Visit with DSR (Siam & Nushan)

Route Payment Tally (Test 2)

Payment mode at this shop *

Full cash Full digital Part cash + part digital No payment today (goods on credit) Cheque Adjusted against return

If any digital, which instrument? (if applicable) (select all that apply)

bKash personal bKash merchant Nagad Rocket Upay Bank transfer QR scan Other

Was any amount left unpaid today? *

No — fully settled Yes — part unpaid Yes — fully unpaid

If unpaid, amount left (BDT) (BDT) (if applicable)

If unpaid, was the stock still delivered? (if applicable)

Yes — full stock left Yes — reduced quantity left No — delivery refused Manager called for approval

Days the DSR said this shop can pay later (days) (if applicable)

Any extra charge mentioned for the delay? (if applicable)

No charge at all Yes — fixed amount Yes — percentage Only tea/snacks Not asked

Were previous dues cleared today? *

Yes Partly No No previous dues

Who handed over the money? *

Owner Staff Family member Nobody present

Anything said at the counter, verbatim (Bangla)

Shop name *

Shop strength (interviewer judgement) *

Strong Average Weak

When did you last take goods without paying in full? *

শেষ কবে পুরো টাকা না দিয়ে মাল নিয়েছিলেন?

Date (if known) (if applicable)

How many days later did you pay? (days) *

কত দিন পরে শোধ করেছিলেন?

How much was taken on credit that time (BDT)? (BDT) *

কত টাকার মাল বাকিতে নিয়েছিলেন?

Did you pay anything extra for those days? *

ওই দিনগুলোর জন্য বাড়তি কিছু দিতে হয়েছিল?

No Yes — amount Yes — percentage Only tea / snacks

How many times did this happen last month? *

গত মাসে কতবার এমন হয়েছে?

Who allowed it? *

কে অনুমতি দিয়েছিল?

DSR Distributor manager Distributor owner Nobody — I was refused

Was any paper or document signed? *

কোনো কাগজে সই করতে হয়েছিল?

No Just noted in a register Signed a slip Post-dated cheque

Verbatim quote (Bangla)

Shopfront photo (JPG / PNG, max 5 MB)

Select your name *

আপনার নাম বেছে নিন