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 ,
PART-A
I DT.PRABHA MALLIKARJUN. *+ Wife of Shri S.S.MALLIKARJUN
Aged 48 years, resident of
o'sh ,t
M.C.C. 'B' avan (mention full postal address), a
candidate at the above Election, do hereby solemnly affirm and State on oath as under:-
(1) I am a candidate set up by INDIAI\ NATI ONAL CONGRESS
(** name of the political party)/** .
(** strike out whichever is not applicable)
(2) MV name is enrolled in 106 - Davangere North Constituency" Karnakata State QrJame
of the constituency and the State), at Serial No 621 in part No. 210
(3) Nay contact telephone no. (s) is 9844095353 and
My e-mail id (if any) is prabhamallikaqiunT6@grnail.com
and my social media accounts (if any) are :
(i) https://drprabhamallikarjun.com
(i i) https ://www. facebook. com/DrprabhaMal likarj un S S
(i i i) https ://www.facebook. com/@ssmdve
(iv) https ://www. i nstagram. c om/DrprabhaMal likali un S S
(v) https ://twitter.com/DrPrabhaS SM
(vi) https :/iluo utube. com/@PrabhaMal I ikarj un
(4) Details of Permanent Account Number (PAN) and status of filing of Income
Tax return:
The financial year Iotal income shown in Income-
Sl. No
for which fhe last tax return (in Rupees) for the
Names PAN
Income-tax return last five Financial Years
has been filed Completed (as on 31't March)
1 Self : Smt.Prabha AHLPMT66OE Nil (i) Nil
Mallikarjun
Nil (ii) Nil
Nil (iii) Nil
Nil ( lv ) Nil
Nil (v) Nil
2. Spouse : ACKPM42O9R 2022-2023 (i) 37s42s30.A0
Mr.S.S.Mallikarjun
2021-2022 ( ii) 20760610.00
2020-2021 (iii) 296s6960.A0
2019-2020 (iv) 2373s280.00
2018-2019 (v) 6122540.00
J HUF (lf candidate is AAJHSl627Q 2022-2023 (i) 840600.00
Kartal Coparcener)
202t-2022 (i i) 784780.00
2020-202t (iii) 718300.00
2019-2020 (iv) 648080.00
Ia
1 2018-2019 (V ) 60s320.00
Contd.....3
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 I ..

4 Dependent-1 IYWPS7246N 2022-2023 (i) ruln24.40

Samarth Mallikariun 2021-2022 (i i) Nil
'Shamanur (iii)
2024-202r Ni1
2019-2020 (iv) Nil
2018-2019 (v) Nil
5 Dependent*2 MOSP53483M 2022-2023 (i) Nit
Kurnari Shreshta 2021-2422 (ii) Ni1
Mallikarjun 202A-2021 (iii) Nil
Shamanur
2019-2420 (iv) Nil
2018-2019 (v) Nil
6 Dependent-3 No PAN allotted Nil (i) Nit
Kumar Shiva Nil (ii) Nil
Mallikarjun Nil (iii) NiI
Shamanur
Nil (iv) Nit
Nil (v) Nil
Note: it is mandatory for PAN holder to mention PAN and in case of no PAN, it should be clearly
stated "No PAN allotted".

(5) Pending Criminal Cases

I
\(D t declare that there is no pending criminal case against rne. (Tick this alternative if there is no
criminal case pending against the Candidate and write NOT APPLICABLE against alternative (ii)
I
below) :\
OR
(ii) The following criminal cases are pending against me: NOT APPLICABLE.
(if there are pending criminal case against the candidate, then tick this altemative and score off
alternative (i) above, and give details of all pending cases in the Table below)

Pr'^.(,{* [NIti-U'.tr--

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Contd.. ...4

c Nqr. r:f Corrcctions \

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 ::4::

TABLE

(a) FIR No. with name and address

Not applicable Not applicatrle Not applicable
of Police Station concerned
(b) Case No. with Name of the
Not applicable Not applicable Not applicable
Court
(c) Section(s) of concerned
Acts/
Codes involved (give no. of the
Not applicable Not applicable Not applicable
Section, e.g. Section of
IPC, etc.)
(d ) Brief description of Not applicable
offence Not applicable Not applicable
(e) Whether charges have been
Not applicable Not applicable Not applicable
framed (mention YES or NO)
(0 If answer against (e) above is
YES, then give the date on Not applicable Not applicable Not applicable
which charges were framed
(e) Whether any Appeali
Application for revision has
been filed against the Not applicahle Not applicable Not applicable
proceedings (Mention YES or
No)

(6) Cases of Conviction

I
(i) 1 I declare that I have not been convicted
for any criminal offence. (tick this alternative, if the
candidate has not been convicted and write NoT APPLICALBE against alternative (ii)
below) : NOT APPLICABLE.
oR
P,,,^r+-* f,,\*-m-k*1-
Y + v
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o Contd.....5

+ *E

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No- of Corrttction,e \
 5

(ii) I have been convicted for the offences mentioned below: NOT APPLICABLE.
(lf the candidate has been convicted, then tick this alternative
and score off alternative (i)
above, and give details in the Table below) :

TABLE
(a) Case No. Not Applicable Not Applicable Not Applicable
(b) Name of the Court Not Applicable Not Applicable Not Applicable
(c) Sections of Acts/Codes Not Applicable Not Applicable Not Applicable
involved (give no. of the
Section, e.g. Section ... of IPC,
etc.,)
(d) Brief description of offence for Not Applicable Not Applicable Not Applicable
which convicted
(e ) Dates of orders of conviction Not Applicable Not Applicable Not Applicable
(f) Punishment imposed Not Applicable Not Applicable Not Applicable
(g) Whether any appeal has been Not Applicable Not Applicable Not Applicable
filed against conviction order
(Mentiotr YES or No)
(h) If answer to (g) above is YES, Not Applicable Not Applicable Not Applicable
give details and present status
of appeal

(6A) I have given full and up-to-date infbrmation to my political party about all pending criminal cases
against me and about all cases of conviction as given in paragraphs (5) and (6).
NOT APPLICABLE.
fcandidates to whom this item is not applicable should clearly write NOT APPLICABLE IN VIEW
OF ENTRIES IN 5(i) and 6(i), abovel

Note:
L Details should be entered clearly and legibly in BOLD letters.
2. Details to be given separately for each case under different columns against each item.
3. Details should be given in reverse chronological order, i.e., the latest case to be mentioned first
and backwards in the order of dates fbr the other cases.
4. Additional sheet may be added if required.
5. Candidate is responsible for supplying all information in compliance of Hon'ble Supreme
Court's Judgment in W.P (C) No.536 of 201 l.

Contd.....6
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 6

(7) Tbat I give herein below the details of the assets (movable
and immovable etc.) of myself, my spouse
and all dependents: List enclosed.
-
A. of ble
Note: I ' Assets in joint name indicating the extent ofjoint
ownership will also have
to be given.

Note: 2' In case of deposit/investment, the details including

Serial Number, Amount,
Date of Deposit. the Scheme Name of the Bank/Institution
and Branch are to
be given

Note: 3' value of Bonds/SharelDebentures as per the current

market value in Stock
exchange in respect of listed companies and as per
books in case of non-listed
companies should be given.

Note: 4' 'f)ependent' means parents, son(s), daughter(s)

of the candidate or spouse and any
other person related to the candidate whethei by blood
o, ma..iage, who have no
separate means of income and who are dependent
on the candidate for their
livelihood.

Note: 5' Details irlcluding amount is to be given separately

in respect of each investment.
Note: 6' Details should include the interest in or ownership
of offshore assets.
Explanation: For the purpose of this Form, the expression o'offshore
all deposits or investments in Foreign Banks and any other includes, details of
assets,,
trody or institution
abroad, and details of all assets and liabilities in foreign "countries,:

n .A^ n r l .
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Contd.....7
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 i,7.:
Detailed statements enclosed as Annexures.
sl. Dependent- f)ependent-
l)escription Self Spousc HUF Dependent- I f
No. .,
(i) (a) Cash in hand 67566 337587 Nil 81751 1 Nil Nil
(i i) Details of Deposit in Bank 1 3761 05 21042455 Nit 9s88s Nil Nil
accounts (FDRs, Tern.r Deposits (Enclosed as (Enclosed as (Enclosed
and all other types of Deposits Annex-A1) Annex-Bl & as Annex-
including saving accounts), 83) ct)
Deposits with Financial
lnstitutions, Non-Banking
Financial Companies and
Co.operative Societies and the
amount in each such deposit
( iii) Details of investment in Bonds, 26s20500 s44037553 Nil 750000 Nil Nil
debentures/shares and units in (Enclosed as (Enclosed as (Enclosed
companies/Mutual funds and Annex-A I ) Annex-Bl & as Annex-
others and the amount B3) cl)
(iv) Details of investment in
NSS, Nil 47521223 Nil 335847 Nit Nil
Postal Saving, Insurance policies (Enclosed as (Enclosed
and investment in any Financial Annex-Bl & as Annex-
instruments in Post office or B3) c1)
lnsurance Company and the
amount
(r) Personal loans/advance given to 20227395 66706825 Nil 665000 Nil Nil
any person or entity including (Enclosed as (Enclosed as (Enclosed
firm, company, Trust etc., and Annex-Al) Annex-Bl & as Annex-
other receivables liom debtors 83) c1)
and the amount
("i) Motor Vehicles/ Aircraftsl Nil Nil Nil Nil Nil Nil
Yachts/Ships(Details of Make,
registration number etc. year of
purchase and amount)
(vii) Jewellery, bullion and valuable
thing(s) (give details of weight
and value)
Gold - 3189.528 grms l 0080989 165739990 Nil Nit Nil Nil
(Enclosed as (Enclosed as
Silver -
Annex-A1 & Annex-Bl &
Others- 5.976 grms ,A3) 83)
Spouse Gold- 646383.976 grms
(viii) Any other assets such as value 1023009 Nil NiI 806006 Ni1 Nil
(Enclosed as (Enclosed m
of claims/interest
Annex-Cl)
Annex-Al)
(i') Gross Total Value s9295564 85L385633 Ni1 3470249 Nil Nil

B. Details of Immovable Assets:

Note: I . Properties in joint ownership indicating the extent ofjoint ownership will also have
to be indicated
Note: 2. Each land orbuild be mentioned separately in this format.

Contd.....8
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+ 9.
*1
No. of Corr?ctions
 :: ::8
Detailed statements enclosed separately as Annexures.

sl. HI.J F Dependent Dependent-

Description Self Spouse Dependent-3
No, 1 2
(i) Agricultural Land
Location(s) (Enclosed as (Enclosed
Survey number(s)
(Enclosed as Nil
Annex-B4) as Annex- Nil Nil
Annex-A2)
c2)
Area (Total measurement Nil
in acres)
47 .11 226.03 50-41 NiI Nil
Whether inherited Yes to the
property (Yes or No) No extent of Nil Nil Nil Nit
7.05 lz Sunta
Date of purchase in case (Enclosed as (Enclosed as (Enclosed as
Nil Nil
of self-acquired property Annex-A2) Annex-B4) Nil Annex-C2)
Cost of Land (in case of
9se3530 36s89970 Nil
purchase) at the time of 44287?0 Nil Nil
purchase
Any investment on the
land by way of Nil Nil Nil Nil Nil Nil
development,
construction etc
Approximate current I 5424000 105312625 I 5 123000 Nil Nil
market value Nil
(ii) Non-Agricultura! Land

Location(s) (Enclosed as (Enclosed as

Survey number(s) Annex-A2) NiI Nit Nil Nil
Annex-B4)
Area (Total measurement
1 l0s0 2408720.84
Nil
in sq. ft.) Nil Nil Nit
Whether inherited Yes. to the
properfy (Yes or No) No extent of
Nit Nil Nil Nil
(sq.ft) 320470

Date of purchase in case (Enclosed as (Enclosed as

of self-acquired property Annex-A2) Nil Nit NiI Nil
Annex-B4)
Cost of Land (in case of
77752360 170769881
purchase) at the time of Nil Nil Nil Nil
purchase
Any investment on the
land by way of Nil I 13032s Nil Nil Nil Nil
development,
construction etc
Approximate current 1601476s0 861403067
Nil Nil Nil Nil
market value

{ tV Contd.....9

?"l-Ul^" y\&U,il.q;
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x, No, of Corr?ction e $1
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 9

sl. HIIF Dependent' Dependent- Dependent-

Description Self Spouse a
No. I 2 -)
(iii) Commercial
Building
(includin g apartments'
-Location(s) (Enclosed as
-Survey number(s) Nil Nil Nil Nil Nil
Annex-84)
Area (Total measurement
Nil 45t570 Nil Nit Nil Nil
in sq.ft.)

Built-up area (total

Nit 45165.50 NiI Nil Nil Nil
measurement in sq.ft.)

Whether inherited
Nil No Nil Nil Nil Nil
property (Yes or No)

Date of purchase in case NiI (Enclosed as Nil Nil Nil Nil

of self:acquired propefty Annex-84)
Cost of property (in case
of purchase) at the time
NIiI 306044 Nit Nil Nil Nir
of purchase
Any investment on the
property by way of NiI 324605 Nil Nil Nil Nil
development,
construction etc
Approximate culrent Nil 29357250 Nil Nil Nil Nil
market value

p**1".

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b
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S*
of Corr?ctions Contd..... I 0
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 :: l0 ::

(i") Residential
Buildings
(i ncludin g apartments)
-Location(s) (Enclosed as (Enclosed as
Annex-A2) Nil Nil Nil Nil
- Survey nurnber(s) Annex-B4)
Area (Total measurement
34484 28600 Nit Nil Nil Nil
sq.ft.)

Built-up area (total

2500 t1526
measurement in sq.ft.) Nil Nil Nil Nil

Whether inherited CIFT from

property (Yes or No) No Nil NiI Nit Nil
Mother

Date of purchase in case (Enclosed as (Enclosed as

of self-acquired property Annex-A2) Nit Nil Nil Nil
Annex-84)
Cost of property (in case
30073 10 76713495 Nil Nil Nit Nil
of purchase) at the time of
purclrase
Any investment on the
properly by way of Nil Nil Nit Nil Nil Nil
development,
construction etc
Approximate current 2fi447072 101437800 Nil Nil Nil Nil
market value
(v) Others (such as interest NiI Nil Nit Nil Nil Nil
in propefty)
(vi) Total of Current
386418722 1097510742 i5i23000 Nil Nil
N'larket Value of (i) to Nil
(v) above

Note: 3. Details should include the interest in or ownership of offshore assets

(8) I give herein below the details of liabilities/dues to public financial institutions and government:-
Q{ote: please give separate details of name of bank, institution, entity or individual and amount
before each item
sl. Description Self Spouse HUF Dependent- Dependent-2 Dependent-3
No I
(i) Loan or dues to Bank/
Financial Institution(s)
Nil Nil Nil Nil Nil Nil
Name of the Bank or Financial
Institution, Amount
outstanding, Nature of Loan

* v
',\
o NO. Of eOff:pgtiOn5 .l1 Contd .. 11
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 ::11 ::

Loan or dues to any other 9728000

individualsl Entity other than 236024778 1371500
(Enclosed (Enclosed
mentioned above. Nil Nil Nil
as Annex- (Enclosed as as Annex-
Name(s), Amount outstanding, Al) Annex-Bl) cl)
Nature of Loan
Any other Liability Nil Nil Nil Ni1 Nil Nil

Grand total of liabilities 9728000 236024778 Nil 1371500 Nil Nil

(ii) Government Dues :

(A) Has the Deponent been in occupation of NO
accommodation provided by the Covernment at any
to departments dealing with time during the last telt years befbre the date of
accommodation notification of the cument election?

(B) If answer to (A) above is YES, the following

declaration rnay be furnished namely:- Not
(i) The address of the Govemment accommodation: Applicable

(ii) There is no dues payable in respect of above

Government accommodation, towards-
(a) Rent;
(b) Electricity charges:
(c) Water charges; and
(d) Telephone charges as on ..... (date)
Not I
[the date should be the last date of the third ijanoticaure
month prior to the nronth in which the election is
notified or any date thereafter].

Note: 'No Dues Certificate' from the agencies

concerned in respect of rent, electricity charges,
water charges and telephone charges for the
above Government acconlmodation should be
submitted.
(ii i) Dues to departrnent dealing with
Governnrent transport (including Nil NO
aircrafts and helicopters)
Self Spouse Dependent- Dependent-
HUF
I 2 J
(iv) Income Tax Dues Nil Nil Nil Nil Nil Nil
(v) GST dues Nil Nil Nil Nil Nil Nil
(vi) Municipal/ Property Tax Dues Nit Nil Nil Nil Nil Nil
(vii) Anv other dues Nil Nil Nil Nil Nil Nil
(viii) Grand total of all Government Nil Nil Nil Nil Ni1 Nil
dues
(i") Whether any other liabilities are
in dispute, if so, mention the Nil Nit
amount involved and the Nil Nil Nil Nil
authority befoge.*,ivhic[ . it is
pendin& m-"83-[ 4 ;

Contd.....12
No. of Corr?ctlons
+ $
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 t2

(9) Details of profession occupation:

(a) Self : Director : Indian Cane Power Ltd.,
Shamanur Agro Tech Pvt. Ltd.,

(b) Spouse : Chairman : Indian Cane Power Ltd.,

Director : Shamanur Agro Tech Pvt. Ltd.,
Universal Bottlers Plt. Ltd..

(9A) Details of source(s) of income :

(a) Self : Agricultural lncome.
(b) Spouse : Business, Salary & Rental Income.
(c) Source of income, if any, of dependents,
Dependent : I - Salary Income.
Dependents 2 &3: .......Ni| ..

(98) Contracts with appropriate Government and any public company or companies
(a) Details of contracts entered by the candidate Nil.. .
(b) Details of contracts entered into by spouse ...... Nil
(c) Details of contract entered into by dependents ... Nil
(d) Details of contracts entered into by Hindu Undivided Family or trust in
which the candidate or spouse or dependents have interest ...... Nil....
(e) Details of contracts, entered into by Partnership Firms in which candidate or
spouse or dependents are partners ...... Nil
(0 Details of contractors, entered into by private companies in which candidate
or spouse or dependents have share ...... Nil

(10) My educational qualification is as under:-

0l lOth STD CBSE 1992

02 PUC P.U Board, Karnataka 1994

03 BDS Kuvempu University I 998

(Give details of highest School/University education mentioning the full form of

the certificate/diploma/degree course? name of the School/College/University and
the year in which the course w-as cornpleted.)
Y
Contd..... I3

l-
Y o\
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 13

PART-B
(11) ABSTRACT OF THE DETAILS GIVEN IN TO OF PART-A
0
I Name ofthe candidate DT.PRABHA MALLIKARJUN
2. Full postal address No.26361 l, "Shivaparvathi"
M.C.C.'B'Block,
Davangere-s77 004.
-)- Number and name of the constituency and State 13- DAVANAGERE, KARNATAKA
4. Name of the Political party which set up the INDIAN NATIONAL CONGRESS
candidate (otherwise write' Independent')
5 Total number ofpending criminal cases Nit
6. Total number of cases in which convicted. Nir
7 Financial year for Total Income
PAN of which last Income Tax Shown
Return filed (Rs.)
(a) Candidate AHLPMT66OF Nil Nil
(b) Spouse: ACKPM42O9R 7022-23 37s42530
(c) HUF AAJHS1627Q 2022-23 840600
(d) Dependent-l IYWPS7246N 2022-23 t4t1220
Dependent-2 MOSPS3483M Not applicable Not applicable
Dependent-3 No PAN allotted Not applicable Not applicable
8. Details of Assets and Liabilities in Runees-Statements enclosed as Annexures
Self Spouse FIUF Deper.rdcnt-1 l)ependent-
Description
2 3

Movable Assets 59295564 85 r 39s633 Nil 347A249 Nil Nil

A.
(Total Value)
B Immovable Assets
ASSETS
Purchase price of 90353200 284703995 NA 4428720 NA NA
li)
self-acquired
immovable propefiy
(i i) Development I Nil t130325 NA NA NA NA
construction cost of
immovable propefty
after purchase (if
applicable)
386018722 1097510742 NA I 5 123000 NA NA
Itl) Approximate
Current market
price of -
(a) selfacquired 175571650 1043169092 NA I 5123000 NA NA
assets (Total value)
(b) inherited assets 21a447072 943416s0 NA NA NA NA
(Total value) -CIFT

f,
Contd.....14

+ g. .{.
o
$
F "\ ?^g*
$o
 :r 14 ii
9 Liabilities
'i) Government dues (Total) Nil Nil Nil Nil Nil Nil
:i i)
Loans fionr Bank, Financial Nil Nit Nit Nit Nil Nil
Institutions and others
10. Liabilities that are under dispute
'i) Government dues ( Total) NiI Nil Nil Nil NiI Nit
i) Loans from Bank, Financial Nil Nit Nil NiI Nil Nil
Institutions and others
ll Highest educational qualification:
Give details of highest School/University educati on
mentioning the full form of the certi
diploma/ degree course, name of the School/College/ University
and the year tn whi ch the course
completed. )

01. 10t1, STD CBSE 1992

02 PUC P.U Board, Karnataka
r994
03 BDS Kuvempu University 1998

VERIFICATION
I, the deponent, above named. do hereby verify and declare
that the contents of this affidavit
are true and correct to the best of my knowl edge
and belief and no part of it is false and
o TA material has been concealed therefrom I further declare
that:-
* * a) there is no case of conviction or pending case against me other than those
c, mentioned in items 5 and 6 of part A and B above;
o )r
, my spouse, or my dependents do not have an y asset or Iiability. other than
o mentioned in items 7 and g of'part A and items 8.9 and
l0 ofPart B above
those

at ^$*c::S==- this the

gfavor
.y*dt.t .qr!l.
.
oF (2 r6-TE
SWORN TO BE

S.^' m 'l-gl-\
ARY PUB Llt
?,qkt^^
DEPONENT
\N\aul:{t

Note:-1. Affidavit should be

PM day ol' fi ling nominations.
Note:2. Affidavit sworn before an Oath Commissioner or Magistrate of
the First
Class or before a Notary Public.
Note:3' All column should filled up and no column to be left blank. If there is no
.be
information to_furnish in respect of any item, either ,,Nil,,or ,,Not
applicull",,, as the
case may be. should be mentioned.
Note:4. The af-fidavit should be either typed or written legibly
and neatly.,,
Note:5' Each page of the Affidavit should be signed by
the deponent and the At1idavit
should bear on each page the stamp of the Niotary
or oath commissioner or
Magistrate before whom the Affidavit is sworn.