1.Name of Candidate: _____________________ Include father's name and grandfather's name. Leave blank if these are not known. 2.Present Address: Give details. (i) Name of Jail: _____________________ (ii) Cell Number: _____________________ 3.Political Party: _____________________
4.Sex: [ ] A- Male B- Female C- Transsexual D- Uma Bharati 5.Nationality: [ ] A- Italian B- Bangladeshi C- Indian 6.Reasons for leaving last party (circle one or more) A- Defected B- Expelled C- Bought out D- All of the 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 (If you choose "D", attach Certificate of Sanity from a Recognized Government Psychiatrist) 8.What kind of public service experience do you possess? A- Social service (the middleman between criminals and dirty cops) B- I was rejected for latrine cleaning C- I sold bananas D- I serviced the public 9.Give details of any criminal cases pending against you (You may use as many additional sheets as no doubt required) 10.How many years have you spent in Jail? (Do not confuse with question 8) A- 2 years less a day B- 2-10 years C- Life D- None - I use anticipatory bail 11.Are you involved in any financial scams? A- Of course why should I be left behind B- No. It's always someone else. C- I see a Pakistani hand. 12.What is your Annual Corruption Income? Include hawala. A- 100-500 Crores B- 500-1000 Crores C- Swiss account deposit limit reached ... 13. Do you have any developmental plans for India in mind? A- No B- Yes if they involve bribes and travel C- Turning Bombay into Singapore. 14.Describe your achievements in space provided hereunder: [_________] 15. Please declare your assets. A- I don't have any. Everything belongs to my wife. B- I shall acquire them after I am elected C- So much even I don't know. 16. Do you believe in secularism A- Yes, if it's the same as Hinduvta. B- It's a dirty word. C- It died with Nehru. 17. Do you believe in equality for women? A- As long as they wear Pink Cheddies. B- As long as they leave some liquor for the men C- As long as they fetch dowry.
- List ONLY the Last Five parties in Chronological (Order)
Issued in public interest by Election Commission of India.