1.Name of Candidate:_____________________
2.Present Address:(i.)Name of Jail:_____________________
(ii.)Cell Number:_____________________
3.Political Party:_____________________
*List ONLY the last 5 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.No of years of public service experience do you possess? [ ]A- 1-2 yrs
B- 2-6yrs
C- 6-15yrs
D- 15+yrs
9.List the criminal cases pending against you(Use as many
Additional Sheets as you want)
10.How many years have you spent in Jail?[ ]
(Don’t 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- No Comment
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 Crore
B- 500-1000Crore
C- Overflow...
(Convert all your $ earning from hawalaetc 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:[_________]
2.Present Address:(i.)Name of Jail:_____________________
(ii.)Cell Number:_____________________
3.Political Party:_____________________
*List ONLY the last 5 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.No of years of public service experience do you possess? [ ]A- 1-2 yrs
B- 2-6yrs
C- 6-15yrs
D- 15+yrs
9.List the criminal cases pending against you(Use as many
Additional Sheets as you want)
10.How many years have you spent in Jail?[ ]
(Don’t 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- No Comment
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 Crore
B- 500-1000Crore
C- Overflow...
(Convert all your $ earning from hawalaetc 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:[_________]
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