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Application Form For Lok Sabha Election1. Name of Candidate: ____________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- ItalianB- Indian5.Reasons for leaving last party (circle one or more)A- DefectedB- ExpelledC- Bought outD- None of aboveE- All of above6.Reasons for contesting elections (circle one or more)A- To make moneyB- To escape court trialC- To grossly misuse powerD- To serve the publicE- I have no clue(If you choose �D, attach Certificate of Sanity from aRecognized Government Psychiatrist)7.How many years of public service experience do you possess?A- 1-2 yrsB- 2-6yrsC- 6-15yrsD- 15+yrs8.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 yearsB- 2-6 yearsC- 6-15 yearsD- 15+years10.Are you involved in any financial scams? [ ]A- Why notB- Of CourseC- DefinitelyD- I deny it allE- I see a foreign hand.11. What is your Annual Corruption Income? [ ]A- 100-500 CroresB- 500-1000 CroresC- Overflow�(Convert all your $ earning from Hawala etc to Rupees)12. Do you have any developmental plans for India in mind? [ ]A- NoB- NoC- NoD- No13.Describe your achievements in space provided:[_________]Issued in public interest by Election Commission of India.
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