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.Sex: [ ]
A- Male
B- Female
C- I dont Know
D- Daily
 
5.Nationality: [ ]
A- Italian
B- Indian
 
6.Reasons for leaving last party (circle one or more)
A- Defected
B- Expelled
C- Bought out
D- None of above
E- All of 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
E- I have no clue
(If you choose “D, attach Certificate of Sanity from a
Recognized Government Psychiatrist)
 
8.How many years of public service experience do you possess?
A- 1-2 yrs
B- 2-6yrs
C- 6-15yrs
D- 15+yrs
 
9.Give details of any criminal cases pending against you (Use as many Additional Sheets as you want)
 
10.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
 
11.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.
 
12. What is your Annual Corruption Income? [ ]
A- 100-500 Crores
B- 500-1000 Crores
C- Overflow…
(Convert all your $ earning from Hawala etc to Rupees)
 
13. Do you have any developmental plans for India in mind? [ ]
A- No
B- Why?
C- Not interested
D- All of the above
 
14.Describe your achievements in space provided:
[_________]