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Application Form For Lok Sabha Election

1. Name of Candidate: ____________ _________

2. Present Address:

(i.)Name of Jail: ____________ _________ (ii.)Cell Number: ____________ _________

3. Political Party: ____________ _________

*List ONLY the Last Five parties in Chronological (Order)

4. Nationality: [ ]

A- Italian B- Indian

5. Reasons for leaving last party (circle one or more)

A- Defected B- Expelled C- Bought out D- None of above E- All of above

6. 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)

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

A- 1-2 yrs B- 2-6yrs C- 6-15yrs D- 15+yrs

8. Give details of any criminal cases pending against you (Use as many Additional Sheets as you want)

9. 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

10. Are you involved in any financial scams? [ ]

A- Why not B- Of Course C- Definitely D- I deny it all E- I see a foreign hand.

11. What is your Annual Corruption Income? [ ]

A- 100-500 Crores B-500-1000Crores C- Overflow… (Convert all your $ earning from Hawala etc to Rupees)

12. Do you have any developmental plans for India in mind? [ ]

A- No B- No C- No D- No

13. Describe your achievements in space provided: [_________]

Issued in public interest by Election Commission of India.

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