T.N.T.C.

Form 75-C
(See Rule S.R. 74 (b) under T.R. 16)
Bill form for drawal of Provisional Pension/Gratuity/Death-Cum-Gratuity by the head of the Office
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District Head of Account Voucher No. for list
Received the amount of Gratuity due to
Thiru/Tmt.
For the month of
And gratuity / D.C.R.G. sanctioned vide letter No.

Less : Deductions
Income Tax : -------------------------------------------
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Net amount payable in words
(Rupees ………………………………………………………………………………..……………only)
Certificate from the pensioner regarding non-employment is attached.
Certified that the amount drawn in the last month’s bill has been duly disbursed and the receipt
obtained from the pensioner.

CONTENTS RECEIVED
Please issue cheque in favour of :
Thiru/Tmt………………………………………………………….……

Signature
Designation of
Drawing Officer Drawing Officer

Station : Date : Examined and entered :

Treasury Accountant

Pay Rs. Rupees

Cash Rs. Rs.

IV Taxes on income
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Dated : Treasury Officer

FOR USE IN AG’S OFFICE

Admitted Rs.____________________________________
Objected Rs.____________________________________

Auditor Superintendent
T.N.T.C. 75(c)-3-14-2-9=80.

(P.T.O)
 CERTIFICATE
Certified that the amount claimed has not been drawn and paid before.

Certified that no Government dues are to be recovered from the retired officer.

Certified that no provision gratuity has been paid to the retired officer.

Certified that no event has occurred after forwarding the papers to the A.G. which has a bearing to
revise the pension benefits downwards.

Certified that no charges pending against the retired officer.