PLEASE FILL UP THE ATTACHED FORM AND HAND OVER TO THE NEAREST OFFICE OF THE ELECTION COMMISSION

 

Application Form for Contesting Indian Elections

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  1. Name of Candidate :  _______________________

 

  1. Present Address

 

(i)  Name of Jail       :  _______________________

 

(ii) Cell Number       :  _______________________

 

(If not in Jail, please attach proof of residence)

 

  1. Political Party :  _______________________ (List ONLY the Last Five parties in Chronological Order)

 

  1. Sex [ ]A – Male

[ ]B – Female

[ ]C – Mayawathi

[ ]D – Jayalalitha

 

  1. Nationality [ ]A – Italian

[ ]B – Indian

 

  1. Reasons for leaving last party (please tick one or more)

[ ]A – Defected

[ ]B – Expelled

[ ]C – Bought out

[ ]D – None of above

[ ]E – All of above

 

  1. 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’ please attach Certificate of Sanity from a recognised

Government Psychiatrist)

 

  1. How many years of public service experience do you possess ?

[ ]A – less than a year

[ ]B – none

[ ]C – are you joking?

[ ]D – what is this ‘public’?

[ ]E – I am not not servant of public, I am their ‘neta’…what you mean?

 

 

  1. Give details of any criminal cases pending against you

(Use as many additional sheets as you want)

 

  1. How many years have you spent in Jail ?

(Do not confuse with  question 8)

[ ] A – 1-2 years

[ ] B – 2-6 years

[ ] C – 6-15years

[ ] D – 15+ years

 

  1. Are you involved in any financial scams ?

[ ] A – Why not (please explain separately)

[ ] B – Of Course

[ ] C – Definitely

[ ] D – I deny it all

[ ] E – see a foreign hand.

 

  1. What is your Annual Corruption Income ?

[ ] A – 100-500 Crores

[ ] B – 500-1000 Crores

[ ] C – Overflow…

(Convert all your $ earnings from Hawala etc to Rupees)

 

  1. Do you have any developmental plans for the country in mind?

[ ] A – No

[ ] B – No

[ ] C – No

[ ] D – No

 

  1. Describe in space provided, all your achievements: ____

 

Thank you for taking the time to fill this up…we will revert to you.

 

 

 

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Thumb Impression of Candidate

(Not that of the person who

filled the form)