LOK SABHA ELECTIONS 2014

DAILY REPORT OF BANKS FOR TRANSACTIONS OF CASH/DEPOSITS FOR AMOUNTS EXCEEDING Rs 1,00,000/-(One lakh rupees) and above.
NAME OF THE PARLIAMENTARY CONSTITUENCY:
NAME OF THE BANK & BRANCH:
LOCATION OF THE BANK:
DATE OF REPORTING:
DEPOSITS

PAYMENTS

Sl
no

Name of the
person/Association/body/
any other from whom the
amount has been
received/deposited in the
Bank

Account
Number

Whether the
Account no
is of a
Contesting
Candidate
(Yes/No)

Details of
cash/cheque/
DD/RTGS etc
with Bank
name &
Branch .

Amount

0
1

02

03

04

05

06

Cheque
no/ DD
no /RTGS
etc/ Cash
withdrawal
with
details.
07

Name of
the payee

Account no

08

09

Whether
the
Account no
is of a
Contesting
Candidate
(Yes/No)
10

Amount

REMARKS

11

12

Signature:
Name & Designation
of official

with date & seal:

:
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