Banks usually has their own format to provide the Balance Certificate, usually it conatins Name of the Account Holder, Account Type, Amount in the account on that day, bank seal and official signatures. it is on the bank letterhead.
In addition to providing bank cert one can ask the bank to indicate the deposits with their comments. like
USD 200 - 11th March 2009- Salary
USD 50 - 10th April 2009- Witdraw