ANNEX URE

[Para. 7 of GO Ms. No. 22 Dated 22-01- 2013 of Finance (Pension.I) Department] Statement showing the details of DA arrears adjusted to the CSS Account in respect of Sri / Smt. / Kum. __________________________________________________, Designation: _____________________, Emp. Id. No. __________________, O/o the __________________________________________. Designation of the Drawing and Disbursing Officer: ________________________ S. No.

Month & Year

Amount adjusted to CSS Account

Transaction Id. No. with Date

Amount transferred to CPS

Amount paid in cash

Certified that the above details are verified and found to be correct as per the records of this office.

Signature of Drawing and Disbursing Officer.

Date: Office Seal: // Countersigned //

Verified and found correct (Treasury Officer)

Para. 7 of GO Ms. No. 22 Dated 22-01- 2013 of ... -

Certified that the above details are verified and found to be correct as per the records of this office. Date: Office Seal: ... (Treasury Officer). Signature of Drawing.
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