Rice Miller Claim Bill Form

(FORTIFIED RM BILL)

Agency Name :DCFS, HOOGHLY District :HOOGHLY

KMS 2022-2023 Name of the Rice Mill MADINA RICE MILL P LTD.
Claim No F222308360301 Type of the Rice Mill Perboiled
Claim Submission Date 27/11/2023 GSTN 19AAGCM9430R1ZM
Total Claim Amount(in Rs.) 77,234.88 PAN AAGCM9430R
Pool State Contact No 9474402511
Mail madina.fkm@gmail.com
Bank A/C No 50105832972
IFSC IDIB000A649

RRO NO RRO Date e-WQSC No e-WQSC Paddy Resultant FRK added Final CMR
Approval date Quantity(Qtl.) CMR(Qtl.) (Qtl) quantity(Qtl)
HGL/CPC/0836/2309121 28/02/2023 2022- 12/03/2023 1555.90000 1058.01200 10.58012 1068.59212
23/338/1759
Total (in Qtl.) 1555.90000 1058.01200 10.58012 1068.59212

Claim Towards the Cost of Fortified Rice Kernel Purchased for the KMS 2022-2023

Particulars Rate/Qtl (in Rs.) Quantity (in Qtl) Total Amount (in
Rs.)
Charges for FRK 73.00 1058.01200 77234.8760000
Gross Claim (in Rs.) 77234.8760000
Gross Claim (Round off in whole rupees)(in Rs.) 77235
(Rupees: Seventy Seven Thousand Two Hundred Thirty Five Rupees only)

Declaration : I declare that the claim have not been submitted/drawn previously either manually or through e-Mode.If any amount is
found to be paid in excess shall be refunded or adjusted from next bills.

Name of Rice Miller : MADINA RICE MILL P LTD.