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8 Ground on witch leave is applied: Going to Home Town (At-Ubadi,The & Dist- Khargone M.P.)
for personal Domestic work.
11 Address during the leave period : At – Ubadi, Post - Aghawan, Teh & Dist- Khargone ( M.P.)
(O.P.Patidar )
SDE,NWRSD,
CWC, Himmatnagar
Sign.
Designation
Signature
Designation
Signature
Designation
Performa
GOVERNMENT OF INDIA
CENTRAL WATER COMMISSION
Performa
GOVERNMENT OF INDIA
CENTRAL WATER COMMISSION
प्रममाणणित ककियमा जमातमा हह ककि .....................................................स्टटे शन किटे स्व:लटेखख वरमार्षाममापख एवव समाधमारणि
वरमार्षाममापख ककि मटेनटे दटे ख-रटे ख ककि और ददनमावकि ..................................सटे ददनमाकिव ............................तकि ककि अवधध किटे चमाटर्षा
किमा सवग्रह ककियमा हह जजसकिटे ललए र .........................(र ) भत्तमा किमा दमावमा ककियमा जमातमा हह ׀
प्रममाणणित ककियमा जमातमा हह ककि .....................................................स्टटे शन किटे स्व:लटेखख वरमार्षाममापख एवव समाधमारणि
वरमार्षाममापख ककि मटेनटे दटे ख-रटे ख ककि और ददनमावकि ..................................सटे ददनमाकिव ............................तकि ककि अवधध किटे चमाटर्षा
किमा सवग्रह ककियमा हह जजसकिटे ललए र .........................(र ) भत्तमा किमा दमावमा ककियमा जमातमा हह ׀
1 Name :
2 Post Held :
3 Department, office & section :
4 Pay :
5 House rent & other
Compensatory allowances
Drown in present post
6 Nature & Period of Leave applied for: -
& dt. From which required
Sign.
Sign.
Designation
Signature
Designation
Signature
Designation
APPLICATION FOR EARNED LEAVE / MEDICAL LEAVE
11 Address during the leave period : At – Ubadi, Post - Aghawan, Teh & Dist- Khargone ( M.P.)
(O.P.Patidar )
SDE,NWRSD,
CWC, Himmatnagar
Sign.
Designation
Signature
Designation
Signature
Designation
APPLICATION FOR EARNED LEAVE / MEDICAL LEAVE
8. Date of return from last leave & Dated 01/12/2014 to 05/12/2014.(Five days)
Nature & period of that leave : Necessary work at home
9. I propose/ do not propose to
Avail myself leave travel
Concession for the block year.
during the ensuing leave :
10. Address during the leave period : 349, Veena Nagar, Sec-6, Hiran Magari, Udaipur (Raj.)
Sign.
Sign.
Designation
Signature
Designation
Signature
Designation
Name of Payee:-
HAND RECEIPTS
(Central P.W.A. Code Paragraphs 212, 218, 234)
(To be used as sample form of voucher for all miscellaneous and advances
for which none of the special forms 24, 25, 26, 27 is suitable)
Dated the
#Witness Signature of
payee
*The officer authorizing payment should initial and date pay order after scoring out of the word cheque or cash each as the case may
be.
The person actually making the payment should initial and date payment certificate.(2)
In case of works the accounts of which are kept by Sub-heads the amount chargeable to each sub-head be specified by disbursing
officer.
#Payment should be attested by some known person when the payee’s acknowledgement is given by a mark seal or thumb
impression.
Name of Payee:-
HAND RECEIPTS
(Central P.W.A. Code Paragraphs 212, 218, 234)
(To be used as sample form of voucher for all miscellaneous and advances
for which none of the special forms 24, 25, 26, 27 is suitable)
(2) Paid by me
Dated the
#Witness Signature of
payee
*The officer authorizing payment should initial and date pay order after scoring out of the word cheque or cash each as the case may
be.
The person actually making the payment should initial and date payment certificate.(2)
In case of works the accounts of which are kept by Sub-heads the amount chargeable to each sub-head be specified by disbursing
officer.
#Payment should be attested by some known person when the payee’s acknowledgement is given by a mark seal or thumb
impression.
INDEX
DETAILS Page no
OTA APPLICATION FORM 2
APPLICATION FOR ADVANCE FROM G.P.FUND 3
‚ãã‡ãŠãäÔ½ã‡ãŠ/ ¹ãÆãä¦ãºãâãä£ã¦ã/ 5
GRAND TOTAL
( Rupees……………………………………………………………………………..only)
( Àã‡ãñŠÍã ØããõÀã¶ãã )
ÔãÖã¾ã‡ãŠ ‚ããä¼ã¾ãó¦ãã
GOVERNMENT OF INDIA
CENTRAL WATER COMMISSION
I certify that particulars given above are correct & complete to the best of my knowledge and belief and
that nothing has been concealed by me.
2) ¹ãª¶ãã½ã ----------------------------------------------------------------------------
ÙÔ¦ããàãÀ
ãäÔãû¹ãŠããäÀÍ㠇㊦ããÃ
Ô©ãÊã:- ---------------
ÔãÖã¾ã‡ãŠ ‚ããä£ãÍããÔããè
‚ããä¼ã¾ãâ¦ãã
GOVERNMENT OF INDIA
CENTRAL WATER COMMISSION
T.R. – 28 (Treasury Rules)
ACQUINTTANCE ROLL
A quittance roll of Permanent or Temporary Establishment of (NCA SITE
PATI)The………………………………………………………………….. for the
Ite Name & Designation Net Dated signature (with
m Amount stamp where
Rs. necessary). Unpaid
items to be noted as
such and attested.
1 Shri Amal Chand Bepari
SWA
GOVERNMENT OF INDIA
CENTRAL WATER COMMISSION
T.R. – 28 (Treasury Rules)
ACQUINTTANCE ROLL
A quittance roll of Permanent or Temporary Establishment of (NCA SITE
PATI)The………………………………………………………………….. for the
Ite Name & Designation Net Dated signature (with
m Amount stamp where
Rs. necessary). Unpaid
items to be noted as
such and attested.
1 Shri Inder Singh Solanki
Work Sarkar
1. Name of work………………………………………………………………………….
2. Name ofAgency…………………………………………………………………………
(Rupees…………………………………………………………………………………)
Certified that :-
a. Bill verified and found correct.
b. Materials received correctly and in good condition.
c. Work done satisfactorily.
d. Entered in…………………………………A/C Register Page No…………………..
e. Entered in M.B. No……………………….…… Page No…………………..
Junior Engineer
3. Superimposed S. D. Curve
AUTHORITY LETTER
………………………………………………………………………………..…………………….)
towards……………………………………………………………………………………………
Signature :-
Name :-
Designation :-
Receipt
……………….…………………………………………………..…………………………..….…)
towards………………………………………………………………………..……….
Signature :-
Name :- (O. P. Patidar)
Designation :- Sub Divisional Engineer
FORM OF APPLICATION FOR CONVERSION OF AN ADVANCE INTO FINAL
WITHDRAWAL
Place : Indore
Date : (Signature of the applicant)
Ministry of Water Resources
Central Water Commission,
Narmada Division, Bhopal
M.N. Sub-Division-III, Indore
2. Account Number :
4. Pay :
6. Date of superannuation :
ã䪶ããâ‡ãŠ :
¹ãÆã©ããê ‡ãñŠ ÖÔ¦ããàãÀ
¹ãª ¶ãã½ã :
ãä¶ã¾ãâ¨ã¥ã ‚ããä£ã‡ãŠãÀãè ‡ãŠãè ã䛹¹ã¥ããè / ãäÔã¹ãŠããäÀÍã
ã䪶ããâ‡ãŠ :
ÖÔ¦ã
ãàãÀ
¹ãª ¶ãã½ã :
¹ãª ¶ãã½ã :
FORM G.F.R. 27
(See GOI Decision (1) below Rule 199)
APPLICATION FORM FOR AN ADVANCE FOR THE PURCHASE OF
MOTOR CAR/ PERSONAL COMPUTER/ MOTOR CYCLE
1. Name of Applicant :
2. Applicant’s Designation :
3. District and Station :
4. Pay
i) Substantive Pay :
ii) Officiating pay or pay drawn in Temporary :
post
iii) Special/Personal Pay :
5. Anticipated price of motor Car/ Personal :
Computer/Motor Cycle
6. Amount of advance required :
7. Date of Superannuation or retirement or date of :
expiry of contract in case of a contract officer
8. Number of installments in which the adv. is :
desired to be repaid
9. Whether adv. for similar purpose was obtained
previously and if yes
i) Date of drawal of the adavance :
ii) The amount of advance and/or incorporate :
thereon still outstanding, if any
10. Whether the intention is to purchase
a) A new or an old Motor Car/ Personal :
Computer/Motor Cycle
b) If the intention is to purchase Motor Car/ :
Personal Computer/ Motor Cycle from a
person having Official dealings with the
Govt. Servant, Whether previous sanction
of the competent authority has been
obtained as required under rule 15(2)of the
Central Civil Services (conduct) rules
1964
11. Whether the officer is on leave or is about to
proceed on leave.
a) The date of commencement of leave :
b) The date of expiry of leave :
12. Are any negotiations or preliminary enquiries
being made so that delivery may be taken of the
Computer/Motor Cycle with in one month from
the date of drawl of the advance.
13. a) Certified that the information on given above is complete and true
b) Certified that I have not taken delivery of the computer/motor cycle on account of which I apply for
the advance, that I shall complete negotiation for the purchase of pay finally and take possession of
the computer/motor cycle before the expiry of one month from the date of drawl of the advance and
that I shall ensure it from the date of taking delivery of it.
Place:
Date: (Signature of the Applicant)
MONTHLY DATA
(MONTH :-…………………………)
Name of Site :-
Name of River :-
Code No:-
Zero of Gauge :-
Period From………………….To……………………… ,
MONTHLY DATA
Period From………………….To……………………… ,
Received sum of Rs…8120/- (Rupees Eight thousand one hundred twenty only)
Towards the repairing & servicing of Govt. vehicle no MP-09 –v-1093 . vide D.D. no.
927917 dated 06.04.2009 from the Executive Engineer, Narmada Division, CWC,
Signature
Date :-
Place :- Indore
No:- Date:-
MONDAY DATA
( For Date :-…………..……)
1. Name of Site :-
2. River :-
3. Code No :-
4. Zero of Gauge :- ………………………….. mt
5. Mean Water Level;- ………………………….. mt
6. Discharge :- Discharge Suspended due to Negligible flow /
Stagnant Water/ Dry River
Junior Engineer
Central Water Commission
CURRENT METER DESPATCH SLIP
1) Current Meter No :-
2) Date of Last Rating :-
3) Date of First Use :-
4) Nos. of Hours Used :-
5) Nos. of Days Used :-
6) Accessories attached (if any) :-
7) Reason for sending the Current meter (Tick mark in the Box).
a) C.M. is due for Re-rating.
b) C.M. is damaged & not in working condition.
c) C.M. is not yet due for re-rating, but the
C.M. is not required at site now, hence sent
for further use at other site or so.
Date :-
Site :-
1. Current Meter No :-
2. Date of Last Rating :-
3. Date of First Use :-
4. Nos. of Hours Used :-
5. Nos. of Days Used :-
6. Accessories attached (if any) :-
7. Reason for sending the Current meter (Tick mark in the Box).
a) C.M. is due for Re-rating.
b) C.M. is damaged & not in working condition.
c) C.M. is not yet due for re-rating, but the
C.M. is not required at site now, hence sent
for further use at other site or so.
Date :-
Site :-
CERTIFICATE ‘B’
(To be completed in case the case of patients who are admitted to hospital for treatment)
PART A
I, Dr……………………………………………………………..hereby certify –
(a) That the patient was admitted to the hospital on the advice of ….…………….………………..…
……………………………………….(name of the medical officer) on my advice.
(b) That the patient has been under treatment at………………………………………. and that the under mentioned
medicines prescribed by me in this connection were essential for the recovery/ prevention of serious
deterioration in the condition of the patient. The medicines are not stocked in the………………………………..
(name of the hospital) for the supply to private patients and do not include proprietary preparations for
which cheaper substances of equal therapeutic value are available nor preparations are primarily foods,
toilets or disinfectants.
(c) that the injections administrated were/were not for immunizing of prophylactic purposes.
(d) That the patient is/was suffering from…………………………………… and is/was under treatment
from…………………………. to………………………..
(e) That the X-ray, laboratory tests, etc., for which an expenditure of Rs……………. was incurred were
necessary and were undertaken on my advice at…………… …………………………….(name of hospital or
laboratory).
(f) That I called on Dr……………………………………… for specialists consultation and that the necessary approval
of the ……………………………………………. (Name of the Chief Administrative Medical Officer of the State) as
required under the rules, was obtained.
PART B
I certify that the patient has been under treatment at the…………………….………………. hospital and that the service
of the special nurses for which an expenditure of Rs……..…………… was incurred vide bills and receipts attached, were
essential for the recovery/prevention of serious deterioration in the condition of the patient.
COUNTERSIGNED
Medical Superintendent
CHARAK Hospital
* I certify that the patient has been under treatment at the…………………………………. hospital and that the facilities
provided were the minimum which were essential for the patient’s treatment.
Medical Superintendent
Note.- Certificates not applicable should be struck off. Certificate (d) is compulsory and must
be filled in by the Medical Officer in all cases.
*The ‘minimum of facilities certificate’ may be signed either by the Medical Superintendent
of the Hospital concerned or another gazetted Medical Officer who has been authorized in this
behalf by the Medical Superintendent.
[G.I., M.H., O.M. No. F. 2-35/52-LSG(H.I.), dated the 19 th. September, 1958]
1. Name of Site
Signature of J.E.
Site………………………………..
Application For grant of LTC Advance
a.
b.
c.
I declare that the particulars furnished above are true and correct to the best of
my knowledge. I undertake to produce the tickets for the outward journey within ten
days of receipt of the advance.
In the event of cancellation of the journey or if I fail to produce the tickets within
ten days of receipt of advance, I undertake to refund the entire advance in lump sum.
Date………………………… Signature…………………………
CHECK - LIST
(For use in office)
1. Particulars in Cols 1 to 6 verified :
2. Amount entitled for :
reimbursement
(Fare Rs………. x 2 x No of tickets)
3. Advance admissible ( 90% of :
amount in column 2)
Advance of Rs…………………………………..
may be sanctioned
D.A. J.A.O./S.O.
(Form of applicant for Final Payment of Balances in the Provident Fund Account of
a SUBSCRIBER to be used by the Nominees or any other claimants where no
nomination subsists.)To
Sir,
It is requested that arrangements may kindly be made for the payment of the
accumulations in the …………………………….. Provident FundAccount of Shri / Shrimati
……………………………………. The necessary particulars required in this connection given below –
Yours faithfully
Station:………………….
(Signature of claimant)
Dated ………………….. ( Full name and address)
---------------------------------------------------------------------------------------------------------------------
* This applies only when payment is not desired through the Head of Office
4 The last fund deduction was made from his/her pay for the month
of…………………….drawn in this office Bill No………………..,dated …………………Cash Voucher
No……………………………of………………….Treasury, the amount of deduction being
Rs……………………and recovery, on account of refund of advance of Rs…………
5. Certified that he/she was neither sanctioned any temporary advance nor any final
withdrawal from his/her Provident Fund Account during the 12 months immediately
preceding the date of his/her death.
Or
Certified that the following temporary advances/final withdrawals were sanctioned to
him/her and drawn from his/her Provident Fund Account during the 12 months immediately
preceding the date of his/her death.
1. Initial km reading =
2. Final km reading =
3. Total km run =
4. Opening balance of Diesel/Petrol =
5. Diesel/Petrol purchased during the month =
6. Closing balance of Diesel/Petrol =
7. Total Diesel/Petrol consumed =
8. Total M. Oil purchased during the month =
9. Total Coolant purchased during the month =
10. Average of the vehicle =
FORM GFR 24
(See Rule 207)
This INDENTURE made this ……………………day of …………two thousand and five BETWEEN
Shri Rakesh Gaurana (here in after called the “Borrower” which expression shall include his heirs,
administrators, executor and legal representatives) of the one part and the PRESIDENT of India
(herein after called “the President”, which expression shall include his successors and assigns) of
the other part. WHEREAS the BORROWER has applied for and has been granted an advance of
Rupees…………………………………………to purchase a Motor Vehicle / Computer and/or to pay
customs duty in respect of a (the) Motor vehicle / Computer on the terms of Rule 199 to 211 of the
General Financial Rules,1963, of the Central Government (hereinafter referred to as “ the said
Rules” which expression shall include any amendment thereof or addition thereto for the time being
in force) AND WHEREAS one of the conditions upon which the said advance has been/was granted
to the Borrower is/was that the Borrower will/would hypothecate the said Motor Vehicle / Computer to
the President as security for the amount lent to the Borrower AND WHEREAS the Borrower has
purchased and/or paid customs duty with or party with the amount so advanced as aforesaid the
Motor Vehicle / Computer particulars whereof are set out in the Schedule hereunder written.
NOW THIS INDENTURE WITNESSETH that in pursuance of the said agreement and for the
consideration aforesaid the Borrower doth hereby convenant to pay to the President the sum of
Rs…………….aforesaid or the balance thereof remaining unpaid at the date of these presents by
equal payments of Rs…………………. each on the first day of every month and will pay interest on
the sum for the time being remaining due and owing calculated according to the said Rules and
Borrower doth agree that such payments may be recovered by monthly deductions from his salary
in the manner provided by the said Rules or where, in the event of proceeding on deputation out of
India for a period exceeding twelve months or of his being transferred to a post outside India, the
competent authority has allowed repayment of the amount of advance remaining unpaid and/or
interest as aforesaid on the happening of such an event, in rupees in India, the Borrower doth hereby
agree to pay to the President such dues by remittance through Bank draft drawn by the 15 th of every
month in favour of the Accounts Officer in whose books the accounts of the aforesaid advance are
kept, and in further pursuance of the said agreement the Borrower doth hereby assign and transfer
unto the President the Motor Vehicle / Computer the particulars whereof are set out in the Schedule
hereunto which by was of security for the said advance and the interest thereon as required by the
said Rules.
And the Borrower doth hereby agree and declare that he has paid in full the purchase price of the
said Motor Vehicle / Computer and or/the entire customs duty payable and that the same is his
absolute property and that he has not pledged and so long as any money remain payable to the
President in respect of the said advance will not sell, pledge or part with the property in or
possession of the said Motor Vehicle / Computer, PROVIDED ALWAYS and it is hereby agreed and
declared that If any of the said instalments of principals or interest shall not be paid or recovered in
manner aforesaid within ten days after the same are due or if the Borrower shall die or at any time
cease to be in Government Service or if the Borrower shall sell or pledge or part with the property in
or possession of the said Motor Vehicle / Computer or become insolvent or make any composition or
arrangement with his creditors or if any person shall take proceedings in execution of any decree or
judgment against the Borrower the whole of the said principal sum which shall then be remaining
due and unpaid together with interest thereon calculated as aforesaid shall forthwith become
payable AND IT IS HEREBY AGREED and declared that the President may on the happening of
any of the events hereinbefore mentioned seize and take possession of the said Motor Vehicle /
Computer and either remain in possession thereof without removing the same else may remove and
sell the Motor Vehicle / Computer either by public auction or private contract and may out of the sale
moneys retain the balance of the said advance then remaining unpaid and any interest due thereon
calculated as aforesaid and all costs, charges, expenses and payments property incurred or made in
maintaining, defending or realizing his rights hereunder and shall pay over the surplus, if any to the
Borrower, his executors, administrators or personal representatives PROVIDED FURTHER that the
aforesaid power of taking possession or selling of said Motor Vehicle / Computer shall not prejudice
the right of the President, to sue the Borrower of his personal representatives for the said balance
remaining due and interest or in the case of the Motor Vehicle / Computer being sold the amount by
which the net sale proceeds fall short of the amount owing AND THE Borrower hereby further agree
that so long as any moneys are remaining due and owing to the President he will not permit or suffer
the said Motor Vehicle / Computer To be destroyed or injured or to deteriorate in a greater degree
than if would deteriorate by reasonable wear and tear thereof AND further that in the event of any
damage or accident happening to the said Motor Vehicle / Computer, the Borrower will forthwith have
the same repaired and made good.
THE SCHEDULE
Description of Motor Vehicle / Computer
Makers Name
Description
No. of Cylinder
Engine Number
Chassis No.
Cost Price
IN WITNESS WHEREOF the mortgagor/Borrower has hereunto set his hand and
Shri………………………………………. In the Ministry/Office of ………….for and on behalf of the
President of India has hereunto set his hand.
1………………………………
2………………………………
(Signature of Witnesses)
Signed by ………………………………
(Name and designation)
………………………………….
For and on the behalf of the President of India in the presence of
1………………………………… 2……………………………..
FORM GFR 22
(See Rule 207)
IN WITNESS whereof the Mortgagor / Borrower has hereunto set his hand and Shri
………………………….in the Ministry/Office of……………………..for and on behalf of the
President of India has hereunto set his hand.
1…………………………………………. ……………………………………….
( Signature and designation of the Borrower)
2………………………………………….
(Signature of Witnesses)
…………………………………………
for and on behalf of the President of India in the presence of
1…………………………………………. ……………………………………….
( Signature and designation of the Officer)
2………………………………………….
(Signature of Witnesses)
(ANNEXURE-II)
PERFORMANCE REPORT
To,
The Manager,
State Bank of India,
Main Branch, Indore
AUTHORITY LETTER
(Rupees Two Lacs Eighty Five Thousand One Hundred & Eighty One Only)
of Demand Draft No. 969630, dated 30/05/2006. His attested Signature given below.
Signature :-
( ) Name :- ( )
Designation :-
To,
Yours faithfully
Date: ( )
2. CWC/RD-2 Data
3. CWC/RD-3 Data
4. CWC/RD-4 Data
5. CWC/RD-5Data
6. CWC/RD-6 Data
7. Others
8. Inspection Registers
B Records of Silt Data
1. CWC/RD-7 Data
2. Check Sample
3. CDC –S-3
4. D.O. Test Registers
5. Water Sample Registers
6. Bed Material Registers
7. VVD/VSD Registers
8. Others
9.
C Graphs of Gauge & Discharge
1. Stage Vs Disch. Area ,Velocity ,N, Slope
2. Disch. Vs Area, Velocity, Slope, N
3. Cross Sections & Bar charts
4. Hydrograph
5. Rain fall Chart
6. Others
D Graphs of Silts
1. Sediment load Vs Discharge
2. Sediment Hydrograph
3. Silt bar Chart
4. Others
E Field Books
1. Discharge Field Book
2. Hourly Gauge Field Book
3. Gauge book of W/L Station
4. Water level register of W/L Station
5. Others
प्रतत,
अधधशमासख अलभयवतमा
ममाहह मवडल
किटेन्दहय जल आययोग
गमावधखनगर
ववरय :- प्रस्थमान सच
स नमा |
महयोदय,
उपरयोक्त ववरय मम लटेख हह ककि मटेरह प्रस्थमान ससचनमा आवश्यकि किमायर्षावमाहह हटे तस प्रटेवरत हह |
1 नमाम एवव पद ओ.पख.पमाटहदमार,उप मवडल अलभयवतमा,दहमतनगर
2 अवकिमाश किमा वववरणि अजजर्षात अवकिमाश 13 ददन,ददनमावकि 15/02/2016 सटे
ददनमावकि 27/02/2016 तकि
3 अवकिमाश स्वखकिकतत आदटे श क्रममावकि स्वखकिकतमाधधन
4 पव
प र्षा ययोजनमा अवकिमाश द्ववतखय शतनवमार ददनमावकि.13/02/2016 एवव रवववमार
ददनमावकि 14/02/2016
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6 अवकिमाश किमालहन डमाकि – पतमा 20,वल्लभ नगर,मगरल रयोड,गलह न.3,खरगयोन
(प.तन.)MM.P
7 मसख्यमालय प्रस्थमान ससचनमा ददनमावकि -12/02/2016 (Afternoon)
ओ.पख.पमाटहदमार
उप मवडल अलभयवतमा
NWRSD - दहम्मतनगर
प्रतत,
अधधशमासख अलभयवतमा
ममाहह मवडल
किटेन्दहय जल आययोग
गमावधखनगर
महयोदय,
उपरयोक्त ववरय मम लटेख हह ककि मटेरह आगमन ससचनमा आवश्यकि किमायर्षावमाहह हटे तस प्रटेवरत हह |
ओ.पख.पमाटहदमार
उप मवडल अलभयवतमा
NWRSD - दहम्मतनगर
I hereby apply for the reimbursement of children education allowance for my child and relevant
particulars are furnished below.
1. (a) Name of the child ( in BLOCK letter) :- _____________________________________
(b) Date of birth :- ______________________________________
2. (a) Name and address of the school in
witch studying :- ______________________________________
_______________________________________
(b) class in witch studying :- _______________________________________
4. The quarter of year and Academic year for witch the Children Education Allowance is applied
now
Quarter of year Academic year
5. (a) Whether the children for whom Children Education Allowance applied is disable
child:-
Yes/ No.
(b) If yes, indicate the nature of disability :- ........................................................
(c) Indicate the percentage of disability :- .........................................................
(d) Date of disability certificate :- .........................................................
6. (a) Detail of expenses incurred towards school fee for purpose of text books & note books,
Two
sets of Uniform & Shoes and for which reimbursement of Children Education
Allowance
now.
Signature of applicant
CERTIFICATE
Principal
Annexure -1
It is also certified
that .............................................................................................................
Is recognized by the educational authority Madhya Pradesh ( Not applicable for
Government institution and school run by panchayat samitee or zila parisad)
Principal
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ÌãÆŠ½ããâ‡ãŠ:- ã䪶ããâ‡ãŠ -
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Ô©ãÊã:- ---------------
1. ¶ãã½ã :-
2. ¹ãª :-
3. „½ãÆ †Ìã⠕㶽ããä¦ã©ããè :-
4. Ìã¦ãýãã¶ã Ìãñ¦ã¶ã †Ìãâ Ìãñ¦ã¶ã½ãã¶ã :-
5. Íãõàããä¥ã‡ãŠ †Ìãâââ ¦ã‡ãŠ¶ããè‡ãŠãè ¾ããèؾã¦ãã :-
6. Ìã¦ãýãã¶ã ½ãò ¦ãõ¶ãã¦ããè ¦ããÀãèŒã †Ìãâ ãäÌãÞããÀã£ããè¶ã
ÌãÓãà ‡ãñŠ ªãõÀã¶ã ãä‡ãŠ¾ãñ Øã¾ãñ ‡ãŠã¾ãà ‡ãŠã
ãäÌãÌãÀ¥ã :-
7. ÍããŒãã/‚ããä£ã‡ãŠãÀãè /•ãÖãú ãä•ãÔã‡ãòŠ Ôãã©ã
‡ãŠ½ãÃÞããÀãè
¦ãõ¶ãã¦ã Öõ :-
8. ‡ã‹¾ãã ãäÖ¶Ìããè /‚ãâØãÆñ•ããè ãäÊãŒã †Ìã⠹㤠Ôã‡ãŠ¦ãñ
Öõ :-
9. ãä¶ã½¶ããäÊããäŒã¦ã ¹ãÀ ã䛹¹ã¥ããè :-
¾ããñؾã¦ãã /ºãìã䣪½ã¦¦ãã
‚ã¶ãìÍããÔã¶ã
ƒÃ½ãã¶ãªãÀãè †Ìãâ Ô㦾ããä¶ãÓŸã
Ôã½ã¾ã ¹ããÊã¶ã
‡ãŠã¾ãà ‡ãñŠ ¹ãÆãä¦ã ÊãØããÌã
10.‡ã‹¾ãã ÌãÖ „ÞÞ㠹㪠½ãò ¹ãÆãñ¸ããä¦ã ‡ãñŠ ãäÊã¾ãñ
„¹ã¾ãì‡ã‹¦ã Öõ
11.‡ã‹¾ãã ‚ãã¹ã „Ôãñ ‚ã¹ã¶ãñ ¹ããÔã ÀŒã¶ãñ ‡ãŠãñ ¦ãõ¾ããÀ Öõ
12.‚㶾ã ã䛹¹ã¥ããè
ãäÀ¹ããñ›Ã ‡ãŠÀ¶ãñ ÌããÊãñ
‚ããä£ã‡ãŠãÀãè ‡ãñŠ ÖÔ¦ããàãÀ
¹ãª
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FORM GFR – 33
(See Rule 78)
Certificate of transfer of charge
Certified that I/ We have in the Forenoon / Afternoon of this day :- 17.12.2016 respectively
made over and received charge of the office of of the Sub Divisional Engineer, Northern Western
River Sub Division ,CWC Himmatnagar in pursuance of Order No :- तमामव/स्थमा-I/तनफमा/2016/4592-94
Dated 25 /11/2016.
(for use of Audit Office only)
Noted in A/R at page ………. Relieved Officer
Noted in A/C at page ………. Signature ………………
Leave Salary Certificate / Service Name in Block letters: O.P.PATIDAR
statement issued on…………………… Designation : Sub Divisional Engineer
Auditor. Supdt. AAG station Station : Himmatnagar
Date: :- 17.12.2016 (F/N)
--------------------------- (Proceeding on Transfer/ Leave /Retirement)
AAO
Certified that I/ We have in the Forenoon / Afternoon of this day :- 29.02.2016 respectively
made over and received charge of the office of of the Sub Divisional Engineer, Northern Western
River Sub Division ,CWC Himmatnagar in pursuance of Order No – MD/EC-01/PF-OPP/450-52
Dated 04/02/2016.
(for use of Audit Office only)
Noted in A/R at page ………. Relieved Officer
Noted in A/C at page ………. Signature ………………
Leave Salary Certificate / Service Name in Block letters: GOVIND NARAYAN
statement issued on…………………… Designation : Sub Divisional Engineer
Auditor. Supdt. AAG station Station : Ahmedabad
Date: :- 29.02.2016 (F/N)
--------------------------- (Proceeding on Transfer/ Leave /Retirement)
AAO
Certified that I/ We have in the Forenoon / Afternoon of this day :- 29.02.2016 respectively
made over and received charge of the office of of the Sub Divisional Engineer, Northern Western
River Sub Division ,CWC Himmatnagar in pursuance of Order No – MD/EC-01/PF-OPP/450-52
Dated 04/02/2016.
(for use of Audit Office only)
Noted in A/R at page ………. Relieved Officer
Noted in A/C at page ………. Signature ………………
Leave Salary Certificate / Service Name in Block letters: GOVIND NARAYAN
statement issued on…………………… Designation: Sub Divisional Engineer
Auditor. Supdt. AAG station Station : Palanpur (Additional Charge)
Date: :- 29.02.2016 (F/N)
--------------------------- (Proceeding on Transfer/ Leave /Retirement)
AAO
(To be used as sample form of voucher for all miscellaneous and advances for which non of the special form 24,25,26,27
is suitable)
Signature of payees
……………………………………………………………………………………
*The officer authorizing payment should initial and date pay order after scoring out of the word cheque or cash each as the case may
he.
*The person actually making the payment should initial and date payment certificate.
In case of the work the account s of which are kept by sub heads the amount chargeable to each sub head be specified by disbursing
officer.
Payment should be attested by some known person when the payee’s acknowledgement is given by a mark seal or thumb impression.
Certified that:-
1. The bills have not been claimed earlier
2. The materials were received in full and good condition.
3. The work has been done satisfactory.
4. The materials Purchased at the reasonable rates prevailing in the market.
5. The payment made in the interest of urgent Govt. works only
6. This bill has been verified and found correct.
7. Expenditure incurred from personal money by cash as no sufficient imprest amount was with me.
8. Entered in History Sheet of Vehicle No page No
9. Taken in to ………………… …..Account at page ………….
10. Entered in M. B. No…………. Page No…………………..
Signature
Imprest Cash Voucher No:- ……………………… Dated:- -----/-----/2017
Name of work: - ……………………………………………………………………….……
Head of A/C:- 2711-(01-00-27)-FC&D, MW (N-P)
Authority No: - ……………………………………………………………….…………….
Name of Agency: - ………………………………………………………………………….
Situation: - …………………………………………………………………………………..
Date of Purchase/Work Done:-……………………………………………………………..
Details of Payments:-……………………………………………………………………….
Certified that:-
1. The work has been done satisfactory.
2. The materials were received in full and good condition.
3. The materials Purchased / work done are at the reasonable rates prevailing in the market.
4. The payment made in the interest of Government work.
5. This bill has been verified and found correct.
6. Taken in to MAS/Telephone/Misc. work/Electricity/Contingency register on page no.…….
7. Entered in M. B. No…………. Page No…………………..
Signature
Signature
Certified that:-
1. The work has been done satisfactory.
2. The materials were received in full and good condition.
3. The materials Purchased / work done are at the reasonable rates prevailing in the market.
4. The payment made in the interest of Government work.
5. This bill has been verified and found correct.
6. Taken in to MAS/Telephone/Misc. work/Electricity/Contingency/Stationary register Account at page……….
7. Entered in M. B. No…………. Page No…………………..
Signature
Signature
Certified that:-
1. This bill has not been claimed as earlier in any shape.
2. The work has been done satisfactory.
3. The materials were received in full and good condition.
4. The materials Purchased / work done are at the reasonable rates prevailing in the market.
5. The payment made in the interest of Government work.
6. This bill has been verified and found correct.
7. Taken in to MAS/Telephone/Misc. work/Electricity/Contingency/Stationary register on page .…….
Signature
Passed for Rs 1505/ (Rupees One Thousand Five Hundred and Five Rupees only) and Paid
Rs. 1505/ (Rupees One Thousand Five Hundred and Five Rupees only )by me in cash from my imprest
account vide C.V. No ……... Dated 15/06/2017.
Signature
फतमर टट.आर. 73/ FORM-TR -73
( सख.रूल २३ 0/ See Rule -230 )
अवततम वटेतन प्रममाणि पत /LAST PAY CERTIFICATE
अवततम वटेतन प्रममाणि पत शख एम. सख. शखममालह, वकिर्षा सरकिमार ग्रटेड -2, उत्तरह पजश्चमख नददयमाव उप मण्डल, किटेन्दहय
जल आययोग ,दहम्मतनगर किमा स्थमानमावतरणि बनमास लन
प ख उप मण्डल, किटेन्दहय जल आययोग, पमालनपरस किटे अन्तगर्षात गटेज एवव
डडस्चमाजर्षा स्थल धचतमासनख,तह- पमालनपरस ।
1. Last pay Certificate of shree M. C. Shrimali Work sarkar-Gr-II , North
Western River Sub Division, CWC, Himmatnagar , transfer to the
Gauge & Discharge Site , Chitasani, Under banas Luni sub Division,
CWC,Palanpur.
2. He has been paid up to 31/05/2015 (A/N) at the following rates.
Details of Salary Amount Deduction Amount
Substantive Pay 12440/- GPF(C) 4000/-
Grade Pay 2800/- GPF(Adv.) 5000/-
Special Pay 0 CGEIS 30/-
Personal Pay 0 Professional Tax 200/-
Leave Salary 0 Income Tax 0
Allowances Edu. Cess 2% 0
a) DA / ADA (113%) 17221/- Hr. Edu. Cess 1% 0
b) HRA @ Rs 10% 1524/- CGHS 0
c) Transport All@ 800/- 800/- Licence Fee 0
d) D.A. all Trap. All (113%) 904/- MD Co. Operative 6000/-
Socity Gandhinagar
e) Trival Area Allowance 0 Festival Advance 450 /-
f) Washing allowances 90/-
Total :- 35779/- 15680/-
3. GPF account number MD/GNR/WC/GPF/139 is maintain by the Mahi Division,
CWC, Gandhinagar.
4. Recoveries are to be made from the emoluments etc. of the govt. servents as
detailed overleaf.
5. He has been sanctioned leave proceding joining time for as per rules.
6. He finances the insurance policies datailed below:
Name of no. of policy amount of due date for the
insurance premium payment of
company premium
Nil Nil Nil Nil
Dated
Signature
Designation
Details of recoveries
Dated
Signature
Designation
DUTY CHART
SITE – -----------------------
MONTH --- -----------------
Days 08.00 To14.00 hrs 14.00 To 22.00 hrs 22.00 To 08.00hrs 08.00 To 16.00 hrs
st
1 Gen. Duty
Ten day
2nd
Ten day
3rd
Ten day
Ôã㹦ãããäև㊠‚ãÌã‡ãŠãÍã
1) ØãìÂÌããÀ :- ---------------------------------------
2) Íãì‰ãŠÌããÀ :-------------------------------------------
3) Íããä¶ãÌããÀ :--------------------------------------------
4) ÀãäÌãÌããÀ: -----------------------------------------------
5) -------------------------------------------------------
6) ------------------------------------------------------
¶ããñ› :-
1. ‡ãŠã¾ãà ãäªÌãÍã ½ãñ ãä¶ãÔÔããÀ¥ã Öñ¦ãì Ôã¼ããè ‡ãŠ½ãÃÞããÀãè „¹ããäÔ©ã¦ã
ÖãñØãòý
2. Ô©ãÊã ¹Çã¼ããÀãè ‡ãñŠ ‚ã¶ãì½ããä¦ã ãäºã¶ãã ‡ãŠãñƒÃ ¼ããè ‡ãŠ½ãÃÞããÀãè
‡ãŠ¦ãÃ̾ã Ôãñ ‚ã¶ãì¹ããäÔ©ã¦ã ¶ãã ÀÖòý
3. ã䪶㠇ãñŠ Ôã½ã¾ã •ãÊã Ô¦ãÀ ½ãñ 1.00 ½ããè. Ôãñ •¾ããªã Þãü¤ãÌã ¾ãã „¦ããÀ
Öãñ¶ãñ ¹ãÀ ‚ããä¦ããäÀ§ãŠ ¹Çãñàã¥ã ( Additional Observation )ÊãñÌãò ý
4. Øãñ•ã †Ìãâ ãä¶ãÔÔããÀ¥ã ‚ãããäª Ôã¼ããè ãäÀ‡ãŠã¡Ã Ôã½ã¾ã ¹ãÀ ¹ãî¥ãà ÀŒãòý
5. Øãñ•ã ºãì‡ãŠ ¹Çããä¦ã Ü㥛ã Ôã½ã¾ã ¹ãÀ ¼ãÀòý
6. Ôã㹦ãããäև㊠‚ãÌã‡ãŠãÍ㠇㊽ãÃÞããÀãè ‡ãŠãè ¡¿ãì›ãè, •ã¶ãÀÊã ¡¿ãì›ãè
‡ãŠ½ãÃÞããÀãè, ‡ãŠÀñØãããý
ÖÔ¦ããàãÀ
Ô©ãÊã ¹Çã¼ãÀãè
Designation
DUTY CHART
SITE – NWRSD, Himmatngar
MONTH – JUN 2015
Days 06.00 To14.00 hrs 14.00 To 22.00 hrs 22.00 To 06.00hrs 08.00 To 16.00 hrs
1st
Gen. Duty
Ten day Sh Manjeet Kumar Sh. V. M. Vankar Sh. A. P. Vankar
Outsource 1
(1 to 10)
2nd
Ten day Sh. V. M. Vankar Sh Manjeet Kumar Sh. A. P. Vankar Outsource 1
(11 to
20)
3rd
Ten day Sh Manjeet Kumar Sh. A. P. Vankar Sh. V. M. Vankar Outsource 1
(21 to 30)
Ôã㹦ãããäև㊠‚ãÌã‡ãŠãÍã
1) बध
स वमार:- Sh. V. M. Vankar
3) Íãì‰ãŠÌããÀ:- Outsource 1
5) -------------------------------------------------------
6) ------------------------------------------------------
¶ããñ› :-
7. ‡ãŠã¾ãà ãäªÌãÍã ½ãñ ãä¶ãÔÔããÀ¥ã Öñ¦ãì Ôã¼ããè ‡ãŠ½ãÃÞããÀãè „¹ããäÔ©ã¦ã
ÖãñØãòý
8. Ô©ãÊã ¹Çã¼ããÀãè ‡ãñŠ ‚ã¶ãì½ããä¦ã ãäºã¶ãã ‡ãŠãñƒÃ ¼ããè ‡ãŠ½ãÃÞããÀãè
‡ãŠ¦ãÃ̾ã Ôãñ ‚ã¶ãì¹ããäÔ©ã¦ã ¶ãã ÀÖòý
9. ã䪶㠇ãñŠ Ôã½ã¾ã •ãÊã Ô¦ãÀ ½ãñ 1.00 ½ããè. Ôãñ •¾ããªã Þãü¤ãÌã ¾ãã „¦ããÀ
Öãñ¶ãñ ¹ãÀ ‚ããä¦ããäÀ§ãŠ ¹Çãñàã¥ã ( Additional Observation )ÊãñÌãò ý
10. Øãñ•ã †Ìãâ ãä¶ãÔÔããÀ¥ã ‚ãããäª Ôã¼ããè ãäÀ‡ãŠã¡Ã Ôã½ã¾ã ¹ãÀ ¹ãî¥ãà ÀŒãòý
11. Øãñ•ã ºãì‡ãŠ ¹Çããä¦ã Ü㥛ã Ôã½ã¾ã ¹ãÀ ¼ãÀòý
12. Ôã㹦ãããäև㊠‚ãÌã‡ãŠãÍ㠇㊽ãÃÞããÀãè ‡ãŠãè ¡¿ãì›ãè, •ã¶ãÀÊã ¡¿ãì›ãè
‡ãŠ½ãÃÞããÀãè, ‡ãŠÀñØãããý
ÖÔ¦ããàãÀ
CERTIFICATE FOR T.A ON TOUR
Certified that;
1. I have performed the journey in the interest of Government work/ public service.
2. I have travelled by Railway mail/Exress in a class of accomodation not lower than for which
fares are claimed in the Bill and to which I am entitled.
3. No return tickets were available for this journey / return tickets (Railway) were available
but were not purchased because of return journey was not expected to be performed within
the period for which such tickets were available.
4. I was not provided for free railway pass .
5. The journeys were performed by the shortest routes.
6. I did not claim at the higher rates by taking a single seat in any public conveyance
(excluding Steamer) which plies regularly to hire between fixed points and journeys were
not performed in any vehicle with payment of hire charges incurring it in running expenses.
7. I have travelled in Air India's Economy Class as I am entitled for performing the tour by air.
8. I avail myself / did not avail of credit facilities for booking air passes with the airlines
Corporation of India / Air India International by requisitionthrough an exchange order.
9. I was actually and not merely constructively i the camp during Sundays and Holidays during
the Period for which daily allowance has been claimed.
10.I was not on Casual leave/ Restricted Holiday or Earned leave or half pay leave during the
tour.
11.The halts for which full or Half daly allowance has been claimed were neccessitated by the
performance of duty at the place of halts.
12.The distance by road for which road mileage allowance has been claimed is correct to the
best of my knowledge.
13.I did not avail any Govt Transport during the journey except where mentioned.
14.The journeys were performed by the departmental vehicle and are talying with the Log-
book.
15.I have been / have not been provided with free lodging and/or boarding at the expenses of
State Government / Central Government Autonomous body or a local authority in which
Govt founds have been invested or in which Govt have any other interest .
16.I stayed from __________________ to _______________________ at
_______________________________________________________________________________
_______________________ which provide boarding / lodging at scheduled tariffs.
17.There was no reduction in actual expenditure during the period in excess of thirty days
claimed in this bill .
18.I have taken an advance of Rs _________________( Rs
____________________________only) in respect of this journey.
19.The claim (s) have not been performed / preferred previously.
Certified that :-
Signature ……………………..
Designation………………………
Date …………………………….
CERTIFICATE
Certified that :-
Signature ……………………..
Designation………………………
Date …………………………….
C.O.P. Cash Voucher No:- ……………………… Dated:- -----/-----/2015
Name of work: - ……………………………………………………………………….……
Head of A/C:- 2711-(01-00-27)-FC&D, MW (N-P)
Authority No: - ……………………………………………………………….…………….
Name of Agency: - ………………………………………………………………………….
Situation: - …………………………………………………………………………………..
Date of Purchase/Work Done:-……………………………………………………………..
Details of Payments:-……………………………………………………………………….
Certified that:-
1. The work has been done satisfactory.
2. The materials were received in full and good condition.
3. The materials Purchased / work done are at the reasonable rates prevailing in the market.
4. The payment made in the interest of Government work.
5. This bill has been verified and found correct.
6. Taken in to MAS/Telephone/Misc. work/Electricity/Contingency register on page no.…….
7. Taken into Misc. work register on page no.
8. Entered in M. B. No…………. Page No…………………..
Certified that:-
1. The calls have been utilized in the interest of govt. bonafied works.
2. Taken into Misc. work register on page no.
3. Entered in M. B. No…………. Page No…………………..
Certified that:-
1 All the calls have been utilized in the interest of govt. bonafied works.
2 Taken into Misc. work register on page no.
3 Entered in M. B. No…………. Page No…………………..
5. Particulars
Details Rent per Month Amount in Remarks.
Rs.
For providing the Land Rent for
Telemetry station at chitrasani
( Balaram) For the Month/ Period
of
-------------------------------------------
--------------/---------------------------
-----------------------
Signature of Landlord
Pre Receipt
Received Rs . --------------------------
( Rupees ----------------------------------------------------------------------------------------------)
Signature of Landlord