njv
26th April 2006, 05:19 AM
1. Name ...........................
(Give all possible name, including your "binami/proxy" name. Dont forget to list the original name given by your parents also
2. Educational Qualification
a. Elementary School
b. 10th Std Pass
c. 10th Std Fail
d. None of the above
3. Party for which you would like to contest? .......................
(If its congress, please kindly let us know which group you belongs to and if possible which subgroup you belongs to)
4. Number of years in public service
a. Fresher
b. Less than 5 years
c. Between 5 and 10 years
d. More than 10 years
5. Number of criminal case against you
a. Between 5 and 10
b. Between 10 and 50
c. More than 50
d. Not sure.
6. Numbers of jail services
a. Less than 5 time
b. 5 - 10 times
c. more than 10 times
(Note: Please do not confuse this question with question no 4)
7. When did you switch your political party at last
a. Yesterday
b. Last week
c. Last month
8. Reason for switching
a. I didnt get seat again
b. I got seat but didnt get money for election expense
c. Got better "deal" from the new party
9. Whats your current asset worth
a. None
b. 10 crore
c. between 10 to 50 crore
d. More than 50 crore
(Make sure that what you select for 9 is the same as what you selected for 4, otherwise this form will be rejected from further processing)
10. If you are elected, what would you do ___
This is not a multiple choice question, you need to fill this out. Please do not list any items that improves
your and/or your family life. It is your responsibility. We would like to here from you what you would do
beyond your responsibility and capacity
Thumb Expression
-----------------------------------
(Please do no link your tounge. Inkpad provided free of cost
Please do not take inkpad to your home. This application form does not entitle you to behave as if you won the election.
(Give all possible name, including your "binami/proxy" name. Dont forget to list the original name given by your parents also
2. Educational Qualification
a. Elementary School
b. 10th Std Pass
c. 10th Std Fail
d. None of the above
3. Party for which you would like to contest? .......................
(If its congress, please kindly let us know which group you belongs to and if possible which subgroup you belongs to)
4. Number of years in public service
a. Fresher
b. Less than 5 years
c. Between 5 and 10 years
d. More than 10 years
5. Number of criminal case against you
a. Between 5 and 10
b. Between 10 and 50
c. More than 50
d. Not sure.
6. Numbers of jail services
a. Less than 5 time
b. 5 - 10 times
c. more than 10 times
(Note: Please do not confuse this question with question no 4)
7. When did you switch your political party at last
a. Yesterday
b. Last week
c. Last month
8. Reason for switching
a. I didnt get seat again
b. I got seat but didnt get money for election expense
c. Got better "deal" from the new party
9. Whats your current asset worth
a. None
b. 10 crore
c. between 10 to 50 crore
d. More than 50 crore
(Make sure that what you select for 9 is the same as what you selected for 4, otherwise this form will be rejected from further processing)
10. If you are elected, what would you do ___
This is not a multiple choice question, you need to fill this out. Please do not list any items that improves
your and/or your family life. It is your responsibility. We would like to here from you what you would do
beyond your responsibility and capacity
Thumb Expression
-----------------------------------
(Please do no link your tounge. Inkpad provided free of cost
Please do not take inkpad to your home. This application form does not entitle you to behave as if you won the election.