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Form-A

LOK SABHA CANDIDATE DETAILS

(PERSONAL INFORMATION)

Name: ------------------------------------------------------------------------------------------------------------

Gender: -------------------------------- DOB --- ------------------------------

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.………………of the electoral roll for ……………………………… ...........................………..… Assembly Constituency,

Note: Where ever the word used ‘Family,’ It means Parents, Life Partner (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)

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2. Details of Family members:

S.no Name Relation Age Gender Occupation

3. Have you or your family member has been convicted for any offence or any case/FIR which has been filed. 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 memberarepart of any political party. If yes then mention.

S.no. Name of the Person

Party Name Post From Up to

5. Do you or any of your family membersever 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. Do you or any of your family member are 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? ---------------------------------------------------------------------------------------------------------------------------------------------

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10. Why should you be selected as candidate over other applicants?

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11. If you have not been selected as candidate. What will you do?

Contest as independent candidate.

Try to get ticket from some other party.

Other (Please give details)………………………………………………………………………………. …………………………………………………………………………………………………………….....………………….

12. Why do you think that you will win the election?

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13. For decentralization of power, have you read the SWARAJ book? What is your opinion about that?

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14. What strategies would you adopt to win the election? And how much expenses would be required?

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15. Do you have team apart from party volunteers? How many team members/volunteers, you have in each assembly constituency?

Assembly constituency No. of members/volunteers

(List of members/volunteers with name and phone numbers has to be provided)

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List of 100 Proposing Voters from each Assembly constituency of respective Lok Sabha

We undersigned are the resident and voters of …………………………………… Assembly constituency and

we proposed the name of …………………………………………………………………………………………………………….

as the candidate of Aam Aadmi Party from ………………………………………………………………….Lok Sabha.

S.No. Name Complete Address Assembly

Constituency

Part No. & S.No. in Voter list

Phone No.

Signature

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100 Note: - Your application shall be deemed rejected for giving wrong and incomplete information of the proposer’s.

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AFFIDAVIT Date: …………….

(To be submitted on Rs.10 Stamp Paper)

I………………………………………….son/daughter/wife of ……………………………………………………..

Resident of ……………………………………………………………………………………….…………………………..

I take an oath to contest the election from Aam Aadmi Party for Lok Sabha

Constituency ……………………………………………………………………………………………………………..

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 such law/s at the earliest.

6. Govt should not acquire any land without the permission of public. I’ll put my

full efforts to bring 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