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

Bank Branch Code:

STATE BANK OF HYDERABAD

Bank Name

Bank Branch Name:

HUSNABAD

Non-Plan=N/
Plan=P

Charged=C/
Voted=V

Sub Head
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 :

Err:511

Date:

Thumbs Impression or Pensioner,s

FOR USE IN TREASURY/PAY & ACCOUNTS OFFICE ONLY

Pay Rs :

Err:511
by cash / Cheque / Draft / Account Credit as under and Rs.......
(Rupees..........only by adjustment.)

NBST/Ba
nk
Seal

Treasury Officer/Pay& Accounts Offi

CERTIFICATE ON NON- EMPLOYMENT

(To be signed by all pensioners expect ex-interior servants and ex-policemen who are in receipt of a pen
more than Rs. 10 per monsoon)

I declare that I have received any remuneration for serving in any capacity either in a Gove
establishment or any establishment paid from a Local Fund during the period for which pension claimed
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 Ed
funds.Port and Marine Funds etc.mentionedin instruction 2 in Chapter IV in Part III and also any "Local Fu
the control of Central Government.

Signature of the P

or Left Thumb Im

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 Imp

LIFE CERTIFICATE

Certificate that the pensioner named in this bill is alive this day,the ..day of ....20.
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 P
or Left Thumb Im

0.00
0.00
0.00
0.00
0.00

0.00

sion or Pensioner,s Signature

NLY

...

.only by adjustment.)

ay& Accounts Officer

(P.T.O)

in receipt of a pension of not

y either in a Government
h pension claimed in this bill

nchayat Funds Educational

also any "Local Fund" under

gnature of the Pensioner

r Left Thumb Impression

/ Left Thumb Impression

.day of ....20. and has

gnature of the Pensioner

r Left Thumb Impression