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(Rupees in words)

rR, se(c) 2014 Vide G O (P)No 14912014lFin dated, 26 04.2014 & G.O.(P)No.306/2014lFin dated ,23 07

NATURE OF CLAIM. Name of Treasury Name of DDO/SDO Designation of DDO/SDO

Name of Dept D D O Code /SDO Code

PEN of DDO/SDO

Name of office

PAN/GIR Bill

No :(DDO Code

+ Type of payment+serial no)

Expenditure Head of Account

Plan (P) / non Plan (N)

Voted (V) / Charged ( C)

Salary Head of Account

Plan (P) / non Plan (f',1) CPS/CSS

Voted (V) / Charged ( C)

Period of claim: (From)

Amount Number and Date of Sanction order

Brief discription of transaction

Sl.No

Rs

Total accou nt/other accou nts/cash)

Payees particulars : ... with the codal provisions, rules Please pay the amount as detailed above' This bill is prepared strictly in accordance and requaltions. The amount claimed in-this bill has not been drawn Previouslv. nature of SDO/DDO Appropriation for current year : ... " ' Expenditure till date : .... Expenditure including in this bill : . ''

Signature of DDO/Cpnlcllng-el!9g

FOR TREASURY Pay Rs

(Rupees

Rs

Rs....

only) in CASH/cheque

only) by RBR and . only) by Transfer Credit to

Treasury/Bank account Pay Order Cheque No /UTR No. Accountant Received Pay Order Cheque

Space for audit enfacement

Pay Order Cheque issusg_by