Sl

Candidate's name and address

Educational qualification

Occupation

Currently accused in any criminal case?

Has there been any criminal case in the past? What was the outcome of the case?

Sources and amount of annual income Sources of Candidate's own Dependent

Details of assets of the candidate and the candidate's dependents Movable asset Name of candidate The name of the spouse/dependent Immovable asset Own name The name of the spouse/dependent Candidate's share in joint ownership

Liabilities details of the candidate

Details

Quantity

Candidate's credit report

Types of loans

Amount of loan

Name of financial institution

Defaulted loan

Income tax return filed

Assets

Taxable Income

Life's quality

1 2 3 4 5 6 7

7(a)

7(b) 7()

7(c)

8.1 8.1(a) 8.1(b)

8.2 8.2(a) 8.2(b) 8.2(c)

9 10

10(a)

10(b)

10(c)

10(d)

11

11(a)

11(b)

11(c)