FORM 4N.I.
Form of return of election expenses required by section forty-sixN.I.
Election in the................................................................................constituency
[F1 or................................................................................[F2 district electoral area]],
Date of publication of notice of election................................................................................
Name of candidate................................................................................
1. I am the election agent of the person named above as a candidate at this election [am the person named above as a candidate at this election and was my own election agent].
(Where there has been a change of election agent suitable variations may be introduced here and elsewhere in the return).
2. I hereby make the following return of the candidate's [my] election expenses at this election.
Receipts
(Include all money, securities or equivalent of money received in respect of expenses incurred on account of or in connection with or incidental to the above election).
| Received of the above-named candidate ( or, if the candidate is his own election agent, paid by me) | £.................... |
| Received of ( set out separately the name and description of each person, club, society or association and the amount received from him or them) | £.................... |
Expenditure
NOTE.—The return shall deal under a separate heading or sub-heading with any expenses included therein as respects which a return is required to be made by section forty-six.
| Candidate's personal expenses— | |
| paid by him [by me as candidate] | £.................... |
| paid by me [by me acting as my election agent] | £.................... |
| Received by me for my services as election agent ( omit if candidate is his own election agent) | £.................... |
| Paid to *as sub-agent of the polling district of | £.................... |
| Paid to *†as polling agent | £.................... |
| Paid to *†as clerk [messenger] for days services | £.................... |
| Paid to the following persons in respect of goods supplied or work and labour done— | |
| to *† (set out the nature of the goods supplied or work and labour done thus: —[printing], [advertising], [stationery]) | £.................... |
| Paid to *†as a speaker at a public meeting at........................................on 19..................... as remuneration [expenses] | £.................... |
| Paid for the hire of rooms— | |
| for holding public meetings— | |
| paid to *†for hire of ( identify the rooms by naming or describing them) | £.................... |
| for committee rooms— | |
| paid to *†for hire of ( identify the rooms by naming or describing them) | £.................... |
| Paid for hire of vehicles | £.................... |
| Paid for postage | £.................... |
| Paid for telegrams | £.................... |
| Paid for miscellaneous matters— | |
| to *† (set out the reason for the payment) | £.................... |
| In addition to the above I am aware ( unless the candidate is his own election agent add as election agent for the above-named candidate) of the following disputed and unpaid claims— | |
| Disputed claims— | |
| by *for (set out the goods, work and labour, or other matter on the ground of which the claim is based) | £.................... |
| Unpaid claims allowed by the court to be paid after the proper time or in respect of which application has been or is about to be made to the court (state in each case whether the High Court or some other court) | |
| by *for ( set out the goods, work and labour, or other matter on the ground of which the claim is due) | £.................... |
Signature of person making return............................................................
* Set out separately the name and description of each person with the amount paid to or claimed by him.
† These particulars may be set out in a separate list annexed to and referred to in the account thus e.g., Paid to polling agents as per annexed list £ ..