APTC FORM -75/76

( PENSIONER'S BILL )
FOR THE MONTH OF
Date:

NAME OF THE PENSIONER:

Trans ID:

P.P.O. Number:
Treasury/PAO CODE

15040308002

DDO Code:

Major Head
Sub Major Head

DDO Designation:

M.E.O HUSNABAD

Minor Head

DDO Office Name:

MRC- HUSNABAD

Group Sub Head

Sub Head

Bank Branch Code:

STATE BANK OF HYDERABAD

Bank Name
Bank Branch Name:

HUSNABAD

Non-Plan=N/
Plan=P

Charged=C/
Voted=V

Detailed Head
Sub Detaied Head

Contigeny Fund MH/

Service Major Head

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 :

0.00
0.00
0.00
0.00
0.00

0.00

Rupees Nil

Date:

Thumbs Impression or Pensioner,s Signature

FOR USE IN TREASURY/PAY & ACCOUNTS OFFICE ONLY

Pay Rs :

Rupees Nil

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

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

NBST/
Bank
Seal

Treasury Officer/Pay& Accounts Officer

(P.T.O)

CERTIFICATE ON NON- EMPLOYMENT

(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.
Signature of the Pensioner
or Left Thumb Impression

Please pay net amount of the bill to:

(For use in Accountant -General's Office)
Admitted:
Objected:
Total:
Date:

Auditor

Superintendent

Singnate of pensioner / 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
Station :

Signature:

Date :

Designation:

Received Contents"

Signature of the Pensioner

or Left Thumb Impression