(4)

Memorandum or Payment made Amount COPY OF CONTRACTOR RECEIPT

Amount of previous from last certificate No. of Rs

P Rs. Recieved Rupees......

a
y By Cash 47,926
m
e
n Cheque 282,396 ..........as per Details in the bill
t
n By value of stock supplied Date.................Signed
o fines etc. is noted to
w
m Rs............ P..........
a
d Details on the reverse Witnessess to Contractor's Signature or Marks
e

Total payment now made : 294,929.90

Total payment to date : 0.00 Signature ................

Total value to work done : 294,929.90

True Copy Clerk

Detail Number Reference by Head Clerk (to be continue half Order By Disbursing Officer
Of Bill margin on full scape if necessary)