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ELECTION
OFFENCES
FORM
B
[
Section 23 (1) ]
THE
ELECTION OFFENCES ACT 1954
RETURN RESPECTING ELECTION EXPENSES
Constituency
Electoral ward |
................................................................................ |
| Name
of candidate .................................................................................. |
| Name
of election agent ............................................................................ |
Date of publication
of the result of the election in the Gazette
.................................................................................................................................
_______________________________________________________________________
RECEIPTS. Note 1. Give details of any money, security, or valuable
consideration received or promised in respect of expences incurred
on account of or in connection with or incidental to the election.
Details of money or security supplied by the candidate must included.
| Name
of
donor |
Description
(Association, Club, Society or individual)
|
Type
of donation
(Contribution, Loan, deposit, etc) |
Amount |
| $ |
c. |
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Total
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ELECTION EXPENSSES. Note
2. All payments are to be vouched for by a bill stating the particulars,
except as provided by section 16 of the Election Offences Act 1954.
_______________________________________________________________
ELECTION EXPENSES INCURED
_______________________________________________________________
| Description |
Details as in List
No. |
Amount |
| $ |
c. |
| Payment to agents, clerks and messagers |
|
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|
| Travelling expenses of above .. .. |
|
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| Travelling expenses of other persons .. |
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| Printing .. .. .. .. .. |
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| Advertising .. .. .. .. .. |
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| Stationery .. .. .. .. .. .. |
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| Postage, telegrams and telephone charges |
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| Hire of rooms for public meeting or as committee
rooms .. .. .. .. |
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| Licenses .. .. .. .. .. .. |
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| Miscellaneous expenditure .. .. .. |
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| Licenses .. .. .. .. .. .. |
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| Miscellaneous expenditure .. .. .. |
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| Expenses by person authorized .. .. |
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| Disputed claims .. .. .. .. .. |
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| Unpaid claims .. .. .. .. |
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Total .. |
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DECLARATION
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To be completed by agent.
I, ......................................................
being election agent, make the foregoing return respecting
election expenses of the said candidate in the said election
and certify that to the best of my knowledge and belief
it is complete and correct.
Signature
.......................................................
Date .................................
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To
be completed by candidate acting as his own agent.
I, .............................................................
acting as my own election agent, make the foregoing return
respecting my election expenses at the said election and
certify that to the best of my knowledge and belief it is
complete and correct.
Signature
....................................................
Date .............................. |
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