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APPLICATION FORM FOR POLITICIANS

1. Name of Candidate : _______________________
   
2. Present Address
   (i) Name of Jail : ______________________
   (ii)Cell Number : ______________________
3. Political Party : _______________________
   (List ONLY the Last Five parties in the Chronological (Order)
4. Gender: [ ]
   A - Male
   B - Female
   C - Mayawati
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 - No
    C - No
    D - No
14. Describe your achievements in space provided: [_________]

Thumb Impression of candidate above
(Not that of the person who filled the form)

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