FORM No. 42-C

(See Chapter XVIII, paragraph 385)

覧覧優epartment.

覧覧覧涌ffice.

Schedule of deductions on account of subscriptions to Postal Life Insurance for the month of覧覧

Number of policy

Number of subscriber

Period of pay bill

Amount recovered

Remarks

1

2

3

4

5

Signature覧覧

Designation覧覧