1. Name of Candidate: ____________________________ [Real name only]
2. Present Address:
Name of Jail : ________________________________
Cell Number: ________________________________
(If not in Jail, attach proof of illegally occupied residence)
3. Political Party: _______________________________ (List ONLY the Last Five Parties in chronological Order)
4. Sex: [ ]
A.Male
B.Female
C.Mayawati
5. Nationality: [ ]
A.Italian
B.Indian
(If Indian, attach attested copy of ration card, police certificate, passport, birth certificate, electricity bill, phone bill and local goondas NOC.
If Non-Indian, just check box A)
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 election (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’, then attach certificate of sanity from a recognized government PSYCHIATRIST)
8. How many years of public service experience do you possess? [ ]
A.1-2 years
B.2-6 years
C.6-15 years
D.15+ years
9. Give details of any criminal cases pending against you..
(use as many additional sheets as you want)
10. How many years have you spent in jail? (Do not 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.Why not
B.Of course
C.Definitely
D.I deny it all
E.See a foreign hand
12. What is your Annual CORRUPTION Income?
A.100-500 Crores
B.500-1000 Crores
C.Overflow….
(Convert all your $ earning from Hawala etc. to Rupees)
13. Do you have any developmental plans for the country in mind?
A.No
B.No
C.No
D.No
14 . Describe your achievements in the space provided in brackets :
[ ] !!!!!!!
Thumb Impression of the Candidate:
MERA BHARAT MAHAAN
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Contributed by Abhijeeth