GIS Final Payment Software

(for the period 1-1-2016 to 31-03-2024)

Employee Particulars
Name of the Employee Sri K. Sankar Rao
Designation Senior Assistant
Treasury ID (7 Digits)
Employee ID
03XXXXX
Place of working Kakinada Division, Kakinada
Reason for discontinuation Death
Name of the Nominee Smt. XXXXXXXXXXXXXX
Relation with deseased Employee Wife
Date of Death 31/03/2024
Subscription Recovered and remitted
FROM TO

11/1/1984 10/31/1994
11/1/1994 10/31/1998
11/1/1998 3/31/2024

Treasury Details
STO/PAO Office DTO, Rajahmundry
District East Godavari
Treasury Bank Code & Place 01425 SBI, Innispeta Branch, Rajahmu
DDO Details
DDO Code 03120402003
Department name Forest
Name of the DDO Sri [Link] Prasad, IFS.,
Designation of DDO Divisional Forest Officer
Office Name Kakinada Division
Office Address Kakinada
Procdg. No. & Date 235/2019-A2

Disclaimer: [Link] care has been taken to keep the information upto date and correct and is for educational purpose onl
 Software
31-03-2024)
s
nkar Rao
or Assistant Proceedings
CFMS ID (8 Digits) Calculation Sheet
14XXXXX3
nada Division, Kakinada Annexure-C
h Please select option
XXXXXXXXXXX
Please select option
31/03/2024
Form-40-(Page-1)
remitted
Amount Form-40 -(Page-2)
(in Rs.)
20 Proceedings-
Insurance
30
Disclaimer:[Link] care has been taken to keep the information upto date and correc
60

TO, Rajahmundry
East Godavari
Innispeta Branch, Rajahmundry

03120402003
Forest
[Link] Prasad, IFS.,
sional Forest Officer
akinada Division
Kakinada
3/31/2024

rrect and is for educational purpose only. [Link] are encouraged to verify with experts before submitted the bill based on this calculato
 Government of Andhra Pradesh
Forest Department
Rc No : 235/2019-A2 Office of the Divisional Forest Officer,
Dated: 31-03-2024 Kakinada Division, Kakinada
PROCEEDINGS OF THE DIVISIONAL FOREST OFFICER, KAKINADA DIVISION, KAKINADA
Present : Sri [Link] Prasad, IFS.,
Sub : Forest Department – Final Payment of Group Insurance Scheme – Payment of Accumulated
savings together with interest to Smt. XXXXXXXXXXXXXX, Wife of Sri K. Sankar Rao, Senior
Assistant, Kakinada Division, Kakinada who expired on 31-03-2024 – Orders issued – Reg.

Ref : 1) [Link].293, Finance (Plg) Department dated: 08.10.1984

2) [Link].367 Fin & Plg. (FW [Link]) Dept., Dt.15-11-1994 and read with
[Link].382 Fin & Plg. (FW [Link]) Dept., Dt.05-12-1994
3) [Link].41 Finance ([Link]) Department. Dated 13.05.2020
4) Application of the Individual.
****
In pursuance of the orders issued by the Govrnment in the references 1st to 3rd cited above, the share of
Savings Fund contributed by the employees to [Link] Govt. Employees Group Insurance Scheme should be
refunded together with interest at prescribed rates on retirement and lumpsum amount along with the accumulated
savings and interest in the case of death while in service.

Contribution to [Link] Govt. Employees Group Insurance Scheme made by Sri K. Sankar Rao, Senior
Assistant, of Kakinada Division, Kakinada from 1-11-1984 to 31-3-2024 from time to time as follows.

Rate of
No of Contribution Calculation of total benefits
From To contribution Total
units per month under GIS saving
per one unit
2 unit(s) from 11/1984 up to Mar,
01-11-1984 31-10-1994 10 2 20.00 2024 = 2 X 34537.85 69075.70

01-11-1994 31-10-1998 15 2 30.00 No extra units 0.00

4 unit(s) from 11/1998 up to Mar,

01-11-1998 31-03-2024 15 4 60 2024 = 2 X 10337.11 20674.22

30-12-1899 30-12-1899 10 0 0 No extra units 0

Total No of GIS Units and net GIS Benefit to the employee up to 31-03-2024 89749.92
Saving Fund Interest Total amount Payable
Rs.15468/- Rs.74282/- Rs.89750/-
Sanctioned [Link] Govt. Employees Group Insurance Scheme to Smt. XXXXXXXXXXXXXX, Wife
of Sri K. Sankar Rao, Senior Assistant, Kakinada Division, Kakinada who expired on 31-03-2024 together with
the Government share and interest at prescribed rates on his death as follows.

Total amount Payable = 89750.00

Calculation of ACS with interest sheet enclosed to this proceedings

The amount is payable to the party through cheque / DD and the expenditure is debitable from Head of
Account "8011-Insurance and Pension Funds, 107-Other Insurance and pension Funds, 02-GIS, 002-Principle,
003-Interest"

Copy to the individual, Divisional Forest Officer

Bill Kakinada Division
DTO, Rajahmundry Kakinada
 CALCULATION SHEET
Calculation of Saving Fund under Employees Group Insurance Scheme in respect of Sri K.
Sankar Rao, Senior Assistant who is died on 31-03-2024
Name of the Employee and Designation : : Sri K. Sankar Rao, Senior Assistant
Employee HRMS & CFMS ID : 03XXXXX 14XXXXX3
Date of Commencement of the Scheme : 11/1/1984
Last installment contributed : 3/31/2024
Reason for discontinuation of the Scheme : Death

Subsription Recovered and remitted :

Subscriptio No of Subscription No of Total Insurance Saving
From to remitted per Group
n per unit units
month
Months amount Fund (Rs.) Fund (Rs.)
01-11-1984 31-10-1994 10 2 20 C 120 2400 750 1650
01-11-1994 31-10-1998 15 2 30 C 48 1440 432 1008
01-11-1998 31-03-2024 15 4 60 B 305 18300 5490 12810
10 0 0 0 0 0 0 0

Total 22140 6672 15468

Calculation of Saving Fund with interest :

Table showing acumulated savings and Interest of benefits from Savings Fund per each
unit of Rs.20/- From November 1984 and Rs.30/- from November 1994

Employee died in Mar, 2024 service Calculation of total benefits under GIS No of Total
particulars saving Units
From 11/1984 to 10/1994 Rs.20/- per 2 unit(s) from 11/1984 up to Mar, 2024
month 2 unit(s) = 2 X 34537.85 2 69075.70

From 11/1994 to 10/1998 Rs.30/- per

month 2 unit(s)
No extra units 0 0.00

From 11/1998 to 03/2024 Rs.60/- per 4 unit(s) from 11/1998 up to Mar, 2024
month 4 unit(s) = 2 X 10337.11 2 20674.22

From 01/1900 to 01/1900 Rs.0/- per

month 0 unit(s)
No extra units (4) 0.00

0 0.00 0 0.00
Total No of GIS Units and net GIS Benefit to the employee up to 31-03-2024 4 89749.92
ABSRACT
Saving Fund Interest Total
15468.00 74282.00 89750.00
Total Amount Payable : 89750.00
(RUPEES: EIGHTY NINE THOUSAND SEVEN HUNDRED FIFTY ONLY}
DDO Signature
 ANNEXURE - C
FORM OF BILL FOR GROUP INSURANCE AT THE TIME OF RETIREMENT/
RESIGNATION / DEATH

Received a sum of Rs. Rs.89750/-

Interst on saving fund Rs.74282/-

Savings fund Rs. Rs.15468/-

Rupees: (Eighty Nine thousand Seven hundred Fifty only)

For payment to the subscriber / or the nominees of the subscriber as per particulars given below.

1. Name of the employee / member Sri K. Sankar Rao

Designation of the Post held immediately before

2. Senior Assistant
retirement /death

3. Group to which the employee / member belonged. Group - B

Name of the beneficiaries in the event of death of the

4.
employee / member
1. Smt. XXXXXXXXXXXXXX, Wife

2.

3.
5 Relevant biodata of employee / member
Date of commencement of insurance cover / member
a) 1-11-1984 -------- Group - C
ship and the group to which he belonged initially.

b) Year of acquiring membership in higher group :

i) Group - C -------- 1994
ii) Group - B -------- 1998
iii)

c) Date of retirement / resignation / death : 3/31/2024

Certified that in respect of the amount claimed in this bill subscription to the Group
Insurance Scheme has been covered regularly at appropriate rates from the date of the
subscriber admission to the scheme to the month of cessation of duties

Signature of DDO
Date Designation : Divisional Forest Officer
Kakinada Division, Kakinada
 FORM NO.1
( As per [Link]. 293 dt: 8-10-1984 )
OFFICE OF THE : ZPHS KANDI MDL:KANDI SANGAREDDY TS

MEMORANDUM

Sri . RAMAN. a Group-A Employees has been enrolled as a member of

the Andhra Pradesh State Government Employees Group Insurance Scheme, with effect
from Nov-1986 his monthly subscription of Rs. 20/- (Rupees Twenty rupees only) (shall
be deducted from his salary/wages commencing from the month of Nov-1986 and he
will be eligible to the benefits of the scheme appropriate to group Cwith effect from
Nov-1986

HEAD OF OFFICE
 FORM NO.2
( As per [Link]. 293 dt: 8-10-1984 )
OFFICE OF THE : ZPHS KANDI MDL:KANDI SANGAREDDY TS

MEMORANDUM

Sri . RAMAN has been promoted on a regular basis from Group C to

Group C with effect from Nov-1994 .His/Her monthly subscription for the Andhra
Pradesh State Employees Group Insurance Scheme, shall be raised from Rs 20 to Rs.30
(Rupess Thirty rupees only) from the month of Nov-1994 and he will be eligible to the
benefits of the scheme appropriate to Group C with effect from Nov-1994

HEAD OF OFFICE
 NON- DRAWAL CERIFICATE
Certified that the amount claimed in this bill has not drawn and paid previously as
per the Office records.

signature of the DDO

CERTIFICATE

Certified that the Late Sri/Smt…………………………………………

was in service on the date of his death. He was holding the post of ………………
in the …………………………office / Department.

signature of the DDO

 ADVANCE STAMPED RECEIPT

Receieved an amount of Rs:89750/- (Rupees Eighty Nine thousand Seven hundred

Fifty only) from the Divisional Forest Officer, Kakinada Division, Kakinada towards GIS
refund Amount for the period from 01-11-1984 to 31-03-2024

Passed for Rs:89750/- ( RUPEES Eighty Nine Thousand Seven Hundred Fifty Only)

Applicant

Station:
Date:

Countersigned

DDO signature

FORM NO.1
( As per [Link]. 293 dt: 8-10-1984 )
Office of the Divisional Forest Officer, Kakinada Division, Kakinada

MEMORANDUM

Sri K. Sankar Rao is a Group-C Employees has been enrolled as a member of the
Andhra Pradesh State Government Employees Group Insurance Scheme with effect from
Nov-1984 his monthly subscription of Rs.20/- (Rupees Twenty only) shall be deducted
from his salary /wages commencing from the month of Nov-1984 and he will be eligible to
the benefits of the scheme appropriate to group with effect from Nov-1984

HEAD OF OFFICE
 FORM NO.2
( As per [Link]. 293 dt: 8-10-1984 )
Office of the Divisional Forest Officer, Kakinada Division, Kakinada

MEMORANDUM

Sri K. Sankar Rao has been promoted on a regular basis from Group - C to Group -
C with effect from Nov-1994. His monthly subscription for the Andhra Pradesh State
Employees Group Insurance Scheme, shall be raised from Rs.20/- to Rs.30/- (Rupees
Thirty only) from the month of Nov-1994 and he will be eligible to the benefits of the
scheme appropriate to Group - C with effect from Nov-1994.

HEAD OF OFFICE

NON- DRAWAL CERIFICATE

Certified that the amount claimed in this bill has not drawn and paid previously as per
the Office records.

signature of the DDO

###
CERTIFICATE

Certified that the Late Sri K. Sankar Rao was in service on the date of his death. He
was holding the post of Senior Assistant in the office of Divisional Forest Officer,
Kakinada Division, Kakinada.

signature of the DDO

 Payble at DTO, Rajahmundry
APTC FORM - 40
BILL FOR WITHDRAWAL FROM GPF /GIS/FBF / EWF / LOANS AND ADVANCES

For the Month & Year 0 3 2 0 2 4 Bill For GIS Final Payment

( For Treasury Use Only)

Date : ……………………
District : East Godavari

Trans ID :
Office Bill No / D. D. O’s T.B.R No

Head of Account
Under Rupees Eighty Nine thousand Seven hundred Fifty One only

Insurance and
Treasury / P.A.O. Code 0 3 1 2 Majot Head 8 0 1 1
Pension Fund

D.D.O. Code 03120402003 Sub Major Head 0 0

State Govt.
[Link] Divisional Forest Officer Minor Head 1 0 7
employees GIS

DDO Office Name : Group Sub-Head 0 0

Kakinada Division, Kakinada

Bank Code 01425 Sub Head 0 1 Group Insurance

SBI, Innispeta Branch,

Detailed Head 0 0 0
Bank Branch Name : Rajahmundry

Sub-Detailed Head 0 0 2 Savings & Interest

Contigency Fund MH
Non-plan = N/ Plan = P N Charged = C/ Voted = V V Service Major 2 4 0 6
Head

Pay Bill Amount Rs.89750/- (In words Eighty Nine thousand Seven hundred Fifty only)

Rupees only ) By Cash / Adjustment / Cheque /

Account Credit/ Draft.

Drawing Officer

FOR USE IN TREASURY / PAY & ACCOUNTS OFFICER ONLY

Pay Rs. ______________ ( Rupees _________________________________________________________________

________________________________________________________________________________________________________
____________________________ Only) by Cash / Cheque / Draft / Account Credit / Adjustment.

Treasury Officer / Pay & Accounts Officer

Sl. Name & Designation Pay Account No & Date of sanction Nature & Amount of Remarks
No / Subscriber / Employee or in Rs. No of the proceedings Withdrawal
nominee
Final /Part final Advance
payment in Rs
in Rs

(1) (2) (3) (4) (5) (6) (7) (8)

1 Smt. XXXXXXXXXXXXXX Proceedings RC 89750.00
W/o Sri K. Sankar Rao, No.235/2019-A2
Senior Assistant (Expired) dated.31-03-2024 of
the Divisional Forest
Officer, Kakinada
Division, Kakinada

C e r ti fi c a t e s :
[Link] that the amount claimed in this bill has not drawn and paid previously.
[Link] entries are recorded in the SR of the individual.
3. Certified that the employee has not availed any EOL during the period of the claim.
4. Certified that the individual has not misappropriated any Govt. money during his servie.
[Link] that the employee comes under the category of Superior /Inferior service.

Certificates :
6. Certified that the employee has completed two years of serivce when he admitted to the GIS.
E n c lo s e r s :
1) Proceedings
2) Calculation Sheet
3) Annexure -C

[Link] that the amount claimed in this bill has not drawn and paid previously.
[Link] entries are recorded in the SR of the individual.
3. Certified that the employee has not availed any EOL during the period of the claim.
4. Certified that the individual has not misappropriated any Govt. money during his servie.
[Link] that the employee comes under the category of Superior /Inferior service.
6. Certified that the employee has completed two years of serivce when he admitted to the GIS.
Enclosers :
1) Proceedings
2) Calculation Sheet
3) Annexure -C

Total 89750.00
(Rupees Eighty Nine thousand Seven hundred Fifty only)

Drawing Officer

Designation of the Sanction Authority Divisional Forest Officer, Kakinada Division, Kakinada

Note: Original sanction order should be enclosed

Budget Details
1. Allotment of Budget for the year ___________________ Rs________________
2. Incurred expenditure inclusive of this Bill _____________ Rs ________________
3. Balance Rs. _______________

Drawing Officer

FOR USE IN ACCOUNTANT GENARL OFFICER

 Govt. of Andhra Pradesh APTC FORM - 101
PAPER TOKEN (See subsidiary Rule 2 (W) Under Treasury Rule 15:
Govt. Memo No. : 38907 / Accounts / 65-5, Dtg: 21-02-1963)
(For Treasury Use Only)
STO Code : 0 3 1 2

STO NAME : DTO, Rajahmundry Date : DDO Code : 03120402003 Treasury / PAO Code : 0312

Treasury / PAO DTO, Rajahmundry

DDO CODE 03120402003 Trans ID : DDO design : Divisional Forest Officer, Kakinada Divi
Name :

DDO Designation Divisional Forest Officer DDO Office Name Kakinada Division, Kakinada To,

Bank Branch Code 01425

Name : SBI, Innispeta Branch, Rajahmundry The Treasury Officer / Manager,

Head of Account : 8 0 1 1 0 0 1 0 7 0 0 State Bank of

(Major Head) (Sub-MH) (Minor Head) (Grp-SH)

0 1 0 0 0 0 0 2 Please Pay Bill No dated for Rs. 89750.00

(Sub Head) (Det. Head) (Sub Det. Head) (Net Rupees Eighty Nine thousand Seven hundred Fifty only)
Non-Plan=N Charged = C Contingency Fund MH/
N V 2 4 0 6
Plan = P : Voted = V : Service Major Head to Sri/Smt. for the office of the
Guntur Circle, Guntur whose specimen signature is attested
Gross Rs. 89750.00 Deductions Rs. 0.00 Net Rs. 89750.00 herewith.

(Net Rupees Eighty Nine thousand Seven hundred Fifty only)

Signature of the Govt. Servant Received the payment
Messenger Name: Designation : Dated: Dated:
(As ub APTC Form - 101)

Attested
Specimen Signature of 1)

Messenger 2)
Signature of the DDO Signature of the Govt. Servant
receiving the payment
DDO Signature Attested STO Signature

DDO DDO Signature Treasury

Seal Seal
 Government of Andhra Pradesh
Forest Department
Rc No : 235/2019-A2 Office of the Divisional Forest Officer,
Dated: 31-03-2024 Kakinada Division, Kakinada
PROCEEDINGS OF THE DIVISIONAL FOREST OFFICER, KAKINADA DIVISION, KAKINADA
Present : Sri [Link] Prasad, IFS.,
Sub : Forest Department – Final Payment of Group Insurance Scheme – Payment of Accumulated
savings together with interest to Smt. XXXXXXXXXXXXXX, Wife of Sri K. Sankar Rao, Senior
Assistant, Kakinada Division, Kakinada who is died on 31-03-2024 – Orders issued – Reg.

Ref : 1) [Link].293, Finance (Plg) Department dated: 08.10.1984

2)
[Link].367
[Link].382
& Plg. (FW Fin & Plg. (FW [Link]) Dept., Dt.05-12-1994"
[Link]) Dept.,of the Individual.
4) Application
****
In pursuance of the orders issued by the Govrnment in the references 1st and 2nd cited above, the share of
Savings Fund contributed by the employees to [Link] Govt. Employees Group Insurance Scheme should be
refunded together with interest at prescribed rates on retirement and lumpsum amount along with the accumulated
savings and interest in the case of death while in service.

Sanctioned [Link] Govt. Employees Group Insurance Scheme to Smt. XXXXXXXXXXXXXX, Wife
of Sri K. Sankar Rao, Senior Assistant, Kakinada Division, Kakinada who is expired on 31-03-2024 towards
Insurance under A.P. State Government Employees Group Insurance Scheme on his death as follows.

Insurance amount Payable = Rs.60000/-

(Rupees Sixty thousand only)

The amount is payable to the party through cheque / DD and the expenditure is debitable from Head of
Account "8011-Insurance and Pension Funds, 107-Other Insurance and pension Funds, 02-GIS, 001-Insurance"

Copy to the individual, Divisional Forest Officer

Bill Kakinada Division
DTO, Rajahmundry Kakinada
 Payble at DTO, Rajahmundry
APTC FORM - 40
BILL FOR WITHDRAWAL FROM GPF /GIS/FBF / EWF / LOANS AND ADVANCES

For the Month & Year 0 3 2 0 2 4 Bill For GIS Final Payment

( For Treasury Use Only)

Date : ……………………
District : Guntur

Trans ID :
Office Bill No / D. D. O’s T.B.R No

Head of Account
Insurance and
0 3 1 2 Majot Head 8 0 1 1
Under Rupees Sixty thousand One only

Treasury / P.A.O. Code

Pension Fund

D.D.O. Code 03120402003 Sub Major Head 0 0

State Govt.
[Link] Divisional Forest Officer Minor Head 1 0 7
Employees GIS

DDO Office Name : Kakinada Division, Kakinada Group Sub-Head 0 0

Bank Code 01425 Sub Head 0 1 Group Insurance

SBI, Innispeta Branch,

Detailed Head 0 0 0
Bank Branch Name : Rajahmundry

Sub-Detailed Head 0 0 1 Insurance

Contigency Fund MH
Non-plan = N/ Plan = P N Charged = C/ Voted = V V Service Major 2 4 0 6
Head

Pay Bill Amount Rs. 60000.00 (In words Sixty thousand Rupees only)

Rupees only ) By Cash / Adjustment / Cheque /

Account Credit/ Draft.

Drawing Officer

FOR USE IN TREASURY / PAY & ACCOUNTS OFFICER ONLY

Pay Rs. ______________ ( Rupees __________________________________________________________________

________________________________________________________________________________________________________
____________________________ Only) by Cash / Cheque / Draft / Account Credit / Adjustment.

Treasury Officer / Pay & Accounts Officer

Sl. Name & Designation Pay Account No & Date of Nature & Amount of Remarks
No / Subscriber / Employee in Rs. No sanction of the Withdrawal
or nominee proceedings
Final /Part Advance in
final payment Rs
in Rs

(1) (2) (3) (4) (5) (6) (7) (8)

1 Smt. XXXXXXXXXXXXXX Proceedings RC 60000.00
W/o Sri K. Sankar Rao, No.235/2019-A2
Senior Assistant (Expired) dated.31-03-2024
of the Divisional
Forest Officer,
Kakinada Division,
Kakinada

C e r ti fi c a t e s :
[Link] that the amount claimed in this bill has not drawn and paid previously.
[Link] entries are recorded in the SR of the individual.
3. Certified that the employee has not availed any EOL during the period of the claim.
4. Certified that the individual has not misappropriated any Govt. money during his servie.
[Link] that the employee comes under the category of Superior /Inferior service.

Certificates :
6. Certified that the employee has completed two years of serivce when he admitted to the FBF.
E n c lo s e r s :
1) Proceedings
2) Calculation Sheet
3) Annexure -C

[Link] that the amount claimed in this bill has not drawn and paid previously.
[Link] entries are recorded in the SR of the individual.
3. Certified that the employee has not availed any EOL during the period of the claim.
4. Certified that the individual has not misappropriated any Govt. money during his servie.
[Link] that the employee comes under the category of Superior /Inferior service.
6. Certified that the employee has completed two years of serivce when he admitted to the FBF.
Enclosers :
1) Proceedings
2) Calculation Sheet
3) Annexure -C

Total 60000.00

Drawing Officer

Designation of the Sanction Authority Divisional Forest Officer, Kakinada Division, Kakinada

Note: Original sanction order should be enclosed

Budget Details
1. Allotment of Budget for the year ___________________ Rs________________
2. Incurred expenditure inclusive of this Bill _____________ Rs ________________
3. Balance Rs. _______________

Drawing Officer
FOR USE IN ACCOUNTANT GENARL OFFICER
 Govt. of Andhra Pradesh APTC FORM - 101
PAPER TOKEN (See subsidiary Rule 2 (W) Under Treasury Rule 15:
Govt. Memo No. : 38907 / Accounts / 65-5, Dtg: 21-02-1963)
(For Treasury Use Only)
STO Code : 0 3 1 2

STO NAME : DTO, Rajahmundry Date : DDO Code : 03120402003 Treasury / PAO Code : 0312

Treasury / PAO DTO, Rajahmundry

DDO CODE 03120402003 Trans ID : DDO design : Divisional Forest Officer, Kakinada Divi
Name :

DDO Designation Divisional Forest Officer DDO Office Name Kakinada Division, Kakinada To,

Bank Branch Code 01425

Name : SBI, Innispeta Branch, Rajahmundry The Treasury Officer / Manager,

Head of Account : 8 0 1 1 0 0 1 0 7 0 0 State Bank of

(Major Head) (Sub-MH) (Minor Head) (Grp-SH)

0 1 0 0 0 0 0 1 Please Pay Bill No dated for Rs. 60000.00

(Sub Head) (Det. Head) (Sub Det. Head) (Net Rupees Sixty thousand only)
Non-Plan=N Charged = C Contingency Fund MH/
N V 2 4 0 6
Plan = P : Voted = V : Service Major Head to Sri/Smt. for the office of the
Kakinada Division, Kakinada whose specimen signature is attested
Gross Rs. 60000.00 Deductions Rs. 0.00 Net Rs. 60000.00 herewith.

(Net Rupees Sixty thousand only)

Signature of the Govt. Servant Received the payment
Messenger Name: Designation : Dated: Dated:
(As ub APTC Form - 101)

Attested
Specimen Signature of 1)

Messenger 2)
Signature of the DDO Signature of the Govt. Servant
receiving the payment
DDO Signature Attested STO Signature

DDO DDO Signature Treasury

Seal Seal