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 GFR 12*C
[(See Rule 239)]

FORM OF UTILIZATION, CERTIFICATE (FOR

STATE GOVERNMENTS)
(Where expenditure incurred by Govt.
boai",
"niyj

Cerlified tholoutof Rs.............. .... . ... ....... Of

gronis sonciioned during lhe yeor..,............-....in
fovour o.f
..;
, ,.,.,
;..:,. .. ...... . ...under tl.re Minisiry/Deporlment
LellerNo. given in lhe morgin ond Rs...........,,....,.,.,....on
occount o{ rrnspenl bolonce of lhe previous yeor,
o sum o{
Rs..,....._........,. . ..... .1.o. been ulilized fo,
ll.r" pr,rpose of
...............for which il wos sorrclioned ond
thot
lhe bcrlonce of Rs.......
ot the end oi rt,. yu., lJr'
Governmenl (vide l.lo.
0... '"rTri}'J:r::t""';3
,,..,.doied.............:..,,..,
)/will be odiusied
lowords the gronts poyoble juring
yeor.
the nexl
.... ...., .. ..

2' Cerlifiedlhollhovesotis{iedmyselflholthecondilionsonwhich16egronts-in-oidwossonclionedhovebeen
duly Iulfilled/ ore being fulfiJled ond tlrot
I hor" the loiloiinq
"*"r.iuud '
rurrvYY rs clrecks to see lho1 il," -urr"y *o,
ocluolly utilized forthe propose Iorwhich
it *or ron.iion";.-

Kincls c.,f clrecks exercised

I
,2

4.
5.

Signoiure.,.,..
Desigrrolion.. "

Dole,

PSr The uC sholl disclose seporolely lhe ocluol

expendilure incurred orrd loons ond odvonces given
slores crnd ossets, to construclion ogencies ro suppriers of
ond lil<e ln o.lorJon."
lhe scherne obieclives, which do nol .onrtiirt"
*;h;;"r"
guidelines ond in fud;eronce to
Or, o,,o*"O t: be corried {orword,
expendirure
"r
*tr" urg", ih"rn ,[oll b. i;;.J;;
uiiti."a groni,

.,. ,.,,a., ,,,,,., -

:ti,i 6&iir
i,' , ,;1,;i;1;,;r 111
 l:
i,, .,,1t
': ; ,;-ri
i .it':
1 "',
.i . i
l''l{
iJ
I{ame & Address of
ir
, '1

*av***G* fl a*,;,*
r Jy4/[*,
,

Inrp lenrentilg A geiiciil

Hik*
UtiLizatioru Certificate* d
FORM OFR 19-A ISee Rute ? l2 (I )]

sl. MIDB Lg(er-No, Anrorrnt

No, and Dai* (Rs1

I' undui
\ul,u1o, l;etf ei
I
tlis
o ffir ll* 11

U , gr[o*.f ra

'l'\+\tla).
Tolnl-

2' Certified ttrat I have satislred nryself, that the conditions

on which the funds were sanotioned
bv tlt
National Fisheries p.1u"i"prnent il*r,i-r,*. tr*"a]rii
rrrniri"* being futfiled and
that I have exercised the following clreclcs to seo
purpose lor whlch it was sanctioned.
that the money *u* aarrutfy rrtiiized fbr the

Ki nds oj chedks exercise d:

(i) Exrract ol Cash Htjok/Bank pass Boolq,

Uda;h L^ -
i
SigiLature .,. . ..
,t lr,f r Desig:ratiorr ..

icer of GuW, Inslitrrle/ Organization/

lmplementing Agency

''';il .-+i.',;:r ,

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