FORM NO. 3

(See Chapter IV, paragraph 92)

STATEMENT OF RENT RECOVERABLE IN CASH OR BY DEDUCTION FROM PAY BILLS

Name of Division __________________

Name of Canal, etc._____

Major Head to be credited_____

Register no. of building

Name of building

Name, rank and office of occupant with rates of his pay and allowances, as known to the Divisional Officer

Amount due to end of 19

TO BE FILLED IN BY THE TREASURY OFFICER

Amount recovered during 19

Remarks with date and other particulars of changes in the rate of emoluments shown in column 3.

1

2

3

4

5

6

Rs.

p.

Rs.

p.

Date_____ Divisional Officer.

Completed and returned to the officer-in-charge_____division.

Certified that the pay and allowances of the tenants named therein remained unchanged during the month except as indicated in column 6.

Dated_____ Treasury Officer.