FORM 6-D

(This form should be in pink colour)

(See Chapter XI, Paragraph 251)

Bill for General Provident Fund Advance/Withdrawal of non-gazetted Government servant.

Head of Account	"805-State Provident Funds—A—Civil—General/Contributory Provident/Fund."	Voucher no._____ first of_____ second list of Payment
		dated_____

Serial number	Name and designation of the subscribes	Account number	Temporary advance	*Amount of			Remark*
Serial number	Name and designation of the subscribes	Account number	Temporary advance	Nonrefundable advance	Advance for payment of premium	Final payment	Remark*
1	2	3	4	5	6	7	8

*The purpose of the advance should be indicated in the remarks column.

Total amount_____

In words (Rupees_____).

___________________________________________________________________

Sanctioned by____in_____dated_____duly authenticated (copy enclosed).

Signature of the Drawing Officer_____

Designation______________________

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 credit on this date. Policy no. ...............has been accepted by the Accountant General. U.P., vide his letter no. ........dated.........

(iv) The amount withdrawn previously on the same account has been utilised by subscriber for the purpose for which it was intended and that the relevant premium receipt has been duly enfaced by me.

Dated Signature of the Drawing 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_____19 .

Treasury Officer.

PAYEES’ DISCHARGE TO THE BANK

Received payment

Name_____

Office_____

FOR USE IN ACCOUNTANT GENERAL’S OFFICE

Admitted for Rs.

Objected to Rs.

Auditor

Superintendent

*To be stated in words and figures.