MADRAS TREASURY CODE FORM NO. 40-A[See Instruction 4(I) to (III) under Treasury Rule 17]

BILL FOR WITHDRAWAL FORM GENERAL AND OTHER PROVIDENT FUNDS (MADRAS)

the establishment of the office of

S.No. PayNature of withdrawal

Acquittance RemarksOthers

1)

Total . . Deduct amounts short drawn in this bill . .

Net amount . .Particulas of amount refunded-

S.No

Total

Contents Received

District . Sub-Account Voucher No. of .State provident Fund . Provident Fund BranchBill for withdrawing Final payment/Temporary Advance/Other withdrawals from the Provident fund of Sri. .

_________________________for the month of October 2014 . D.P.Code D.O.Code

Name and Designation of subscriber

Fund Account Number

Number and date of sanction letter of authority Final

PaymentsTemporary Advances

Net amount required for payment (Rs. )

Name of subscriber and designation

Fund account Number

Date of withdrawal

Particulars of amount drawn

Amount now refunded

Rupees .

Signature of Drawing officer___________________ Designation______________________________

Station .Please credit this bill amount through ECS in favour of .

Signature of Messenger________________ Signature__________________________________Date .

21 Certified that I have satisfied myself that all sums included in bills (Form No.40A), drawn one month/two months/three months previous to this date favour

efunded by deduction in this bill) have disbursed to the proper persons and that their "acquittances" have been taken and filed in my office with for every payment receipt stamps duly cancelled in excessof Rs.20.

2 Certified that the balance in the fund atmy credit

on the date of withdrawal covers the sum drawn in the bill.at the credit of the subscriber

3 Cetified that the policy/policies detailed below has/have already been assigned in favour of the Governor of Tamil Nadu and forwarded to the Accounts Officer for safe custody/the details of the policy/policies proposed to be taken up have been communicated to and accepted by the Accounts Officer in his letter

No.____________________dated___________________________Certificates:

S.No Name of company Stock number

[1] [2] [3] [4] [5] [6] [7]

1

2

3

4

54 Certified that In respect of withdrawals made in bills (Form No.40-A), one month/two months/three months previous to this date towards payment of Insurance

Premia, the original premia receipt have been within one month of the date of withdrawalforwarded to the Accountant General,Madras

duly produced by mefor scrutiny with the exception to those relating to________________________for Rs.____________________________ and that necessary endorsements have beenmade on the receipts to the effect that no abatement of income- tax is admissible.

5 (a) Certified that the number of policies financed from the Provident Fund does not exceed four.

5 (b) Or Certified that the number of policies financed from the Provident Fund, which exceed four were already

accepted prior to 21st October 1953 Pay Rs._____________________________6 (a) Certified that this amount drawn in this bill is for payment of the premium to take up a fresh policy.

(b) Certified that the policy is/policies are In full force and free from encumbrance.Treasury

OfficerExamined and Entered Accountant Accounts

For use In Audit Office

Rs. Item___________________of__________________ Details of objection ,if any.

Admitted . .

Objected . .

Total . . Auditor Accountant

NOTE:- *The bills for withdrawal of advances/final withdrawal should be supported by a duly certified copy of the sanction in the proper from the letter of authority issued by the Audit Office In case of non-gazetted Government Servants. The copy should be attested by the Head of the Office In case of bills for withdrawal for payment of insurance premia reference to the letter of authority issued by the Audit Officer permitting the withdrawal should be quoted as also reference to this stock number alloted to the policy assigned in favour of the Governor of Tamil Nadu and sent to the Audit Officer for safe custodyCertificate 5 (a) or 5 (b) may be retained according as the number of policies does not exceeds or exceed four in each individual case

The drawing officers should not present and Treasury Officers should not honour the bills in respect of claims made after the expiry of the period of grace allowed from the due date

of Account No. with exception of those detailed* (of which the total has been been

1.Certified that this amount has not been drawn and paid previously.

Name of the subscriber with provident fund account number

Number of policy

Account of premium

Due date of Premium

2.Certified that the interval between last temporary advance sanctioned and present temporary advance sanctioned is not less than Six months.

Signature________________________________

(Rupees_________________________________)

for payment of premium specified in the statement below the certificate (2). The period of grace should invariably be mentioned in the bill.T. N. T. C. 40-A