FOR THE MONTH OF

NAME OF THE PENSIONER:

P.P.O. Number: Trans ID:

Treasury/PAO CODE 1 5 0 4 Major Head

DDO Code: Sub Major Head

DDO Designation: Minor Head

DDO Office Name: Group Sub Head

Bank Branch Code: 2 1 1 3 5 Sub Head

Bank Name Detailed Head

Bank Branch Name: Sub Detaied Head

Non-Plan=N/

STATE BANK OF HYDERABAD

15040308002

Date:

APTC FORM -75/76

( PENSIONER'S BILL )

Contigeny Fund MH/Service Major Head

HUSNABAD

M.E.O HUSNABAD

MRC- HUSNABAD

Plan=PCharged=C/

Voted=V

Received the amount of my pension for the month andn year :

Pension :

D.R.

Arrears Rs.

Gross Total Rs.

Less: 1.Recoveries if Any Rs.

2.Income Tax Rs.

Net Rs.

Net Rupees :

Date:

Treasury Officer/Pay& Accounts Officer

0.00

0.00

0.00

(P.T.O)

Rupees Nil

Thumbs Impression or Pensioner,s Signature

Rupees Nil

0.00

0.00

0.00

Pay Rs :

Service Major HeadPlan=P Voted=V

(Rupees..........only by adjustment.)

FOR USE IN TREASURY/PAY & ACCOUNTS OFFICE ONLY

by cash / Cheque / Draft / Account Credit as under and Rs.......

NBST/

Bank

Seal

Please pay net amount of the bill to:

(For use in Accountant -General's Office)

Admitted:

Objected:

Total:

Date:

CERTIFICATE ON NON- EMPLOYMENT

Signature of the Pensioner

or Left Thumb Impression

(To be signed by all pensioners expect ex-interior servants and ex-policemen who are in receipt of a pension of

not more than Rs. 10 per monsoon)

I declare that I have received any remuneration for serving in any capacity either in a Government

establishment or any establishment paid from a Local Fund during the period for which pension claimed in this

bill due the amount of Pension Claimed till this bill is due.

Note : The term "Local Fund" means in this certificateany of the District Muncipal or Panchayat Funds Educational

funds.Port and Marine Funds etc.mentionedin instruction 2 in Chapter IV in Part III and also any "Local Fund"

under the control of Central Government.

Auditor Superintendent

Singnate of pensioner / Left Thumb Impression

Station : Signature:

Date : Designation:

Received Contents"

Signature of the Pensioner

or Left Thumb Impression

LIFE CERTIFICATE

Certificate that the pensioner named in this bill is alive this day,the ..day of ....20. and has

signed in my presence this bill and above request for payment to a messenger.

Signature of the Pensioner

or Left Thumb Impression