SAO/FUR

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Kindly arrange to pay me the sum of Rs._____________ lodged under UNPAID towards ___________________________________

Signature of the employee :

Name in BLOCK LETTERS :

Emp.No. :

T.No. :

Shop/Office :

Forwarded to SAO/CBS. The above amount is lodged under UNPAID vide list No. ____________________________________ dated _____________. The payment may be made in the presence of _________________________.

No. Date:

Shop/Office Supdt. ___________________________

(Authorisation by AO/CBS)

No.___________________

AO/X

Please pay the sum of Rs.____________ lodged under UNPAID list No._________________ dated _________________.

ACCOUNTS OFFICER/CBS

(To be filled in by the Expenditure Sec.)

CO 6 No._________________ CO 7 No._______________

Vr. No.______________________________.

PASSED FOR Rs.___________________

LESS: DEDUCTION Rs.___________________

NEXT AMOUNT PAYABLE Rs.___________________

Rupees ___________________________________

__________________________________________

Date:

for FA & CAO

Received payment of Rs._________________ ( Rupees ___________________________________________________ only )

Signature of the employee

Date :

SS/OS/SO

DNR No.____________________ Vr.Cleared on ___________

Cash drawn

Asst. Chief Cashier _________