Transcription
a GOANONJUDICIALSr No.ZPS G****inemomaamue.Place of Vendor Margao, Goa D:21ca/po2Paper:."******a*awusn"**avn*B 516893Value of StampName of Purchaser:.N.xshs.MResiding at:.NDAa.Father's Name. xsaTnanmsserndaAs there i s no one single stamp paperRSof the valueFIFTYRUPEESSPECAforthe vaiueof, additional stamP papers for the completionattached alongwithareSign of amp VendorADHIaSign of PurchaserLIc. NO. PyEN-LIC/2/2005/ACArwin S. Ghes, Margao-GoaELSA S. FERNANDESReg. No. 290ARExp. Dt.27/02/2024Ertire StateELSA S. FERNANDESof Goa/GOAGoVT OFReg. No. 29Exp. Dt. 27/02/2824 *\Entire Ste of Goa/GoVT.DFGOPFORM XXIIIAFFIDAVIT FOR CONTESTING ELECTION TO WARD NO. 5 OFTHE CUNCOLIM MUNICIPALCOUNCILx
resident ofaged 53 years,of Mr. Mohan Kalekar,I,South- Goa, India,Cuncolim, Salcete,House Number. 2/395, Veroda,affirm anddo hereby solemnlyelection,above403703, a candidate at theMr.VishalAR.FERNAMDES. No. 290Kalekar,sonstate on oath as under:.27/02/2024State of Goa1.OF GoMyname(Three)2.MyNo.IIIof Voters list of ward542numberserialatenrolledisof CuncolimcontactMunicipalCouncil.telephone number(s) is/are9422447514and my e-mail id(ifany) is vishalkalekar67@gmail.comand status of3. Details of Permanent Account Number(PAN)filingIncomeTax return:Sr.The financial year TotalPANNamefor which the last shownNo.1.incomeIncome-Taxreturnreturn(inhas beenfiled.Rupees)2020-20211,59,880/-AOZPK6509D Dependent-NotNilNil2(Vedika v.ApplicableDependent(Nirmiti V.Kalekar)4Kalekar)4. I am not accused of any offence(s) punishable with imprisonment fortwo years or more in a pending case(s) in which a charge(s) has/havebeenframed .in
If theNA/EL FERMARNDESNo. 200Entir427/d State02/2of024GoabvOF GOdeponentis accusedorany suchoffence(s),he shall furnish thefollowing information:i).Thehavefollowing case(s) is/arebeenframed bythenotpending againstcourtforin whichmeoffenceanchargespunishablewithimprisonment for two years or more:a). Case/First Information Reportdetails of concerned Policeb).Section(s)descriptionc)./Nos. together with completeStation/District/State.Not Applicable.of theconcerned Act(s) and shortOffence (s) for which charged.of theName ofNo.Court,Not Applicable.Case No. and date of ordertaking cognizance:d).Courts. Not Applicable.which framed thee). Date(s)onwhichcharge(s)charge(s) was/Not Applicable.wereframed. Not Applicable.f). whether all or any of the proceeding(s)Court(s) of competent jurisdiction.ii).Thefollowing case(s) is/arenothave beenstayed byany. Not Applicablepending againstmein whichcognizance has been taken by the Court.(The detailsthe Court,of allpendingirrespectivelycases inof thewhichcognizance have been taken byquantumifcharges should be mentioned)a).Name ofCourt,taking cognizance:b). the detailsframingof. . Not Applicable.of the caseofwhere the court has takenAct(s) and description.Appeal(s)/ Application(s)the above order(s).orCase No. and date ofordercognizance, section(s)c). Details ofpunishmentNotApplicable.for revision (if any) filedagainst. Not Applicable.
(5).I have not been convicted of any offence(s) and sentenced toimprisonment for one year or more.It the deponent is convicted and punished as aforesaid, she shall furnishthe foilowing information:TAAFESNANDES2702/2024In the following cases, I have not been convicted and sentenced to20imprisonment by a Court of law:2te of Goaa). the details of cases, section(s) of the concerned Act(s)A. Not Applicable.and description of the offence(s) for which convicted.b). Name of Court(s), Case No. and date (s)of order(s).Not Applicable.c). Punishment imposed.Not Applicable.d). whether any appeal was/ has been filed against the conviction order.Ifso,details and present status of the.appeal:Not Applicable.(6). That I give herein below the details of the assets (movable andimmovable, etc.) of myself, my spouse and all dependents and all liabilities.SLDescriptionNo.Self irmitiDependent2(Vedika V.v.Kalekar) Kalekar)12Cash in handRs.20,000/Cash in BankRs. 1,50,000/incdudingRs.10,000/ NILRsNilNilNIL2,00,000/-Fixed Deposits inFinancialInstitutionsincluding in PostOffices.3Motor)Zenvehicles(4wheeler wheeler)s and 2 wheelers)Car(four i)SwiftCar(fourwheeler)i)scooter(twoNILNil
Jewelleryywheeler)75 gmsHouse/Bulding/FIat/Land,etc.160 gmsCo-ownedlandPlotof Co-ownedadmeasuringPlot1000 S.mts, alongwith30 gms30 gmsNilNilof landadmeasurinResidential g 1000HouseS.mts,along withResidentialFReLSA MANDEANLoansorBank,dues toHouseNILCarGovernment andloanofNILRs.30,000/-other FinancialNilInstitutions.GA7). Details ofprofession oroccupation(a). Self: selfemployed Civil Engineer(b). Spouse:Government Service.8).My educationalqualificationSr. DetailsofNo. eeringis ncolimUnitedHighCuncolim-Goa(Goa Board)of YearofpassingSchool, March1984Dhempe college of Arts &Science, March,March,1987.1987.Miramar, Panaji-Goa (GoaBoard)of Goa Collegeof Engineering,Farmagudi, Ponda-Goa. (GoaUniversity)1991
VERIFICATION1, Mr. Vishal Kalekar, the deponent, above named, do hereby verify anddeclare that the contents of this affidavit are true and correct to the bestof myknowledgeand belief and nopart ofit is false andnothingmaterial has been concealed therefrom. I further declare that:(a). there is no case of conviction or case pending against me, otherAA27/02/2024EELSALSTAA SFERNAMDE. tRedthan those mentioned in item no.(4) and (5) which are non-applicable tome.S. FERNANDES(D). 1, my spouse or my dependents do not have any asset or liability.No. 290other than those mentioned in itemte of Goa/VerifiedatCuncolim-Goa,onthis(6) above.03rd dayofMarch, 2021.DEPONENT60LEMNILY AFFIRMED AND VERIFLEDARLBPTABIAL. MetRIALOTNOTARIALReg. Ho. 290NOTARIALHO 13 DENTIFIED BEFORE MEREG. NO:6o6/21Gtog 20o?-DATED02l02 202Exp.UtState.27/02/2Goa/024EntireGOyT.BEFORE/ME BYNAaSho r-ofOGCANOTARIALELSA S. FERNANDESNotary for EntireNOTARIALState of Goa-ndia
9422447514 and my e-mail id (if any) is vishalkalekar67@gmail.com 3. Details of Permanent Account Number(PAN) and status of filing Income Tax return: The financial year Total for which the last shown Income-Tax return has been filed. 2020-2021 income Sr. Name PAN in No. Income-Tax return(in Rupees) Self(Vishal AFMPK4594C 1,59,880/- Kalekar)
