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FORM No. A
[ Vide G.O. (P) 405/77/Fin dated 19-10-1977]
Bill for withdrawal of amounts under the Family Benifit Scheme for Government Employees
Name of Treasury ...............................................................................................................................................................
FOR TREASURY USE
Computer Sequence No:\Token No:
Scroll No: ...........................................
DDO Code : (Dept)
(DDO)
Date :
Total
Rs ................................................
Deduct recoveries Rs:............................ Details :.....................................................................................................
Net amount
Rs: .............................(Rupees.............................................................................................only)
Received the above detailed amount.
Signature Name &Designation of Drawing Officer
FOR TREASURY USE ONLY
Pay Rs...................... (Rupees .......................................................................................................................only) in CASH, Rs...........................
(Rupees................................................................... .................................................only) by RBR and
Rs..........................(Rupees.................................................................................. .................................................only ) by TC.
POC NO: .................................................................... Date:............./............./..................
Accountant
Received Pay Order Cheque
Signature of Recipient
Treasury Officer
Pay Order Cheque Issued By
Accountant
CERTIFICATE
Certified that amount claimed in the bill has not been drawn previously and the details
furnished above are correct as the account available in the office and the necessary noting in the
concerned registers.
Place:
Date: