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  • pg 1
									Name of Treasury
Name of Gazetted Officer
Name of Office

Department                             Department of Agriculture
G.E. Number                            S-……...Agri
SDO Code
Head of Account                         2401 119 95                  101
                                       MAJ SMJ MIN                  SUB SSUB
Plan/ Non Plan                         N
Received for the Period    From
GPF Account No                         Agri
Group Insurance Account No
GIS Group                              B
State Life Insurance Account No
State Life Insurance Account No
Salary as on 31st March
Dearness Allowance Percentage
Name of Person going to treasury       Sri/Smt
Date of Submission
Additional Certificates                1. Certified that I have not drawn the amount claimed in this bill, earlier. 2. Certifie
                                       that the statement of claims drawn during the previous month has been furnished
                                       the controlling officer

A. Amount due                 Rate         Amount        B. Deductions                              Rate
Pay/ Duty pay                                            GPF
Leave Salary                                             GPF (Loan Recovery)
Special pay                                              GPF (Arrear DA)
Personal pay                                             GPF (ADA)
Transit pay                                              Group Insurance
DA Arrears                                               State Life Insurance
                                                         State Life Insurance
                                                         SLI (Loan Recovery)
Dearness Allowances 8%             0          0          Recoveries ordered by AG
House Rent Allowance                                     SLI total
CCA                                                      HBA - 1
PTA                                            HBA - 2
PCA                                            SLI (Loan Recovery)
Special Allowances                             HBA Interest
Risk Allowance                                 MCA
Deduct Advance drawn                           MCA Interest
Gross Claim A                0          0      PLI
Total-B                                        Rent
Net Claim = A - B            0          0      Income Tax
                                               Total - B             0

Note: Please don’t make entries in the RED HIGHLIGHTED CELLS
n this bill, earlier. 2. Certified
month has been furnished to

Below Rs 1.00                             Rupees and One Only
                                                     TR 46
                                         [See Rule 164 (a) of KTC Vol. 1]
Name of Treasury        0
                                                                            For Treasury Use
Computer sequence No/ Token No                                                                                                                   Date
Scroll No

SDO Code                 0      0     0     0     0                                              Name       0

Designation          0                                                                           G.E.No     S-……...Agri
Name of Office
                     0                                                                           PAN/GIR          0     0     0        0     0     0     0    0   0     0
Head of Account          2401       119      95       101     0        Plan(P)/Non-Plan(N)              N       Voted(V)/Charged (C)
                         MAJ        SMJ     MIN       SUB SSUB

                                                                       CPS/CSS                                  Ratio
Received for the Period: (From)                             0-Jan-00                             (To)                       0-Jan-00

                A. Amount due                               Rate         Amount                             B. Deductions                              Rate       Amount
Pay/ Duty pay                                                  0.00              0.00     GPF                                                             0.00              0.00
Leave Salary                                                   0.00              0.00     GPF (Loan Recovery)                                             0.00              0.00
Special pay                                                    0.00              0.00     GPF (Arrear DA)                                                 0.00              0.00
Personal pay                                                   0.00              0.00     GPF subs                          Agri                          0.00              0.00
Transit pay                                                    0.00              0.00     Group Insurance                    0                            0.00              0.00
DA Arrears                                                     0.00              0.00     State Life Insurance                     0                      0.00              0.00
                                                                                          State Life Insurance                     0                      0.00              0.00
Dearness Allowances                                            0.00              0.00     Recoveries ordered by AG                                        0.00              0.00
House Rent Allowance                                           0.00              0.00                                                                     0.00              0.00
CCA                                                            0.00              0.00     HBA - 1                                                         0.00              0.00
PTA                                                            0.00              0.00     HBA - 2                                                         0.00              0.00
PCA                                                            0.00              0.00     HBA Additional                                                  0.00              0.00
Special Allowances                                             0.00              0.00     HBA Interest                                                    0.00              0.00
Risk Allowance                                                 0.00              0.00     MCA                                                             0.00              0.00
Deduct Advance drawn                                           0.00              0.00     MCA Interest                                                    0.00              0.00
                                                               0.00              0.00     FBS                                                             0.00              0.00
Gross Claim A                                                  0.00              0.00     PLI                                                             0.00              0.00
Total-B                                                        0.00              0.00     Rent                                                            0.00              0.00
Net Claim = A - B                                              0.00              0.00     Income Tax                                                      0.00              0.00
                                                                                          LIC-Policy No.772089327                                         0.00              0.00
Received Rs                                                                               LIC-                                                            0.00              0.00
(Rs                                                                               only)   LIC-                                                            0.00              0.00
in CASH/tc TO TSB                                                                         LIC-                                                            0.00              0.00
                                                                                          Total - B                                                       0.00              0.00

Station   0                               Signature
Date      0-Jan-00                        Designation

                                                                       FOR TREASURY USE ONLY

Pay Rs                                                (Rupees                                                                                                         only )
in Cash/ Cheque Rs                                                     (Rupees                                                                                        only)
by RBR and Rs                                                          (Rupees
                                                                                                                only) by TC
POC No                                                                     Date

Accountant                                                                                                                                 Treasury Officer

Received Pay Order Cheque                                                                                             Pay Order Cheque issued By

Signature of Recepient                                                                                                Accountant
25/299/2004.       1,50,000               GPM, Govt. of Kerala
Note: Govt. accept no responsibiity, for any fraud or misappropriation in respect of money or draft made over to messenger
CERTIFICATE FOR CLAIMING HRA: I certify that I did not occupy Govt. quarters during the period for which HRA is claimed in this bill.

Date      0-Jan-00                                                                              Signature

LIFE CERTIFICATE referred in No 7: Sri/ Smt                                                                                               is alive
on this                                        (date)

Station                                                                                         Signature
Date                                                                                            Designation

Space for Additional Certificates
 1. Certified that I have not drawn the amount claimed in this bill, earlier. 2. Certified that the statement of claims drawn during the previous month
                                                    has been furnished to the controlling officer

Allotment Details (For PTA, PCA claim)

Appropriation for current year                 Rs
Expenditure excluding the bill                 Rs
Expenditure including the bill                 Rs
Balance                                        Rs

DIRECTIONS FOR USE                                                                                                        Signature of Drawing Officer

  1 A salary bill may be endorsed to a banker or other recognized agent and submitted for collection through such banker or agent if the officer
    desires so.
  2 An officer appointed to Govt. service must furnish a certificate that he has submitted proposals for SLI (Official Branch) and applied for
    admission to GPF as per rules.
  3 Income tax should be deducted as per rules
  4 Leave Salary / Transit pay should be claimed after getting pay slip from AG.
  5 Copy of LPC / Pay Slip should be attached with the pay slip as per rules.
  6 The details of salary encashed should be informed to the head of the office with copy of the FBS schedule.
  7 An officer who signs his own bills while absent on leave must either present it in person or furnish the above life certificate, signed by a
    responsible officer of Govt., or some other well known and trustworthy person known to the treasury officer.
  8 If conveyance allowance is claimed in this bill, a certificate as per rules should be furnished

                                                          FOR THE USE OF AG'S OFFICE

          Classifications                                              Details of objection
          Debit                                                        Chargeable:
          Credit                                                       Head of account
          Total amount of Bill                                         Payable                                                 Treasury
          Admitted                                                     Passed for Rs
          Disallowed                                                   (Rupees                                                                       )
          Objected, See details of objection
          Retrenchment slip No. GA                                                     dated
          Or objection slip No                                                         dated
          Accountant/ CT
          Sr. AO/AO
          AA                                                                                                         Dated :

                                  STATE LIFE INSURANCE DEPARTMENT
                                               (Official Branch)
                         (This form is to be used for State Life Insurance Official Branch only)

Statement showing deductions on account of premia towards Official Branch Insurance fund in the establishment
pay or salary bill of            0                                    0
for the Month of                January-00

                                                        Month to which
       Policy Number

                          Policy Holder
       in Serial Order

                                                                                 Amount Deducted
                          Name of the


                                                         the premia

                                                                          Premium                Loan

                                                                          Rs          Ps    Rs          Ps

            0                                                                  0.00              0.00

                                                                                                                        Advance for January-00


            0                                                                  0.00              0.00

       Total                                                                   0.00              0.00



                          Certified that a sum of ______________________has been deducted in the establishment or

salary bill cashed on _______________________

                                                                                                                 Treasury Officer
                                                                                                             FORM T.R. 104 See Rule 163 (K)

Name of the Account Officer who maintains accounts (See Note No 6) ACCOUNTS GENERAL OF KERALA
Name of the Provident Fund                                             GENERAL PROVIDENT FUND
Statement showing deductions on account of subscription towards the State/ General Provident Fund in the pay Bill of the office of the
0                                                                                                                    Department of Agriculture
of Officers noted below during    January-00

                                                                           Rate of Subscription

                                                                                                                                                                       period from 1/07/05
                                                                                                                                                                        Arrear DA for the
                                                        Salary pay as on
                                                        31st March (Rs)
                                                                                                                                Details of Advance
              Account Number

                                                                                                                                                                           to 31/08/07
                                                                                                                                                                                              Total    Ledger

                                                                                                                                                                                                                   Initial Auditor
                                                                                                                                                                                             Amount   Folio Vol.

                               Name of the Subscriber                                                  Subscription                         Refund of Advance
                                                                                                                                                                                             6+9+11    & Page
  Serial No

                                                                                                                Month to                                    Month to                          (Rs)    Number
                                                                                                                                       No of      Amount
                                                                                                  Amount (RS)   which it            Instalments             which it
                                                                                                                 relates                                     relates
   1            2                         3                   4                   5                    6            7                   8             9        10            11                12        13        14                15








Grand Total Rs                    0.00
      Rupees                       Only
 1 The Account Number should be arranged in serial order. The guide letters allotted to the department viz. G.A. for Central Administration,
    Medl for medical etc. should be included.
 2 The entry columns 4 should the rate of salary pay drawn in respect of the lasted day of the proceeding financial year {vide Rule 11(2) of
    General Provident Fund Kerala Rules}
 3 Salary pay will include Personal pay, Special pay and Dearness pay but exclude all allowances {vide Rule 12(23) of part 1 of Kerala Service Rules }
 4 In the remarks columns give reasions for discountinuanceof subscription such as proceeded on leave, transferred to _____________________________ office
    ________________________________________ district, Quitted service, Died etc. In this column, write description against every new name such as new
    subscriber, came on transfer from __________________________________________ office ____________________________________________ district
    or resumed subscription if interest is paid on advance, mention in this column.
 5 Column 12 to be filled by the ledger poster on Accountant General’s Office.
 6 Separate schedules should be prepared in respect of person whose accounts are kept by different Accounts Officers.

                                                                                                                                                           Head of the Office

   Certified that a sum of Rupees ______________________ (in words) _______________________________________________________________________________'

__________________________________________________________________ has been deducted in the establishment / salary bills of the officers.

Cashed on ______________________________________

Name of Treasury ____________________________________

                                                                                                                                                             Treasury Officer
                                                                     FOR USE IN THE AUDIT OFFICE

Voucher No.                                                        Date
               ______________________________________________________ of Encashment                        ______________________________________________________

 1 Certified that the Name shown in Column 3, amounts of individual deduction (both subscription proper and refund of Advance) and Amounts shown in columns 6 – 9
   and I have checked with reference to bill.
 2 For schedules attached with March pay bills, certified that the rates of salary pay as shown in column 4 have been verified with the amounts actually drawn in the bill.

                                                                                                                                        Auditor, Department of Audit Section

                                                   FORM - B

           Schedule of deductions to 8011 - insurance and pension funds 105 (a) Kerala
State Government Employees Group Insurance Schem - (1) Insurance Fund and (2) Savings Fund

           1 Month to Which the salary relates                          January-00

           2 Account Number                                             0

           3 Name of the Self Drawing Officer with designation          0


           4 Group                                                      B

           5 Amount Deducted                               In Figures Rs 0.00
                                                       In Words Rupees Only

           6 Month/ Months to which the deduction relates               January-00


0-Jan-00                                                                                     0

    Received an amount of Rs. 0.00           (Rupees Only)

from the Sub Treasury Officer, Kazhakuttam being my pay and allowances for the month of   January-00



Contents received. Please pay the amount to Sri/Smt
of this office whose signature is attested below.

Signature of   Sri/Smt                       attested


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