FORM NO. 19

(See Chapter IX, paragraph 194)

Voucher for Refunds

District of Head of service chargeable

Refunds of Revenue

Deduct–Refunds (name of revenue head)

In whose name credited

On what account received

Amount realized

Date of payment into Treasury

Amount in which included and head to which credited

Treasury Officer’s signature in token of verification of Teasuary credit

Name of payee

Amount to be refunded

1

2

3

4

5

6

7

8

Rs

p.

Rs

p.

Rs

p.

(1) Certified that this order of refund has been registered and noted against the original receipt entry in the departmental account under my initials and previous order for refund of the same sum has not been issued.

(2) Passed for payment under sanction given in

(3) Sanctioned and passed for payment.

NOTE—(2) or (3) to be struck out as required.

Received payment.

Claimant’s signature.

Magistrate or other officer

Dated_______________________, 19

Pay rupees____________________ only

Examined Accountant Officer-in-charge of Treasury

In cases where refunds of fines are permitted to be made direct from Treasuries or Sub-Treasuries other than those at which they were credited, the entry in column 5 should include the name of the Treasury of or Sub-Treasury in which amount was credited and column 6 should be filled up by the Treasury Officer of the headquarters (not Sub-Treasury).

FOR USE IN THE ACCOUNTANT GENERAL’S OFFICE

Refund noted in fine statement.

Admitted, for

... Rs.

Objected, to

... Rs.

Auditor,

Superintendent,