COUNTERFOIL

Under Rupees—————

GOVERNMENT OF UTTAR PRADESH

BOOK NO. Place _____

PERSONAL LEDGER ACCOUNT

CHEQUE NO. Date _____

BOOK NO. Place _____

To THE TREASURY/SUB-TREASURY OFFICER_____

CHEQUE NO. Date _____

Pay to —————

TO THE TREASURY/SUB-TREASURY OFFICER_____

Rupees ————— by debit to the Personal Ledger Account of

Pay to———or order

Rs._____

Rs.—————

Rupees—————

Signature of Administrator.

by debit to the Personal Ledger Account of—————

Drawer’s Signature,

Designation.

N.B.—This cheque is current for three months only from the month of issue, thus a cheque issued on any date of January will be payable by 30th April.

This amendment made vide C. S. no. 98 dated 16-03-1992.