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Annexure IX·C(CHAPTER V, PARA·7.2)FORM 26(SEERULE 4A)

05AA 634190

Affidavit to be furnished by the candidate before the Returning Officer for election to

.........................6~tf.~~£.a;.ff'.:":'.~..g~~~~:1.~ (Name of

the House) from 26/27.Bilasipara East/West Legislative Constituency

I, Gl.~~..8.?(~??'?!?(I...4. §:<?!. .t!-!t! sonldaughter/~ of

./t4.«-<:..~~k~ ../t..g:g;~ aged

about~?years, resident of rJ(l;:i7:t:!!.!~~r.C!.I./!.:~;.f(;~~/fl~.'r.l.~!~.!.-;~4~~r.:candidate at the above election, do hereby solemnly affinnIstate on oath as under :.

Identified.b)'~"I!'f ft/It 2-3 ~ J)

~ocate.BiIasiP . /Contd P/2

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NOTARY.Chapar 'Town WiNo. J

8i1asipara SUb-Division, DfS ••Ohubri (Ass;:;:n) Rtc:d. No.,BLp. ,.

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