State: ..

Lok Sabha Applied for...

Form-A

LOK SABHA CANDIDATE DETAILS

(PERSONAL INFORMATION)
Name: ---------------------------------------------------------------------------------------------------------------Gender: -------------------------------- D.O.B.: --- -----------------------------Phone (Mobile): --------------------------------------------------------------------

Photo

Phone (Landline): ---------------------------------------------------------------E-mail:

Education Qualification: Year: ..
If Student then College Name: --------------------------------------------------------------------------------------------------Address: -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Whether you belong to any special category SC ST OBC
Details in electoral roll: S.no. In part no.
Vidhan Sabha ...Lok Sabha...
Note: Where ever the word used Family, It means Parents, spouse (Husband or Wife) and Children (If
unmarried, then family means Parents only.)

1. Your activity towards Janlokpal, Any other Andolan and Social Service etc. (Please give details on
separate sheet and enclosed with this form)

----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------2. Details of Family members:

S.no

Name

Relation

Age

Gender

Occupation

3. Have you or your family member ever been convicted for any offence or any Case/FIRs pending. If yes
please give the detail below& enclosed detail report along with this form.

S.no. Name of the Person

Case
No.

Detail of Section

Detail of
Case

In which
year case
has been
started

Present
Situation

4. Do you or any of your family member are part of any political party. If yes then mention.
S.no.

Name of the
Person

Party Name

Post

From

Up to

5. Have you or any of your family members ever contested in any election? If yes. Please Mention Below.
S.no. Name

Contested
Election

Year

Party
Name

How much Votes

you got

How much money

you spent

Result

6. Are you or any of your family members a part of any social/revolutionary organization if yes. Please
mention below.
S.no. Name

Name of
organization

Post

From Upto

Main activities of
organization

Your
Role

7. Source of Income (About self and family members).

S. No.

Name

Average yearly income

Source of income

8. Detail of property (About self and family members).

S.No.

Name of property
owner

Details of
property

When
purchased

Value at the time of

purchase

Current market
value

9. Why do you want to contest the election?

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10. Why should you be selected as candidate over other applicants?

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------11. If you have not been selected as candidate. What will you do?
Contest as independent candidate.
Try to get ticket from some other party.
Other (Please give details).
......
12. Why do you think that you will win the election?
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13. For decentralization of power, have you read the SWARAJ book? What is your opinion about that?
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14. What strategies would you adopt to win the election? And how much expenses would be required?
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15. Do you have a team apart from party volunteers? How many team members/volunteers you have in each Vidhan
Sabha?
Vidhan Sabha

No. of members/volunteers

(List of members/volunteers with name and phone numbers has to be provided)

AFFIDAVIT
(To be submitted on Rs.10 Stamp Paper)
Date: .
I.son/daughter/wife of
Resident of .....
I take an oath to contest the election from Aam Aadmi Party for
Lok Sabha ..
I will follow the under given points after winning the election:
1. I will not take Red Beacon Car.
2. Ill not take any unnecessary security. Security should be dedicated for Aam Aadmi & not for
their chosen candidate. Leader should not take any security more than awaited to Aam
Aadmi.
3. Ill not take any big bungalow & shall live like any other member of the society.
4. I agree with the concept of Swaraj & that governance should be directly in the hands of public
& not in their chosen representatives. Ill give my full efforts to bring such a law but till time
such law is not passed, all the work in local area shall be done in consultation with the local
public.
5. Im committed towards Janlokpal bill & Electoral reforms. Ill put my full efforts to bring such
law/s at the earliest.
6. Govt. should not acquire any land without the permission of public. Ill put my full efforts to
bring such law/s at the earliest.
7. I have gone through the ideology & principals of Aam Aadmi Party and have also understood
the same & fully believe in it. I have also read the candidate selection process & fully agree
with the same.
I above name deponent do hereby confirm the above contents are true and correct to the best of
my knowledge & belief & that nothing has been concealed.

Deponent

List of 100 Proposing Voters from EACH VIDHAN SABHA of respective Lok Sabha
(E.g. if there are 8 Assembly Constituencies in a Lok Sabha then 800 proposing voters are mandatory)

We undersigned are the resident and voters of Vidhan Sabha and we

proposed the name of . as
the candidate of Aam Aadmi Party from .Lok Sabha.

S.No.

Name

Complete Address

Part No. &

Vidhan Sabha S.No. in
Voter list

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Phone
No.

Signature

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Note: - Your application shall be deemed rejected for giving wrong and incomplete
information of the proposers.

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