FORM No. 42

(See Chapter XV, paragraph 353)

Refund of Lapsed Deposits

To

THE ACCOUNTANT GENERAL/TREASURY OFFICER*

SIR,

THE following refunds of lapsed deposits aggregating Rupees_____ (in words) have been claimed by_____of whose identity and title to the money I have

satisfied myself. I request

your sanction to the refund.

that the amount may be refunded.*

Class of deposit

Particulars of original deposit

Balance credited to Government

Date of lapsed statement

Amount claimed

Remarks

Year

No.

Rs.

p.

Rs.

p.

(Signature)

The_____, 19 .

Judge Magistrate or other Officer.

* Delete which ever not applicable.

REVERSE OF FORM No. 42

Accountant General’s no.—————,dated—————

Sanctioned

Received payment.

Receipt Stamp.

Accountant General.

Claimant

Pay rupees ( )—————————only.

The————, 19 . Examined.

Accountant.

 

Treasury Officer.

NOTE—The signature of the claimant should be obtained on this form and the form should be returned as a voucher in support of the debit.

FOR USE IN THE ACCOUNTANT GENERAL’S OFFICE

Admitted for

/objected to

Auditor-Superintendent.

Noted in the

Number book of order

Superintendent.