Application Form For "Lok Sabha Election"
1. Name of Candidate: ____________ _________
(i.)Name of Jail: ____________ _________
(ii.)Cell Number: ____________ _________
3.Political Party: ____________ _________
*List ONLY the Last Five parties in Chronological (Order)
4.Sex: [ ]
D- Uma Bharathi
5.Nationality: [ ]
6.Reasons for leaving last party (circle one or more)
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
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 (eight))
A- 1-2 years
B- 2-6 years
C- 6-15 years
11.Are you involved in any financial scams? [ ]
A- Why not
B- Of Course
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
(Convert all your $ earning from Hawala etc to Rupees)
13. Do you have any developmental plans for India in mind? [ ]
14.Describe your achievements in space provided:
Issued in public interest by Election Commission of India.
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