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ABSTRACT STATEMENT OF ELECTION EXPENSES
PART-I
I
Name of the Candidate
II
Number and name of Constituency
III
Name of State/Union Territory
IV
Nature of Election (Please mention whether
Sh./SFRUK:m.
C)
VII
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Name and Address of the Election Agent
&\'
If candidate is set up by a political party, Please
mention the name of the political party
VIII
Hov
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Date of declaration of resu It
· VI
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Assembly I Lok Sabha I By- election
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General Election to State
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Whether the party is a recognised political party
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Yes~
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Date:
Place:
t.:;-didate
Name
PART-II: ABSTRACT OF STATEMENT OF ELECTION EXPENDITURE OF CANDIDATE
Sr.
No.
Particulars
I
Expenses in public meeting,
Amt. Incurred/
Auth. by
Candidate/
Election agent
(in Rs.)
I. a : Expenses in public
meeting, rally, procession
;
with star Campaigners of the
Political party (Enclose as
"' -
itl ct ~l, b
per Schedule- I)
I. b : Expenditure inpublic
meeting rally, procession etc.
with the Star Campaigner(s)
(ie: other than those for
general party propaganda)
(Enclose as per Schedule-Z)
Amt. Incurred/
auth. by others
(in Rs.)
Total
Election
expenditure
(3)+(4)+(5)
I
rally, procession etc. :-
etc. (ie : other than the ones
Amt. Incurred/
auth. by Pol.
Party (in Rs.)
b1Qoo
II
Campaign materials other
than those used in the public
I
meeting, rally, procession
etc. mentioned in S. No. I
~B13bO
above (Enclose as per
Schedule-3)
III
Campaign, through print and
electronic media including
{I ooo
cable network, bulk SMS or
internet and Social media
(Enclose as per Schedule-4)
JV
Expenditure on campaign
vehicles(s), used by
~b~Oo3
candidate (Enclose as per
schedule-S)
v
Expenses of campaign
workers/agents (Enclose as
per Schedule-6)
VI
Any other campaign
-
expenditure
Grand Total
C/3? 1~q
PART Ill: ABSTRACT OF SOURCE OF FUNDS RAISED BY CANDIDATE
"" Particulars
Sr.
No.
I
I
Amount of own fund used for the election campaign
(Enclose as per Schedule -7)
·'
II
Amount (in Rs.)
q 37-:rcl~
Lump sum amount received from the party (ies) in cash or cheque
-
etc.
(Enclose as per Schedule-S)
III
Lump sum amount received from any
person/company/firm/associations/body of persons etc. as loan,
gift or donation etc.
(Enclose ~ per Schedule-9)
Total
~51+.J'q
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Schedules~ 1 to 9:
Details of Elections Funds and Expenditure of candidate
Schedule- 1
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i
!
j
Expenses In public meeting, rally, procession etc. (ie: other than those with Star Campaigners of the Political party)
s.
Nature of Expenditure
Total Amount
in Rs.
No
1
1
2
3
2
Erecting Stage, Pandal & Furniture, Fixtures,
poles etc.
3
Arches & Barricades etc.
4
Flowers/ garlands
5
Hiring Loud speakers, Microphone, amplifiers,
comparers etc.
6
Posters, hand bills, pamphlets, Banners, Cutouts, hoardings
7
Beverages like tea, Water, cold drink, juice etc.
8
Digital TV -boards display,. Projector display,
tickers boards, 30 display
9
Expenses on celebrities, payment to musicians,
other artists remuneration etc.
10
Illumination items like serial lights, boards etc.
11
Expenses on transport, Helicopter/ aircraft I
vehicles/ boats etc. charges ( for self, celebrity
or any other campaigner other than Star
Campaigner)
12
13
Power consumption/ generator charges
14
Guards & security charges
15
Boarding & lodging expenses of self, celebrity,
party functionary or any other campaigner
including Star Campaigner
16
I
Amt.
incurred I
by Pol.
Party with
name
Amt. inrurred
by others
5
6
.'1 L '-1 q\•
... -
Amt. incurred
AUU°l. by
Candidate I
agent
4
-
Vehicles for transporting visitors
Source of Expenditure
---
13 ~JD
I(
-gq
?-0
17000
Rent for venue
Others expenses
Total
/,-..t,J/
L'J i_q
!rA'2
- -
Schedule- 2
Expenditure in public meeting rally, procession etc. with the Star Campaigner(s) as apportioned to candidate (ie: other
than those for general party propaganda)
S. No Date and
Venue
Name of the Star
Campaigner(s) & Name of Party
Amount of Expenditure on public meeting Remarks, if any
rally,
with
procession
etc.
the Star
Campaigner(s) apportioned to the candidate
(As
other
than
for
general
party
propaganda) in Rs.
b::Z.. ~
1
1
2
3
5~10-\Lt
Bl1 U f/i."'ti) bR Ii lJD DA
/_
4
(
5
'
Y'1
r:
2
3
4
6 s l5> Qt_;)/-
Total
Schedule-S
Details of expenditure on campaign materials, like handbills, pamphlets, posters, hoardings, banners, cut-outs, gates &
arches, video and audio cassettes, CDs/ DVDs, Loud speakers, amplifiers, digital TV/ board display, 3 D display etc. for
candidate's election campaign ( ie: other than those covered in Schedule- 1 & 2)
s.
Nature of Expenses
Total Amount
in Rs.
No.
1
1
Sources of Expenditure
Remarks, if any
Amt. By
candidate/
agent
Amt. By Pol.
Party
Amt. By others
4
5
6
2
3
~81\'\~
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7
.
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2
3
4
~ 'i/9.3
, bo
Total
Schedule- 4
Details of expenditure on campaign through print and electronic media including cable network, bulk SMS or internet or
social media etc. for candidate
s.
No
1
1
2
Nature of
medium
(electronic
print) and
duration
Name and address
of media provider
I
2
s M__S
Vol
c..z.._.
3
~t/~onic
s I oice/ cable
TV, social media
etc.)
Name and address of
agency, reporter, stringer,
company or any person to
whom charges I
commission etc. paid/
payable, if any
3
4
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Amt. By
candidate/
agent
Amt. By
Pol.
Party
Amt. By
others
6
7
8
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,
B~~vJL
4
Sources of Expenditure
Col. (3) +(4)
5
Total
-----------
Total Amount
in Rs.
~
.....--
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I
Schedule -5
Details of expenditure on campaign vehicle (s) and poll expenditure on vehicle(s) for candidate's election campaign
s.
No
1
Regn. No. of Hiring Charges of vehicle
Vehicle &
Type of
Rate for
Fuel charges
Vehicle
Hiring of
(If not
vehicle I
covered
maintenan under hiring)
ce
3a
2
3b
Driver's
charges
(If not
covered
under
hiring)
3c
No. of
Days for
which
used
Total amt.
incurred/
auth. in Rs.
Source of Expenditure
Amt. By
candidate/
agent
Amt. By Pol. Amt.
Party
By
other
s
4
5
6
7
8
+\-S~
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1
2
3
4
'j 6.;(_ITTJ3 - ~
Total
Schedule- 6
Details of expenditure on Campaign workers I agents
s.
No
Date and
Venue
1
2
Expenses on Campaign workers
Nature of Expenses
Qty.
Total amt.
incurred/
No. Of workers
auth. In Rs.
I agents
3a
3b
3c
6
Campaign workers
honorarium/ salary
etc.
1
Boarding
2
3
Lodging
4
Others
Sources of Expenditure
Amt. By
candidate/
agent
Amt. By Pol.
Party
Amt. By
others
7
8
9
.
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Total
Schedule- 7
Details of Amount of own fund used for the election campaign
S. No.
Date
Cash
DD/ Cheque no. etc. with
details of drawee bank
Total Amount in
Rs.
Remarks
1
2
3
4
5
6
1
:.)O
2
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3
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4
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41 TI
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1
Sr.No
Vehicle No
-1
HR70-N-0100
2
HR37-D-1575
Permission
From
26/09/2014
26/09/2014
Upto
13/10/2014
13/10/2014
Vehicle
Make
XENON
Remark
CREW Cab
Loudspeaker
ACE Tata
With
Without
Loudspeaker
3
HR36 -L-0014
27/09/2014
13/10/2014
Scorpio
-do-
4
HRSl-BB-1314
27/09/2014
13/10/2014
In nova
Without
Loudspeaker
5
HR14-A-0027
28/09/2014
Without
In nova
13/10/2014
Loudspeaker
-
--
6
-
HR-51-AD-0556
28/09/2014
-
Withou
Scorpio
13/10/2014
Loudspeaker
-- HR-04-0-3347
7
---
8
-
9
30/09/2014
13/10/2014
Scorpio
With Mike
HR-37-B-2820
30/09/2014
13/10/2014
Scorpio
With Mike
HR-37-9516
30/09/2014
13/10/2014
Tata
With Mike
Sumo
--
10
-
~
I-
HR-37-C-6255
--
01/10/14
13/10/2014
----
11
UP 15-C00031
02/10/2014
13/10/2014
12
HR37-C-8867
02/10/2014
13/10/2014
-
M&M
Without Mike
Tata 407
With Mike
Three
With Mike
whealer
13
--14
02/10/2014
13/10/2014
Scorpio
With Mike
HR-31-G-4675
04/10/2014
13/10/2014
Safari
With Mike
--
-HR-37-CT-4790
08/10/2014
13/10/2014
M&M
With Mike
--
-
10/10/2014
13/10/2014
LMVCAR Without Mike
14/10/2014
15/10/2014
In nova
15
16
-17
-
HR04-E-2700
18
---
19
20
HR02-AB-0340
---
HR 14-A-0027
~
HR37-C-6255
--
HRSl-BB-1314
--
Rickshaw
14/10/14
14/10/2014
30/09/2014
-
-
-
M&M
15/10/2014
-
Without Mike
---
---
In nova
15/10/2014
13/10/2014
-
Without Mike
-
---
--
-
Without Mike
-
With Mike
--
1
Total
11, iro. b~G
L_, 1+/o'b
Schedule- 8
Details of Lump sum amount received
s.
from
the party (ies) in cash or cheque or DD or by Account Transfer
Name of the Political Party Date
Cash
DD/ Cheque no. etc.
with details of drawee
bank
Total Amount
in Rs.
Remarks, if
any
4,
s
6
7
No.
1
3
2
1
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2
I
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H
I
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,
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"rf
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t-(
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3
4
'
Total
-
Schedule- 9
Details of Lump sum amount received from any person/company/firm/associations/body
donation etc.
of persons etc. as loan, gift or
s.
Name and address
Date
Cath
DD/ Cheque
no. etc. with
details of
drawee bank
Mention
whether loan,
gift or
donation etc.
Total Amount
in Rs.
Remarks
2
3
4
5
6
7
8
No.
1
1
'n\L
2
3
--- '
\-\\\._
~
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-
'
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ct \I,,-__
'-
'4
I
Total
Note:
1. In Schedule 5:(a) copy of the order containing list of all vehicles for which permit issued by the Returning Officer to be
enclosed.
(b) If the vehicle is owned by the candidate/his relative/agent are used for election purpose, notional
cost of hire of all such vehicles, except one vehicle if owned and used by the candidate, notional cost of
fuel and drivers salary for such vehicle, shall be included in total amount of expenditure in the above
table.
2. In all schedules if any expenditure on goods and services, provided by the Political Party; or provided
by any person/ company/ firm /associations/ body of persons etc. on behalf of the candidate, then the
notional market value of such goods or services are to be indicated, in respective columns.
3. In Part -III, the Lump-sum amount of fund received from the political party or others or the
candidate's own funds, should be mentioned date wise. In all such cases such amounts are required to
be first deposited in the bank account of the candidate, opened for election expenses.
4. Each page of the Abstract Statement should be signed by the candidate.
110
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23AA 100364
PART-IV
FORM OF AFFIDAVIT
Before the District Election Officer Ambala (Haryana) (District, State/Union Territory)
Affidavit of Shri Ramk:ishan S/o Late Sh. Lal Singh
I Rt1 Kisban son of Late Sh. Lal Singh, aged 51 years, r/o # 6, Naveen Colony, Ward No. 1,
Naraingarh, District Ambala (I-Iaryana) do hereby solemnly and sincerely state and declare as
undi :(1)
That I was a contesting candidate at the general election/bye election to the House of the
People /Legislative Assembly of Haryana from 003-Naranigarh Assembly constituency,
the result of which was declared on 19.10.2014.
c2)
I
That l/my election agent kept a separate and correct account of all expenditure incurred I
authorised by me I my election agent in connection with the above election between
..................
(3)
;
~
(the date on which I was nominated) and the date of declaration of the
result thereof, both days inclusive.
That the said account was maintained in the Register furnished by the Returning Officer
for the purpose and the said Register itself is annexed hereto with the supporting
vouchers/bills mentioned in the said account.
(4) ~
That the account of my election expenditure as annexed hereto includes all items of
election expenditure incurred or authori.sed by me or by my election agent, the political
Contd ... 2.
-2-
party which sponsored me, other associations I body of persons and other individuals
supporting me, in connection with the election,
withheld/suppressed
and nothing has been concealed or
therefrom (other than i:ne expense on travel of leaders' covered by
Explanations 1 and 2 under section 77 ( 1) of the Representation of the People Act, 1951 ).
(5)
That the Abstract Statement of Election Expenses annexed as Annexure II to the said
account also includes all expenditure incurred or authorised by me, my election agent, the
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political party which sponsored me, other associations I body of persons and other
..... .,.
.:~~µals supporting me, in connection with the election.
l
11
(6) , ~ . t t~
statements in the foregoing paragraphs (1) to (5) are true to the best of my
- 1 ·'"J rtJf-l ·~ , ··· J ~o\\:le.?~,e and belief, that nothing is false and nothing material has been concealed.
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Solemnly affirmed/sworn by
at
(Signature and seal of the Attesting authority, i.e.
Commission or Notary Public)
this day of ?.01
Magistrate
hefore me.
of the first Class or Oath