Form No.

GFR- 19A
Name of the District :- ________________________________

UTILIZATION CERTIFICATE FOR THE YEAR __________

Dated:_________

Sanction letter no. and Purpose Amount

date

Certified that out of Rs.______ /- (Rupees _______________________ only) of

Grants-in-aid sanctioned during the financial year 20___ - 20___ in favour of the
________________ by the ________________ as per letter R. No. ________________
and Rs. ______ /- (Rupees _______________________ only) on account of unspent
balance of the previous years (20___ - 20___), a Sum of Rs. ________ /- (Rupees
_______________________ only) has been utilised for the purpose for which it was
sanctioned and that the balance of Rs.________ /- (Rupees _______________________
only) Remained as unutilised at the end of the year, will be adjusted towards the grants-in-
aid payable during the next year.

Further certified that I have satisfied myself that the conditions, on which the grants-
in-aid was sanctioned, have been duly fulfilled and that I have exercise the following checks
to see that the money was actually utilised for the purpose for which it was sanctioned.

Checks exercised:
Examing of
a) Cash book/Bank Pass book
b) Monthly & Quarterly statements of expenditure
c) Ledgers

Signature.

Note: i) Unspent balance /Unutilized amount of previous year plus released of funds
during the year under audit are the “total funds available”.
ii) Closing balance of the year means “amount remained un-utilised or not spent,”
 Model Format
Name of the Office :

Statement of Expenditure Incurred (SOE) 20___ - ___

Opening Fund Expenditure Incurred Closing

Total
Sl. Balance Received Balance as
Component Expens
No. as on from SHS on
April May June July Aug. Sep. Oct. Nov. Dec. Jan. Feb. Mar. es
01.04.___ 20___ - ___ 31.03.____

Total

10 Bank Interest

Balance as per Day Book

Signature.