06/06/2018
AFFIDAVIT BY THE CANDIDATE FOR
ELECTION TO THE ASSEMBLIES IN GENERAL ELECTIONS 2018
I, .................................................s/o, d/o, w/o......................................., being a candidate for election to the National Assembly / Provincial Assembly of .................................... (name of province) from constituency No......................................................... filed / am filing my nomination papers on ..........................................and in addition to Form A and Form B, I do hereby solemnly affirm and declare to the best of my knowledge and belief that,—
A. I am registered as a voter at serial number ............... in the electoral roll of electoral area.................................................................. of Tehsil/Taluka ................................................ District ..........................................
B. No loan for an amount of two million rupees or more is obtained from any bank, financial institution, cooperative society or corporate body in my own name or in the name of my spouse or any of my dependents, or any business concern mainly owned by me or the aforesaid, stands unpaid for more than one year from the due date, or has got such loan written off; and
C. I, my spouse or any of my dependents or a business concern mainly owned by me or the aforesaid, is not in default in payment of government dues or utility charges, including telephone, electricity, gas and water charges of an amount in excess of ten thousand rupees, for over six months, at the time of filing of nomination paper.
D. The names of my spouse(s) and dependents are given hereunder which is correct and no name has been left out.
Sr.No.
Name of dependent
Relation with the candidate
1
2
3
4
5
6
Note-I: Use additional sheet if required.
E. Neither I nor my spouse(s) nor any of my dependents mainly owns any business/firm/company except the following:
_____________________________________________________________ _____________________________________________________________ _____________________________________________________________
Explanation.— For the purpose of these declarations, the expression —
(i) “loan” shall mean any loan, advance, credit or finance obtained or written off on or after the 31st day of December, 1985, but shall not include the loan the recovery of which has been stayed or suspended by any order of a court or
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tribunal, including the High Court and the Supreme Court;
(ii) “mainly owned” shall mean holding or controlling a majority interest in a business concern;
(iii) “taxes” include all taxes levied by Federal Government, Provincial Government or a local government, but shall not include taxes the recovery of which has been stayed or suspended by any order of a court or tribunal;
(iv) “government dues and utility charges” shall, inter alia, include rent, charges of rest houses or lodges owned by the Federal Government, Provincial Governments, local governments or corporations established or controlled by such governments, but shall not include the government dues and utilities charges the recovery of which has been stayed or suspended by any order of a court or tribunal.
F. No case of criminal offences was pending against me, six months prior to filing of my nomination papers.
AND
The following cases of criminal offences were pending against me, six months prior
to filing of this nomination:
G. My educational qualification is .........................................................................
H. My present occupation is ............................................................................
I. My passport number is ................................................................................
J. My National tax number, if any, is...................................................................
K. The income tax paid by me during the last three assessment years/ financial years is given hereunder:—
Note-II: Attach copies of income tax returns of the years mentioned above. *If more than one income resource, attach detail.
L. Detail in respect of my travel abroad during last three years and cost incurred thereon is as under: (attach complete copy of the passport and detail of expenditure).
Title and number of case
Name of the Court
Total Income
*Source of income
Tax Year
Total Income Tax paid
Year
Detail of countries visited
Period of stay
Cost Incurred
Remarks
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M. The agricultural income tax paid by me during the last three years is given below:
Note III: Attach copies of agricultural tax returns of the last three years mentioned above or the certificate issued by the authority concerned in this behalf.
N. Being elected as Member of National Assembly/Provincial Assembly from Constituency No............................................................... in the year(s) ....................................... I made important contributions for the benefit of my constituency the details of which are as follows:...................................................................................................... ....................................................................................................... ....................................................................................................... ....................................................................................................... ....................................................................................................... ....................................................................................................... .......................................................................................................
O. I have paid a sum of Rs.......................... by way of contribution to the political party which has awarded me party ticket for this election. (Attach detail, if any).
P. I have received a sum of Rs..........................from the party which has awarded me the party ticket (Attach detail, if any).
Q. I shall make all election expenditures out of the money deposited in the exclusive account opened for the purpose detail of which has been mentioned in the nomination form and I shall not make any transaction towards the election expenses through an account other than the above account
R. I have not ceased to be a citizen of Pakistan nor have I acquired or applied for the citizenship of a foreign state.
OR
I possess Foreign Passport No..................... issued by .............................. ............................................................................. [name of country(s)].
S. I have no objection if information concerning myself in relation to acquisition of citizenship of foreign State or application of such citizenship is provided by any foreign state to the Ministry of Foreign Affairs of the Government of Pakistan or Election Commission of Pakistan.
Tax Year
Land Holding
Agricultural Income
Total Agricultural Income Tax Paid
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T. The detail in respect of my Nets Assets is given as under:
a. Net assets as on 30th June of current Financial Year...................................
b. Net assets as on 30th June of previous Financial Year.................................
c. Increase/decrease (a-b).........................................................
U. IacknowledgethatfailuretogivedetailregardinganyiteminrespectofFormAand Form B shall render my nomination to contest election invalid or if any information given therein and hereinabove are found incorrect at any time, my election shall stand void ab initio.
V. I hereby assure that I shall abide by the Code of Conduct issued by the Election Commission.
Signature of candidate ........................................... Thumb impression of candidate ........................................
National Identity Card No. Address..................................................................................................................................................... Contact No. ............................
Dated.....................................
VERIFICATION ON OATH
I, ................................................... s/o, w/o, d/o................................................ do hereby solemnly declare that, to the best of my knowledge and belief, the above contents of this affidavit are correct and nothing has been concealed therefrom.
Signature of the candidate..................................... Date .................................................
Place.....................................................
Attested by the Oath Commissioner...........................................
Note: This affidavit is to be provided on stamp paper that will be duly attested by an Oath Commissioner appointed under the Oaths Act, 1873 (X of 1873).
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