FORM No

FORM No. 42

(See Chapter XV, paragraph 353)

Refund of Lapsed Deposits

THE ACCOUNTANT GENERAL/TREASURY OFFICER*

SIR,

THE following refunds of lapsed deposits aggregating Rupees_____ (in words) have been claimed by_____of whose identity and title to the money I have

satisfied myself. I request					your sanction to the refund.
					that the amount may be refunded.*
Class of deposit	Particulars of original deposit		Balance credited to Government		Date of lapsed statement	Amount claimed		Remarks
	Year	No.
			Rs.	p.		Rs.	p.

(Signature)

The_____, 19 .

Judge Magistrate or other Officer.

* Delete which ever not applicable.

REVERSE OF FORM No. 42

Accountant General’s no.—————,dated—————

Sanctioned

Received payment.

Receipt Stamp.

Accountant General.

Claimant

Pay rupees ( )—————————only.

The————, 19 . Examined.	Accountant.
	Treasury Officer.

NOTE—The signature of the claimant should be obtained on this form and the form should be returned as a voucher in support of the debit.

FOR USE IN THE ACCOUNTANT GENERAL’S OFFICE

Admitted for	/objected to	Auditor-Superintendent.
Noted in the	Number book of order	Superintendent.