FORM NO. 1

(See Chapter III, paragraph 26)

Receipts for payment to Government

Book no_______________Receipt no. _______________Place________________

Date_______________, 19 _______________

Department and office_________________________________________________

Received from ____________________________________________________ the sum of rupees ____________________________________________________ on account of _______________________________________________________

Signature of Government servant granting the receipt.

Rs._____ Designation________

Cashier or Accountant.