FORM 6-C

(This form should be in pink colour)

(See CHAPTER XI, PARAGRAPH 251)

Bill for General Provident Fund Advance/Withdrawals of gazetted Government servant.

NOTE—Government accepts no responsibility for any fraud or misappropriation in respect of money, cheques or drafts made over to a messenger–––––

Name of gazetted servant–––––

Designation–––––

District–––––

G.P.F. Account no.–––––

	"805.State Provident Funds	Voucher No.––
Head of Account	A—Civil-Generall/Contributory	first
	Provident Fund."	of–––list of payment
		second
		Date–––––
			Amount	Purpose
Received–––––
1. Temporary advance sanctioned by–––––vide no.–––––
dated–––––duly authenticated copy of which is enclosed.
2. Non-refundable advance sanctioned by–––––vide no.–––––
dated–––––(copy enclosed)
3. Advance for the payment of premium sanctioned by–––––
vide no.–––––dated–––––(copy enclosed).
4. Final payment sanction by–––––vide no.–––––dated

(copy enclosed)

Total Amount

—Amount to be written in words) Rupees–––––

__________________________________________________________________

Please pay to–––––

Dated

Signature

Signature.

Certified that :-

(i) The amount of advance/withdrawal sanctioned does not exceed the limit prescribed in the relevant rules/orders.

(ii) In the case of ordinary advance twelve months have elapsed since the full repayment of the previous temporary advance.

(iii) The amount drawn does not exceed the amount at my credit on this date, Policy no._____has been accepted by the Accountant General, U. P., vide his letter no._____dated_____

Dated, Signature of the Officer_____

Designation____________________

(A) IN CASE OF PAYMENT AT THE TREASURY

*Pay Rs. ( )_____

Examined and entered.

Accountant

Dated_____19 .

Treasury Officer.

(B) IN CASE OF PAYMENT AT THE BANK

THE AGENT, STATE BANK OF INDIA_____

Please pay *Rs. ( )_____Treasury.

Dated_____ Treasury Officer.

_____

PAYEES’ DISCHARGE TO THE BANK

Received payment.

Name_____

Officer_____

FOR USE IN ACCOUNTANT GENERAL’S OFFICE

Admitted for Rs.

Objected to Rs.

Auditor

Superintendent.

*To be stated in words and figures.