HUF Not Applicable Not Applicable Not Applicable
(d) Dependent BMIPC591OQ Not Applicable Not Applicable
8. Details of Assets and Uabilities (including offthore assets! in rupees

Description Self Spouse HUF Dependen Dependen Dependen

t-l t-ll t-lll
A. Moveable Not
Assets Rs. Appli Not Rs. Not
(Total ralue) Rs.29083V- sTLssol- cable Applicable L,25,ffm,l- Applicable
B. lmmovable Not Rs.
Assets Rs. Not Appli Not 10,00,(x)o Not
L,2A,5O,OOO/- Applicable cable Applicable t- Applicable
I Purchase Price Not
of self-acqulred Not Not Appll Not Not llot
immovable Applicable Applicable cable Applicable Applicable Applicable
property
il Development/c
onstruction cost
of immovable Not Not Not ilot
propefi after Not Not Appli Applicable Applicable Applicable
purchase (if Applicable Applicable cable
applicable)

il Approximate
Current Market
Price-
(a) Self-acquired Not Not Not Not Not Not
assets (Total Applicable Applicable Appli Applicable Applicable Applicable
Value) cable

(b) lnherited Rs. Not Not Not Rs. Not

assets(Total 1,20,50,000/- Applicable Appli Applicable 10,00,(x)o Applicable
Value) cable t-

$t*, $.q: gafiur Rsh'n'n % R,\r\*)' oeA\$."^tN

i..rqll[l*
t+,-* ii;' "
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 a
a-

r$li-$l:l;;
-!?"gn No- I 1tZ0A7
Cgy! of West Bengat
DK Murshidabad

9. Uabilities
(i) Government Not
dues(Total) Not Not Appli Not Not Not
Applicable Applicable cable Applicable Applicable Applicable
(ii) Loans from Not
Bank, Financial Not Not Appli Not Not l{ot
lnstitutions and Applicable Applicable cable Applicable Applicable Applicable
others (Total)
10 Liabilities that are under dispute

(i) Government Not Not Not Not Not Not

dues(Total) Applicable Applicable Applicable Applicable Applicable Applicable
(ii) Loans from
Bank,
Financial Not Not Not Not Not Not
lnstitutions Applicable Applicable Applicable Applicable Applicable Applicable
and others
(Total)
11. llighest educatonal qualifi caff on :
Bachelor of Commerce passed from Beldansa S.R.F Colleqe under Calcutta Unlu€rsitv vear
of 1983
(Give details of highest School/University education mentioning the full form of the
certificate/diploma/degree course, name of the School/College/University and the year in
which the course was completed.)

tfffi:ffiffi
il0, Saflr t Rahman
Advocrr
Bffrs
w
SemamPore Cotfl
wnrhasP0l0 [\,U^A.n\* oL'*J\^*1

15
 ''iHffi"*d
I"gn No- ittzaot
West Bengal
"9y1._gf
DK lylurshidabad-

VERIFICATION
l, the deponent above named, do hereby verifu 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 items 5
and 5 of Part A and B above;

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

Verified at Berhampore this the 1't day of April, 2AZ1-

R
^(n'
J *1"r*rcL"-.lt^*
DEnOilENT o
Note: 1- Affidavit should be filed latest by 3.00 PM on the tast day 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. lf there is no iilfffinafion to

furnish in respect of any item, either "Nil" or "Not applicable", as the case mry he, shoutd be
mentioned.
Note:4. The affidavit should be either typed or written legibly and neatly.
Note: 5. Each page of the Affidavit should be signed by the deponent and the Affidavit drouH bear on
each pa8e the stamp of the Notary or Oath C-ommissioner or Magistrate before nrtrom the

Affidavit is sworn.

r^"!i:ry;w
Id. Satrrrr Rahman M*
Acvocau
Bemamoore Court ,?
r.,r"Bl6a5/2010 "/

I
I

16