1. Name of Candidate: ____________ _________
2.Present Address:
(i.)Name of Jail: ____________ _________
(ii.)Cell Number: ____________ _________
3.Political Party: ____________ _________
*List ONLY the Last Five parties in Chronological (Order)
4.Sex: [ ]
A- Male
B- Female
C- Mayawati
D- Uma Bharathi
5.Nationality: [ ]
A- Italian
B- Indian
6.Reasons for leaving last party (circle one or more)
A- Defected
B- Expelled
C- Bought out
D- None of above
E- All of above
7.Reasons for contesting elections (circle one or more)
A- To make money
B- To escape court trial
C- To grossly misuse power
D- To serve the public
E- I have no clue
(If you choose “D, attach Certificate of Sanity from a
Recognized Government Psychiatrist)
8.How many years of public service experience do you possess?
A- 1-2 yrs
B- 2-6yrs
C- 6-15yrs
D- 15+yrs
9.Give details of any criminal cases pending against you (Use as many Additional Sheets as you want)
10.How many years have you spent in Jail? [ ]
(Do not confuse with question 8)
A- 1-2 years
B- 2-6 years
C- 6-15 years
D- 15+years
11.Are you involved in any financial scams? [ ]
A- Why not
B- Of Course
C- Definitely
D- I deny it all
E- I see a foreign hand.
12. What is your Annual Corruption Income? [ ]
A- 100-500 Crores
B- 500-1000 Crores
C- Overflow…
(Convert all your $ earning from Hawala etc to Rupees)
13. Do you have any developmental plans for India in mind? [ ]
A- No
B- No
C- No
D- No
14.Describe your achievements in space provided:
[_________]
Issued in public interest by Election Commission of India.
