-t

OD!SHA
t1^^ ^oo671
rt.t*{.l/ilrl FORM26
\a/rm{p-
E (Scc Elc4A)

\\x
n*O""i ,o bc tiled by tte candidete rlong with nominrtion peper before , G:-
tng r*urning oficer for election to- Legirletive Asscnbly, Odishe- Neme of
thc House) fromJ4 Keonjhar (ST) constituency (Neme of thc constituency) {
s
'' PART-A ts
,\
li I Sri Mohen C_hjrrn Mrlhi.rson/daughter/wife of teteJgglnaram Maihi
-s
s
ACAd 52 years, resident of AvFo{aikah,Thana-Raisuan Din- s=)
n_-.<-
reSnltrai,oai*ra,Pin No-75fl131 (mention full po-stat idOress), iEididate at
thqabove eleaion, do ileriby solemnly affirm and state on oath as under :- .a

Ji'
l) I arn a candidde set W by BHAnATIYA JANATA PARTY ( BIP) €
a
(** name of the political party)tr* am contesting as an tn@endent
candidate. (**strike out whichever is not applicable) 3
{2) My namc is enrolled in 2I-KIONJIIAR (SI) (Name of the co*inrency,
and tte State), at Scri.l No 519 in Prrt No 55

raT^lv
rb
x-|tlrrt|r
3ovt. el lrrltr
/- n\9
Y-Zolw ^rab Ov At
(hobo"- Oa"- '', r'; yl \r.;. ,.. rY
.t
J(i -.rrr,.tF! I
. |

I
, Itll
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t;--
A.:f (
'.ic.,
I a!,r,,,, I

/ Wi^^ C.kw^n h"^,tu,

rra rth .n, r^i
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..,,!tr{' i .4.. . "' .

. a.. { : I

a ,r, rr
 (3) My contact telephone number (s) iVare ...94371X)8254 and8327701171 my
e-mail id [email protected] (if any) is lare .....

(i) Twitter I'd - @Mohanmajhi_BJP

(iD Facebook I'd-Mohan Charan Majhi
(iiD What's app No - 94371X)8254

(4) Details of Permanent Account Number (PAN) and status of filing of

Income Tax return,

x"-o
ffio PAN The frnancid
year for which
the last Income.
Total income
shown In Income
Tax return ( in
tax return hes Rupees) for the
els been filed last frve Financial
Yeers (as on the

ffi d g
d. No:-
;gtrr 3ls Mar)
ALFPMO9OSB 2023-24
(i)
(ii)
l. Self {iiO AY-22-2}R5 425341)
(iv) AY-2324-RS 426U)
(v) AY-2.,L24Rs422370
(i)AY-r9-20-Rs 251()863
ATQPMI2TEH 2022-23
(ii)AY 20.2r-Rs 2t3l97o
(iii)AY-21-22-Rs 1531420
2. Spouse
(iv)AY-22-23 -Rs 2291 lm
(v)AY-t!2+Rs r350AX)
No PAN Allotted (ilNotApdic.bl.
Not Appliceble
(ii)-Not Afi)|ic|ltr
HUF(lf the candidate is (in)-Not Applic.bl.
-)-
Karta or Coparcener) (iv)-Nor Applicrbh

(v)-Not Applicrble

No PAN Albrt€d (iFNot Applicrblc

Not Appliceble
(ii}.Nol Applicrblc

4. Dependent -l (iiilNor ADplictblc

(itlNoa Applicrlte
(vlNor AppticrHc

No PAltl Albtted Not Appliceble (i)-r{ot Apdkrtt.

(iiFNoi Applicrblc

(iiilNo{ Applkrblc
5. Dependent -2 (iv)-Not Applic.blc

(v),Nol Appli..Hc
(vi>Nor Applicrbk

\^rln\^., (,1^qt6i', AA,a(*

<."==-.*d4
ah
I'?AIV
(aortha? Torn
:odt, of Indla UM
 No PAN Albtted Not Applicrble

tro,
'2 /*

GS for PAN holder to mention PAN and in case of no PAN. it should

Clearly stated"No PAN Alloted'

5. Pending criminal cases

(I) I declare that there is no pending criminal case against me. (fick this alternative if
there is no criminal case against Cendidate and write NOT APpLICABLI against
alternative (ii) below)
OR
(ii) The following criminel cases ere pending ageinst me:
( Ifthere are pending criminal cases against the candidate then tick this alternative and
score olf alternative (i) above and give details ofall pending cases in the table below)
Table

(a) FIR No. with name end FIR No -216 llate.

3ll10/201l.Town Polke Not ApplicrbL
address po Police station
concerned Strtiron, Keonjh:r
(b) Case No. with Name of GR Cace No -
the Court r0lZAltrSlllMJtuorjler Not
Applicablc

(c) Section (s) of concerned UlSl43l34l294ll49 oI

Acys/Codes involved IPC Not
(give no. of the Section Applicable
e.g. Scction-..,.of IPC
etc.)

(d) Brief description of Udawfitl Asscnbly and rord Not

offence blockede Appliceble

' \IrAa-rr Lh.a,va+,,

a{t-rrLt. ^A^W
IO?AiY
Xa..th.r l|ti
Govt. af Indl. uv/,$
 (e) Whether chargcs heve YES Not
been framed( mention Applicable
YES orNO )

(f) Ifanswer against (e) above is Not

YES, Ther give thc date on Applicable

rt
Dare-18/022013
** \'r(hich CHARGES ARE
14 |'\\ . rnePteo
I'9i \vldtfter anv Appeal
.,d1{d[|-rt*ion for revision
NO NO

n1 ftnn**Slea against the

ionYES
t' NO:
S1+3e$.'1'*
w;\
rr.c #)'i
(6) Case of conviction

(i) declare that I have trot been convicted or any criminal offence. (Tick this alternative if
the candidate has not been convicted and write NOT APPLICABLE against alternative
(ii) below)

OR

(ii) I have been convicted for the ofrences mentioned below:

(Ifthe candidate has been convicted. then tick this alternative and score off alternative

(D Above and give details in the Table below)

Table

Brief descripti,on of Not Applhrbh Not Applicebh Not Applicable

ofrence cor whitfi
convicted

o \).,{drar,r Lhpv'ror' M^f

tolAlY
X..rrh.r fcrn
?ovt, of Indlr
 €) Wherther rny Appcel NO NO NO
has been filed es.inst
conviction
tr
order

$RntionYESorNo)
to (g) above is Not Applicable Not Appliceble Not Applicable

thc detril and

I .**NIl
fll. x ltri\"
a,r
lA, ?f
-^ l{o:: "
of appeel
rt \R
t-{Vlj
t".t*3

(a r\-__.-
.-
\\ l.
V-t@l}\b*i
t'^-'-' //

eiven fult and up-todate information to my political party about all pending
cases against me and about all cases of conviction as given in paragraphs (5) and (6).

I candidate to whom this ltem is not applicable should clearly write NOT APPLICABLE
IN VIEW OF'ENTRIES INS(i) end 6(i), abovel

Note:

l. Detsil should be entered clearly and legibty in BOLD tetter.

2. Detail to be given separate$ for which cese under difrerent columns against each
item.
3. Detail should be given in reverse chronological order i.e, the latest case to be
nention first and backrvards in the order ofdete for the other cases.
4. Additional sheet mey be added if required.
5. Candidate is rcsponsible for supplying ell infornetion in compliance of Hon,blc
Supreme Court's judgment in W.P ( C) No. 536 of 2011.

(7) That I give herein below the details of the assets (Movable and Immovable etc) of myself,
my spouse and all dependents.

A. Details of movable assets

Note :- I Assets in joint name indicating the extent ownership will also have to be given.

Note:- 2 In case of deposit/lnvestment, the details including serial Number, Amoun! date of
deposit, the scheme , Name ofBanV Institution and Branch are to be siven.

Note :3 Value o Bonds/Share Debenture as per the current market value of stock Exchange in
respected of listed companies as per books in case of non listed companies should be
qiven

$M^@,r, )l'nta-a \ak

roTAlY
X..rrL? 1|,rlr
g.rt, ot thtl!
 .t Note:4 Dependent means parents, son(s) daughte(s) ofthe candidate are spouse and any
other person related to the candidate whether by blood or marriage , who have no
separate means of income and who are dependent on the candidate for their livehood.

Note 5. Detail including amount is to be given separately in respect ofeach investment.

Note 6 Detail should including The interest in the ownenhip of offshore assets.

Explanetion - For the purpose ofthis Form the expression *ofrshore lssets' includes,
--dclall of Nll deposits or investment in Foreign Banks and any other body or institution
41E q{ detail of all assets and liabilities in foreign countries

t,r.t,:sry KTN." S€lf Spouse

s{frfiV-
HTJF Dependent-
I
Not Apdi.rblc
Dependent-
2
Nol Applicrblc
Dependent-3

Not Applicrble
Zt {ia$o\' {and Rs 30mry- Rs NIL
X(ea- :sF+
I 'Dq/ail!#f deposit (ilsBr,BB Appli.rHc Applicru. Not Applicrtte

N
(i)SBl,Kco Nor (i)SBl,Keof, Noa
['{$t#' njhar-A/C SR-A,/C jharJhun
/tl1.tt.acor'nt No- No- pon-A/C
\Y.! [T.C ,6x",r"r I l3t27tm
t2-Rs
30{r7rx)96
TqRs
No_4182960
5669 Rs
3142.10 50tr&19
-
9ff5.{X)
Deposits and all (ii)uBr,BB (ii)sBlJo
other types of s&A/c de,A/c Ne
No- 401252699
deposits including ts030r0l0 5+rs
1693 -Rs 40r|3.nt-
of saving 252939 (iD
(iiD B()B-
accounts), Deposits BOF Keonihrr,
Keorjhar, A/C No-
with Financial
A./C No- 14990(m
lnstitution, Non- r4990rfito 14i30-Rs
1,l1l29-Rs 6t60-tt
Banking Financial El1.O2 BOF
(iv) UCO - BBSR-
Companies BBSR. A/C Nc
,A/C No- 276502W
societies and 066401tng 00t62-Rs
amounl in each
23664 - Rs E$3A7Lr
&7tl.o2 v-
such deposit. (v) (iiD
BOIJbum PNB,BRS
pura,A,/C R A/c No-
No- l50J0r0t0
54{|l4t0r0 170!Rs
fixlE497- rrz70.6t-
ns 3369.1 Totll Rs
2(vi) Rs
KCCF n2265-6t
KJR.A/C
No-29436
- k3540/-
(YiD
II}BU(JR
.A/C N0-

"k?
frorllrr tltr
;.rrn. rl trdh
" \)Afl.^ t-uewaa )q^1k

ev"6
 r0l5l0{(x}
txl5t953
Rs
l0:i24.03-

7
(viii)
PNB,A./c

{o No-
lgt30r0r0
169'
z( :sl:$Nl 0.00/-F
(rt
a.sd
\*\ " PNB,A/C

\c\ ?h\eri'q No-

12002t619
639-R!
eruo/-F
Tobl Rs
I I I1333)
(iit Details of NIL NIL Not Not Not
ApplilrbL
Not
Applic.blc Applicabl,e Applicrbl€
investrnent if
Bonds Debenhre

/Shares and mits

in companies
/Mutual Funds and
other and the
amount
(iv) Details of oLrc (i) Not Nll NIL Not
investment in NSs, (Polrcy FD(SBr- Applicrble Applicable
Postal Savin&
No- 37A9ai729o
1s7fl1 5l) - Rs
Insurance policies
-Rs 5174737t-
and investment in 2sr3{v- (iD ts or
any Financial Ltc 30tut2v21
instruments in Post (Polky (iD Lrc
of{ice or lnsurance NG (Policy
Company and the
157m319 Nc
-Rs s953t3335
amount,
lur6t2l -Rs
r81306/-
(iii) Lrc
(Policry
No-
lx767r2
-Rr
laS4A9./W

(v) Personal loans/ NIL NIL Not Not Not Not

Applicrble Applic.bb Applic|btc
advance given to Applicable

V,ln/v^ CWa^ ttttt^-

-ffi_zQ^
I 'frr l-rr
IOYAIV
fcorfl.' Ibfi
...oyt. o? | Dafr
 any person or
entity including
firm, company,

fr G
/Et, .u.,nOf\
(D (I ) Hero Not Not Nd Not
t' 't h Jx.)$ I'ORTUNEI{ Hondt Appltorbb Applkrble Appli.rblc
Applicible
sd \1*
\*\ ir't$'* Regd xc Scooty-

\a >--
Yr.
Ibhicles/
achts/S
OIXNBE5
SlX),Year
of
R€gd Nc
OD
2571 ,
IIM

hips (Details of Purchsc- Yerr of

Make, registration a 9. Purchese -
P.cr..t 20t8,
number etc. year of v.hGRs
Prcs8lt
purchase and 25SJ0/- Vdrc - Rs
amount) 30,o0oi-
(vii) Jewellery, bullion GOLD (20 GOLD (30 Not Not Not Not
gr.rs) - gr|ns) - Applicrblc Applktbte Appli..blc
and valuable Appticrble
Value Rs Velue Rs
thing(s) (give lJ0,{no l$0,{n0
details of weight
and value)
(viii) Any other assets NIL NIL Not Not Not Not
Applicrbb AppliBbb Appliqblc
such as value of Applicable
claims/interest
Not Not Not Not
Rs Rs Applhrblc Applicable Applicablc
Applicrble
(ix) 2jt9slxiin 6v272L6t
Gross Total Vdue

B. Details of Immovable Assets:

Note: Properties in joint ownership indicating the extent ofjoint ownership will also have
l.
to be indicated.
Note: 2. Each land or building or apartrnent should be mentioned separately in this format

Note 3 Detail should include the interest in or owner:ship of ofrshore assets .

t$6i-2o24 \M of.a^ (Awa-t"

A\a^
f,--Ie|-r
TO?ArV
Xoorfbr lbfi
36vt. of I ndl,
 S.No Description Self Spouse HUF Dependent- Dependent- Dependent
I 2 -J
(i) Agricultunl Mouza- NIL Not Not Not Not
Land Rsikrh, Applicebfc Applicrbb Applic.ble Applicsble
(i)Khata No'
m{' 2lot13t,

ffi
(ii)Khrte
No..B6,(iii)K
4 hete No-98
i)l/J rd shere NIL Not Not Not Not
t Alea'Kcl
Reod t'( of 0.750 acre - Applicebte Applbable Applicrbk Applicable
\ e*ustt OJS acrc{ii)l/
N 6th shere of

-t @Pr'i"' tn acres)
5.43 acre0.9l
acr{ifi) l/l2tb
share of9J
acre -{f.76
acre, Total
1.92 ecres
Whether Not Not Not Not
inhelited Applicrbb ApplkrbfE Applicablc Applicable
property
YES NIL
(Yes or No)
Date of Not Not Nol Not
purchase in Applicrbh Applicrblc Applicablc Applicable
case of self- tlot ApplkaH€ NIL
acquired
propeny
Cost of Land Not Applhrblc NIL Not Not Not Not
(in case of Appticrbl€ Applicrble Applicable Applicable
purchase) at
the time of
purchase
Any NO NIL Not Not Not Not
investment Applicab}e Applicabl,e Appliceble Applicable
on the land
by way of
development,
construction
etc.
Approximate Rs NIL Not Not Not Not
current r9J,0,w0t- Applbble Applicabl€ Applicrblc Applicrble
market value

WOfu.,,n Ll,,.uta'r M"at^"

TO?AIY
Xrorlhrr
30vt. a? "om
lndlt
 NIL f{L Not Not Not Not
(ii) Applicebb Applic.ble Applhsbb Applicsbl€

Non-
Agriculfurel

re
q ,llarq
fu
Areo.kB^

:( :ilo ir1,x-
trpry
C3;a
NIL NIL Not Not I{Dt Not
w;
\, l\.(t.
ApplicrHc Appli.|bL Atplieb|C Applicrble

-Whether NTL Noa Irlot Not Not

inherited ^.IL ApplhH! Applirblc Applkrbb Applicrblc
property
(Yes or No)
Date of NIL I\IIL Nol Appli.rba. Nor ApplirHc Not Ap0lh.ti. Not

purchase in Applicrbl.

case of self-
acquired
property
Cost of Land NIL tilL Not Not Nol Not
(in case of Apdkrblc Applioblt Apfltu Uc Applicablc
purchase) at
the time of
purchase
Any NIL NIL Not Not Not Not
investment Appli(ruc Applictblc Appli.rblc Applicrble
on the land
by way of
I
development,
constnrction
etc.
Approximale NIL NIL Noa Not Not Not
current Applicrblc Applic|blc Applicrbh Appliceblc
market value
(iii) Commerciel (i)Mouze- Not Aflrf.:rH. F{oa ApplintL Nol ApdhdL Not
Buildings Pahsa Appli..blc
(including (ka)J<hete
NIL
aparUnenS) - No-!)6l91,
Plot No-
Location(s) -
244ftl96

";6p+ 10 Wrylst o$,wan /V\ah,

tts \
to?AlY
faarltor Tatll
3nvt. a? l4al,
exNK/Y\$'
 Survey
numbeds)
(Area (total Aree4.7fl) Not Not Not Not
ApplicibL Apdi6blc Applicrbh Applicrblc
measurement NIL decimelS0t0
-g sq-ft.) 0SqFt

F Petrol Pump
Nd
Applicab|c
Nd
Applic.blc
Not
Applicrbh
Not
Applicrblc

(^ nqt$n1
ea'Keonl
eqd No'
r
m, NIL -3m Sq Ft
for office.
Nor Not Not
Applicrbh
Not

W
Applicrble Apdiebb

a
ilrrf Ud Applicrbh
NIL No

\ =6te of Not Not Not Not

purchase in Applic.blc Applicabk Applicrblg Applicable
case of self- NIL 0242rn6
acquired
property
Cost of Not Noa Not Not
property (in Applicebfe Applic.bfc Applicable Applicable
case of
purchase) at
NIL Rs 4,20,000/-

the time of
purchase
Any Not Not Not Not
invesknent Yes, Applicebb Applieble Appliceble Applicrble
on the Dweloped
property by for
way of
I{IL Instellrrtion
of Petrol
development,
PumprRs
construction 10,00,m/-
etc.
Approximare Rs Not Not Not Not
s2s0'00/- App$ceblc ApplicEblc
cunent Applic.ble Applicable

market value
(iv) Residentral Not Not Not Not
Ruildings Mouzr- Applicabh Applicrblc Applkrble Applicrble
(including MendulKh
apdEnetrts): - NIL ata No'
Locariqt(s) -Survey d)/ll8, Plot
numbe4s) No-254

\Mzfrn Cl''atar Nag

^
w%
11

:il,#ffi
 Area (total
measurement Aree -0,070 Not Not
Not Not
decimelJ0Sll Applicrbte Applicable
in sq.ft.) Appli.rbh Applicrbb
NIL SC Ft
Built up area Not Not Not Not
Applicrblc Appli.:rbtc Applicrbl€ Applicsbl€

N ML 1200 Sq
Ft

6
*{
*
Aroa-KG(
-ffiN Not Not Not Not
Rcad. No Applic.bk Applicrbtr Applicrbk Applicable
\o' (uvot
i\
NIL No
\).c

Date of Not Not Not Not

Applic:bb Appticrble Applicrble Applicrble
purchase in
case of self- NIL 2|ll&20tlt
acqurred

property
Cost of Not Nol Nor Not
AF?ai.rbL ApFlk bh -lFdic|Uc Applicrblc
property (in

case of
purchase) at
NIL R! t'lgUXY-

the time of
purchase

Any NIL Yes, A Nol No( Not Nol

Appli..U. Appliabfc ApCi..bL
investrnent
ssb6tog Applicrble
house hes
on the land been
constructed
by way of
approI...exp
developmen! enditure Rs
10,00,000/-
construction
etc.

Approximate I. NIL Not Noa Nd Not

n! 300lny- ADp6.rbf. AHrSc.Uc A?Ck$L -A,ppliclttc
current
market value

11 \)AAwu, Ctutrtan ALqt*

--.2 --%
;ff#,*
XrorJhr tom
.'ovt. of Indl,
*ws
 Others (such

as interest in Nor
n'd Not

property) NIL No llh-* Applidbh Ap?lirbL Applic{blc

(,vi), Total of
Rs3000000r lN"t Nor
curr€nt market NIL Nol Not

ffi ,to
I Apdi..u. ADDli.rHe

below the details of liabilities/dues to public financial institutions and

Appli..Uc
Appli.rblc

fffi*tr centttte defeils of neine nf hrnk instifrrtinn entifv nr inzliwidrrel and

Self Spouse Dep€nd€nt-l Dependent-2 Dependent-3

..\$rN4sr$'/
(i) r,iliiw.cofoto (i)uco (i)SBuodr,,Amount - Not Not Nol
&(D2-E4rl-"Itletnre of
72,1 Appuc.U. Appli{rbb Appli.rbh
Benk-
Benk/financid Lodn +sb cEdit for
Loan Running of Pctml Pump
institution(s) Amoun ( Limit Rs 75 bcs
Name of the Bank
t dues (ii) SBl"lode,Anout *
Rs 458107.4$i/-.Niture of
or linancial Rs Loan -€ECL for
Rurning ofPetrol Puop
522415 ( Linir
Institution, Amount Rs 27 tacs
.62(Ve
outstandi ng, Natur€ hicle (iii)SBlJod.,Arourt -
of Loan
Lorn) Rs 13,60,{XXV-,Nrtareof
lann -{ECL for
Ru[Di[g of Petrol PuEp
( Linit Rs 14 bcs)
Loan or dues to
any other
individuals/entity
!{ot Not Not
other than Appli.rbL
Apllic.bL
Applicrblc
NIL NIL
mentioned above
Name(s), Amount

outsknding, nature
of loan
l\ol Not Nol
Any other liability tvL NIL Afplic.U. Appli.|bL ApDli..tk
Not Nof Not
Crrnd totrl of lirbilities
Applic.blc Appli6blc Applic!bl€

Wnl^ar^ (nwat'
tVdrt''
tuu
=6?e4
to?Alv
13

xtoit hat Tott

:6Yt. ot l ndla
 Government (A) Has the Deponent been in occupation ofaccommodation YESniO (P/.
dues: tick the
pmvided by the Governmenl at any tirne during the last
appropriale
Dues ten years before the date of notificalion of the current alternative)
Departments
election?
dealing with
Govemment {B) (B) lf answer to (A) above is YES, rhe following
accommodation
declaration may be fumished namely: -
(D The address of the Govemment accomrnodation:

QR NeB- I , Unit-2, Mahatma Gandhi Marg,

Xunatl$rL Bhubaneswar, Odisha-75 I 00 |

=N (ii)
Area-X|onihar Torn
There is no dues payable in rcspect of above
Regd. No:-8181/201,|
ExwDda3&f2l Government accommodation towards-
(a) rent; NIL
@) elechicity charges; ML
(c) \f,ater charges; and ML
(d)Telephone charges-Nll as on
16144/2024.(date)

No dues certilicate enclos€d

I tbe date should be the last date of the third month prior
to the month in which the election is notified or any date
thereafterl.
Note:- 'No Dues Certificatc' fiom the agencies
concemed in respect of ren! electricity charges, water
charges and telephone charges for the above
Govemment accommodation should be submitted.

Du€s to d€partment
dealing with
' ll
Wn(lan L N{izA
M:;-szQ4
JunjFrn*||fc.
rorAlv
x.erlt . ffr
30vt. o? hfi
-%
 Govemment
ff+$i
transport Urt
lincluding uit"-{ ikifl,t{-q
and helicopters) \ Q\Ero'rvDde'-'o'an; [)

(iv) Income tax dues '\:r.> /

Self *.-. Spglso HUF Depsnd€nt-l Depend€ntt Dependent-3
(u) GST Dues NIL NIL NA NA NA NA
(vi) Municipal/Property I{IL NIL NA NA NA NA
tax dues
(vii) Any other dues NIL NIL NA NA NA NA
(viii) Grand total ofall n{IL NIL NA NA NA NA
Government dues
(ix) Whether any other I'IL f{IL NA NA NA NA
liabilities are in
dispute, ifso,
mention the
amount involved
and the authority
before which it is
pending.

(9) Details of profession or occupation:

(a) Self - SOCIAL WORK AIYD POLITICS

(b) Spouse BUSINESS

(9A) Details of sources of income:

(a) Self... AGRICULTURE Ah{D PENSION
(b) Spouse... BUSINESS - PETROL pUMp
(c) Source of income, if ann of dependents, --NlL

(9B) contracts with appropriate Govemment and any public company or companies
(a) details of contracts entered by the candidat€ - NIL
(b) details of contracts entered into by spouse - NIL
(c) details of contracts entered into by dependents - NIL
(d) details of contracts entered into by Hindu Undivided Farnily or trust in which the
candidate or spouse or dependents have interest- NIL
(e) details of contracts, entered into by partnership Firms in which candidate or
spouse or dependents are partners - NIL
(f) Delaits of contracts entered into by private companies in which candidate or spouse

ffi"€D{ Wyl,^^ 0b.qr6,a \alr

doedfrLb
ra?Atv
Xa.ilh.r rfra
:oYt. ot tl}alt

"&6s"
 or dependeds have sharc - I\ilL
(10) My cducrtionel qurlificetion b es unden

Pessed HSC from Jh.'mpura High School in the yeer 1987

Passed +2 ArS from Anrdapur College in the ycar 1990
Pa$ed +3 Arts fron C.S College'Chempue in the yeer 1993
Pased LLB from Dhcnkanrl Lew College in the yerr 20ll

(Give details ofhighest SchooUUniversity education mentioning the firll form ofthe
certificateldiploma/degree corrse, name ofthe SchooVCollege/lJniversity and the year in
was completed.)

'ii#**n*"191L
rr'u t t
Regd r{o:-84br

c-

\iVufu^ (awru'A^4""'

to?Al,Y
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3.vt. ol hdr

15
 4ia$s PART-B
//c
ZI FJS
r<
OF TTiE DETAILS GIVEN IN (I) TO (IO) OF PART-A:

rt 6".
@$fthe candidate MOEAN CHARAN MAJHI
\ 4I; ( 3/"t"t"aa'"u AT/FG RAIKAI,A . P.S-RAISIJAN
r*'l' KEONJHAR.758031

3. Number and narne of the constituency and 24 _

KEONJIIAR (ST) ASSEMBLY
State CONSTITUENCY,ODISHA
4. Name of the political party which set up the BHARATTYA JAI\ATA PARTY
candidate (otherwise write'lndependent') (BJP)
5. Total number of pending criminal cases ,

6
Total number of cases in which convicted NIL

7. PAN of Year for **rich Total income

last income Tax shown
return filed
(a) Candidale ALFPMII!'O8B FY 202t24 AY :2+25 --ns 422370
(b) Spouse ATQPMI2TSH Fv 2022-23 AY -212{ --Rs 1350530

c)HUF No PAN Allotted Not Appliceble Not Applicable

(b)Dependents No PAI\I Allotted Noi Applicabl'e Not Applicable

8. Deteils of Assets end Liabilities in Rupees

Description Self Spouse HUF Dependent-l Dependent Depende
{I nt-III
A. Moveable Rs Rs NIL }iIL NIL NIL
28'E959sJt 67,TZJ2O.M
Assets (Tolal
value)

B.
Immovable Rs Rs NIL NIL I{IL I{IL
Assets r930.0tr,/- Eao&|no
I. Purchase Price NIL NIL NIL NIL NIL NIL
of self-
acquired
immovable
property

11
Vfu(^. Clr,u,ran 4",4h"
rot^lY
Xc.|rJhrf trr
':avt. rf Iri.llf
 il. Development/ NIL NIL l\IIL I\nL NIL NIL
construction
cost of
immovatrle
property after
(if
purchase

fueabre)

67
.)

,ffi;'
-lt l. a,
Rs Rs
t,Jrl 2E 9Jrsj{t 67,7\7tO.6
Ana- icorylri

ffi-
legd. io:-6{
;( &grv (b) NrL
I\{IL I\{IL NIL NIL
K .> 0r' (b) inherired
(b) Rs
r93q|xry-
"assets (Total
Value)
9 Liabilities
(D Government NIL NIL NIL fm ML I\iIL
dues Ootal)
(iD Loans from Rs Rs
Bank, 5?2415.62t- 9036r3{t3Z
NIL NIL nIIL NIL
Financial
Institutions rnd
others (Total)
l0 Liabilities thet are under dispute
(i) Govemmenl NIL NIL NIL I\IIL NIL ML
dues (Total)
(ii) Loans from
Banh
Financial NIL NIL
Institutions
NIL NIL NIL NIL
and others
(Total)
t1 Highest educational qualification: (G@
education mentioning the firll form ofrhe certificateldiplomar'degree course,
name of the SchooVCollegey'university and the year in which the course was

Passed HSC from Jhumpura High School in the year l9g7

Passed +2 Arts fron Anadapur College in the year l99l)
Passed +3Arts from C.S College, Champua in the year 1993
Passed LLB from Dhenkanal Law College in th e year 20ll

\ilfl"a^ C/r,w{a-v. /U.-"y

18
ro?Alv
Xa.rrr[r fbfr
3oyt. of lrGr
 VERIFICATION
above named, do hereby verifu and declare that the contents ofthis
and corect to the best of my knowledge and belief and no part of it is false

has been concealed there from. I firther declare that:-

C\tup'v no case of conviction or pending case against me other than those

9) 5 and 6 of Part A and B above.

) I, my spouse. or my dependents do not have any asset or liability, other than those
mentioned in items 7 and I of Part A and ilerns 8, 9 and l0 of Part B above. Verified at...
Keonjhar Garh this the 3'd day of month of May 2024.

W"rr^" Wnut^" Aah^"

3&$-:Poh{ENr
Note: l. Affidavit should be filed latest by 3.00 PM on the last day of filing nominations.
Note: 2. A{fidavit should be sworn before an Oath Commissioner or Masistrate of the First
Class or before a Notary Public.

Note: 3. All columns should be frlled up and no column to be left blank. If there is no
information to fumish in respect of any item, either "Nil" or 'Not applicable" as the

case rxry be, should be mentioned,

Note: 4. Th€ Alfidavit should be either typed or written legibly and neatly.

Note: 5 Each page of the Affidavit should be sigrred by the deponent and the Affidavit should
bear on each page the stamp of the Notary or oath Commissioner or Magistrate before whom
the Affidavit is swom.

Ministry of Law and Justice Notification No Hl l0l9 (412018- Leg.ll, dated I0s October
201 8 and
-
Notificalion No H-l l0l 9ll3/2}lLLeg II daled 26'h February 2019)
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TOTAR,Y
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