Form A: Form A

FORM A Passport size [See sections 60(2) &110(2)] Photograph of the NOMINATION FORM FOR ELECTION TO AN candidate ASSEMBLY/SENATE [Note: (1) Please fill in this page in capital letters. (2) Strike off the words not applicable.] No. and Name of constituency .........................................National Assembly/ Senate/ Provincial Assembly of .........................................................(Name of the Province) (To be filled in by the proposer of a candidate for an Assembly seat) (1) I................................. (name of the proposer) having National Identity Card No. - - Registered as a voter at serial number........................... in the electoral roll of electoral area .....................................................of Tehsil/Taluka ...................................District/Agency ................................................................................ do hereby propose the name of Mr./Mrs./Ms.................................................................................................. whose address is.........................................................................................as a candidate for election to the seat from constituency No............................... (2) I hereby certify that I have not sub scribed to any other nomination paper in this election either as proposer or seconder. Date......................... Signature of Proposer…………… —————————————————————————————— (To be filled in by the seconder of a candidate for an Assembly seat) (1) I.............................................. (name of the seconder) having National Identity Card No. - - Registered as a voter at serial number...........................in the electoral roll of electoral area......................................................................................... of Tehsil/Taluka.................. District/Agency................................................................... do hereby second the name of Mr./Mrs./Ms................................................................................................... whose address is................................................................................................................... as a candidate for election to the seat from constituency No………………………. (2) I hereby certify that I have not subscribed to any other nomination paper in this election either as proposer or seconder. Date........................ Signature of Seconder ………………. Page 112 of 122 FOR SENATE ELECTION ONLY [Note: (1) Please fill in this page in capital letters. (2) Strike off the words not applicable.] (To be filled in by the proposer of a candidate for a Senate seat) (1) I............................. ........................................... ------------- (Name of proposer) a member of *National Assembly/Provincial Assembly from Constituency No....................................... do hereby propose the name of Mr./Mrs./Ms .......................................................................................... (Name of candidate) son/ wife/ daughter of..................................................................................... resident of .......................………………………………………………..…………..…………..…… (Address) whose name is entered at serial No…................... in the electoral roll of…………..…….. (name of electoral area, tehsil/ taluka and district) as a candidate for election from.................................................Province/ Federal Capital 1[**] against the following Senate seat…………………….……….................................. (2) I hereby certify that I have not subscribed to any other nomination paper in this election either as proposer or seconder. Date........................ Signature of Proposer……………… _________________________________________________________________________ (To be filled in by the seconder of a candidate for a Senate seat) I …………………………………………………………………………….……………… (Name of seconder) a member of National Assembly/Provincial Assembly from Constituency No. ……..................... do hereby second the nomination of the above mentioned candidate against the following Senate seat …………………………………………………………………………………..……….. ……….. … (2) I hereby certify that I have not subscribed to any other nomination paper in this election either as proposer or seconder. Date........................ Signature of Seconder………… Page 113 of 122 1Omitted by Act No. XX of 2024, s. 3. 1[DECLARATION AND OATH BY THE PERSON NOMINATED] 1[1. I, the above mentioned candidate, hereby declare on oath that,— (i) I have consented to the above nomination and that I fulfill the qualifications specified in Article 62 of the Constitution and I am not subject to any of the dis-qualifications specified in Article 63 of the Constitution or any other law for the time being in force for being elected as a member of the Senate/National Assembly/ Provincial Assembly. * *(ii) I belong to …………………………………….…………and (Name of the political party) a certificate from that political party showing that I am a party candidate from the above said constituency is attached. OR I do not belong to any political party. 2. I, the above mentioned candidate, solemnly swear that,— **(i) I believe in the absolute and unqualified finality of the Prophethood of Muhammad (peace be upon him), the last of the prophets and that I am not the follower of any one who claims to be a Prophet in any sense of the word or of any description whatsoever after Prophet Muhammad (peace be upon him), and that I do not recognize such a claimant to be Prophet or a religious reformer, nor do I belong to the Qadiani group or the Lahori group or call myself an Ahmadi. (ii) I will be faithful to the declaration made by the Founder of Pakistan Quaid-e-Azam Muhammad Ali Jinnah, that Pakistan would be a democratic state based on Islamic principles of social justice. I will bear true faith and allegiance to Pakistan and uphold the sovereignty and integrity of Pakistan and that I will strive to preserve the Islamic Ideology which is the basis for the creation of Pakistan. 2[3. I, the above-mentioned candidate, declare that I have opened an exclusive Account No.___________________with_____________________(Name and Branch of Scheduled Bank) . OR I will use my existing Account No. ___________with __________ (Name and Branch of Scheduled Bank for the purpose of Election expenses) (Please enclose statement of the Bank Account).]] 1[4.] My NIC No. is - - 1[5.] My Contact No. is ______________________ 1[6.] My Email address is………………………………….. 1[7.] My statement of assets and liabilities including assets and liabilities of my spouse (s) and dependent children as on preceding thirtieth day of June on Form B is attached. Date...................... Signature of the Candidate………..... 1[*Strike off the words not applicable **For Muslim candidate only.] 1Subs., renumbered & ins. by Act, No. XXXV of 2017, by s. 3. 2Subs. by Act No. XLIV of 2023, s. 54. Page 114 of 122 SOLEMN AFFIRMATION I, ………………...................................... S/o, W/o, D/o ..................................................do hereby solemnly affirm that all the entries in this Form filled by me are correct and complete to the best of my knowledge and belief, and nothing has been concealed. Signature of the Candidate……………………... ELECTION COMMISSION OF PAKISTAN RECEIPT (To be filled in by the Returning Officer) [Note: Strike off the words not applicable.] Serial Number of nomination paper....................................... .......... .. The nomination paper of Mr./Ms/Mrs………………….……..................................a candidate for election to the seat from……………........................ National Assembly/ Senate/ Provincial Assembly of the Punjab/ Sindh/Khyber Pakhtunkhwa/Balochistan was delivered to meet my office at................ (hours) on ............... (date)by................. (person) This nomination paper will be taken up for scrutiny at .......................................…............... (hours) on.........................(date) at................................................(place) Date................................... Returning Officer……………… Page 115 of 122 (ADDITIONAL INFORMATION TO BE ATTACHED BY A CANDIDATE FOR SENATE TECHNOCRAT SEAT) [Note: (1) This additional information is to be attached with the Nomination Form by a candidate for Senate Technocrat seat only. (2) Each item is to be filled in clearly and completely. (3) The information should be typed or hand written legibly. (4) Strike off the words not applicable.] BIODATA 1. Name …………………………….......................................................................... 2. Father/ Husband‘s name………………………………………………………..……. 3. Date of birth …………………………. 4. Place of birth ……………………..…… 5. Marital status: Single / Married / Divorced / Widow (er) 6. Present address: ………………………………………………………............................ 7. Present telephone Nos. Mobile………..……… Office ………..…. Home …..….……. 8. Email address: ……………………………………………………………………….. 9. Education Years attended Academic degrees and Main From To or Diplomas Areas Name and location of Institutioncertificates of study of learning obtained 10. Professional experience A. From ………………………………… to …………………………………….. (the date since employed) Title of present post and nature of duties. Employer (Name and address) and type of business. _________________________________________ B. From ………………………………… to …………………………………….. (the date since employed) Title of present post and nature of duties. Employer (Name and address) and type of business. __________________________________________ Page 116 of 122 C. From ………………………………… to …………………………………….. (the date since employed) (Please use additional sheets if required.) Title of present post and nature of duties. Employer (Name and address) and type of business. -------------------------------------------------------------------------- 11. Please list your special qualifications and skills -------------------------------------------------------------------------- 12. Please list any significant publications you have written (Publications need not be attached). ---------------------------------------------------------------------------- 13. If you have previously held public office (e.g. Minister, Advisor, Senator, Member of Parliament, Provincial Assembly or a local government) please give details: ------------------------------------------------------------------------------- 14. Please list your present and past memberships, if any, of political parties and/ or civil society organizations: ---------------------------------------------------------------------------------- I declare that all the above entries and statements are correct and complete to the best of my knowledge and belief, and nothing has been concealed. Date........................... Signature of the Candidate............................ Page 117 of 122

Effective date: 2017-10-02

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