BR"G]\ D]bI ;NZ o ZZ!

_ TALAL VG[ HFC[Z VFZMuI BFT]P

BR"G]\ D]bI ;NZ o ZZ!_ Medical & P. H.
5|lT4 SF0"P.P G\P (&$
V[P HLP ZFHSM8P DF;v D[v!!

Account BFTFGM Name GFD Pay/and Monthly Refund of Total Rema-rks

G\AZ leve salary subscrip- Withdrawals 5ZT realized S], lJX[QF
of this tion DFl;S YTL p5F0[,L ZSD J;],FT GM\W
month VF OF/M
DF;GM Amount No.of
5UFZq ZSD Instalm
VG[ ZHF –ents C
GM 5UFZ %TFFG
L ;\bIF

1 2 3 4 5 6 7 8
! #REF! #REF! #REF! #REF! #REF! ### #REF!
#REF!
Z 0 Di[.jyi.b).pT[l ### 0.00 0.00 0.00 0.00
TALAL VlWSFZLP
# #REF! JU"vZ
#REF! #REF! #REF! #REF! ### #REF!
#REF!
$ #REF! #REF! #REF! #REF! #REF! ### #REF!
#REF!
S], #REF! #REF! #REF!

DT. sV\S[ ~l5IF CHFZ 5]ZFf

Lrhoble signature of Drawing Officers.
PH/GUJ #REF! p5F0 VlWSFZLGL ;CL ;]JFrI
MED/GUJ #REF! Designation
TOTAL #REF! CMN'M VlW1FS
Z[OZ, CM:5L8, VG[
;FD]lCS VFZMuI S[gN=4
5FZ0L4 HLP J,;F0P
SF0"P.P G\P (&$
Four use in the Audit Officer
VMl08 SR[ZLGF p5IMUDF\ ,[JF ;FZ]P
Vaoucjer Date of Encashment
JFpRZ J8FjIFGL TFZLBo
1 Cetifed that the name, amounts of individual deduction and the total shown in column 7 have been
cheched by refeene to the bill wide para 224 of tje Audit Manual.
1 5|F6LT SZJFDF VFJ[ K[ S[ GFD jIlSTUT S5FTGL ZSD VG[ BFGF * DF\ NXF"J[, ;ZJF/M lA, D]HA RSF;JFDF\ VFJ[, K[P
H]VM VMl08 lGID ;\U|CGM OSZF ZZ$P
2 Certified that the rates of pay as shown in column 3 have been verified with the amounts of actuall
drawn in the bill.
2 5|F6LT SZJFDF VFJ[ K[ S[ BFGF # DF\ NXF"J[, 5UFZGF NZGL lA,DF\ BZ[BZ ZSDMGL ;F[Y[ BZF. SZJFDF\ VFJ[, K[P

Dated initals of the Auditor

VM0L8FL RDLV ;DT[ 8]\SL ;CLP

Department Audit Section

BFTFGM VMl08 lJEFUP
 BR"G]\ D]bI ;NZ o ZZ!_ TALAL VG[ HFC[Z VFZMuI BFT]P
BR"G]\ D]bI ;NZ o ZZ!_ Medical & P. H.
5|lT4 SF0"P.P G\P (&$
V[P HLP ZFHSM8P DF;v D[v!!

Account BFTFGM Name GFD Pay/and Monthly Refund of Total Rema-rks

G\AZ leve salary subscrip- Withdrawals
Amount No.of5ZT realized S], lJX[QF
of this tion DFl;S YTL
ZSDp5F0[,L ZSD
Instalm J;],FT GM\W
month VF OF/M –ents C
DF;GM %TFFG
5UFZq L ;\bIF
VG[ ZHF
1 2 GM 3 5UFZ 4 5 6 7 8
! Di[.nyn.k[.Br&ci
0.00 ### 0.00 0.00 0.00 0.00
TALAL VlWSFZLP
Z #REF! JU"vZ
#REF! #REF! #REF! #REF! ### #REF!
#REF!
# #REF! #REF! #REF! #REF! #REF! ### #REF!
#REF!
$ #REF! #REF! #REF! #REF! #REF! ### #REF!
#REF!
5 #REF! #REF! #REF! #REF! #REF! ### #REF!
#REF!
S], #REF! #REF! #REF!

DT. sV\S[ ~l5IF CHFZ 5]ZFf

Lrhoble signature of Drawing Officers.
PH/GUJ #REF! p5F0 VlWSFZLGL ;CL ;]JFrI
MED/GUJ #REF! Designation
TOTAL #REF! CMN'M VlW1FS
Z[OZ, CM:5L8, VG[
;FD]lCS VFZMuI S[gN=4
5FZ0L4 HLP J,;F0P
SF0"P.P G\P (&$
Four use in the Audit Officer
VMl08 SR[ZLGF p5IMUDF\ ,[JF ;FZ]P
Vaoucjer Date of Encashment
JFpRZ J8FjIFGL TFZLBo
1 Cetifed that the name, amounts of individual deduction and the total shown in column 7 have been
cheched by refeene to the bill wide para 224 of tje Audit Manual.
1 5|F6LT SZJFDF VFJ[ K[ S[ GFD jIlSTUT S5FTGL ZSD VG[ BFGF * DF\ NXF"J[, ;ZJF/M lA, D]HA RSF;JFDF\ VFJ[, K[P
H]VM VMl08 lGID ;\U|CGM OSZF ZZ$P
2 Certified that the rates of pay as shown in column 3 have been verified with the amounts of actuall
drawn in the bill.
2 5|F6LT SZJFDF VFJ[ K[ S[ BFGF # DF\ NXF"J[, 5UFZGF NZGL lA,DF\ BZ[BZ ZSDMGL ;F[Y[ BZF. SZJFDF\ VFJ[, K[P

Dated initals of the Auditor

VM0L8FL RDLV ;DT[ 8]\SL ;CLP

Department Audit Section

BFTFGM VMl08 lJEFUP
 oo HM0F6 v ! oo
sGF6F lJEFUGF TFP!(v_ZvZ__Z GF 9ZFJ S|DF\S THZ !)vZ___v!#5 sZ__Zfh VgJI[ f
s5UFZ AL, ;FY[ HM0FJJFGL R[SMGL DF\U IFNLf
!P SR[ZLG]\ GFD ov VlW1FS4 Z[OZ, CM:5L8, VG[ ;FP VFP S[gN= 5FZ0L HLP J,;F0
MONTH :- D[v!!

VPG lJUT R[S >:I] SZJFn) S],

\P
rkm
! # $
1 pgirn) rkm b[>k Kiti mi> jmi krvi 85307 85307
miT[ b[>kn) SiKin[ c&kvvin) rkm
b[>k SiKin& nim
2 p5F0 JC[R6L VWLSFZLGL TZO[6DF VF5JFGL 85307 85307
R[SGL ZSD
S], 85307
#5 sZ__Zfh VgJI[ f
Lf
Z0L HLP J,;F0
 BR"G]\ D]bI ;NZ o ZZ!_ Medical & P. H.
SF0"P.P G\P (&$

ZL G]\ GFD ov VlW1FSzL4 Z[OZ, CM:5L8, VG[ ;FD]CLS VFZMuI S[gN=4 5FZ0L4 TFP 5FZ0L4 HLP J,;F0P

jIJ;FI J[ZFGL S5FT NXF"JT] 5+S DFC

D[v!! G]\ 5+S S[ H[GL ZSD c _Z(c VWZ 8[S;L;
VMG .gSD BR" s!f 8[S;L; VMG 5|MO[XG, 8[1F S0,L\u; V[g0 V[d5,M.D[g8 sV[f 8[S;L; VMG
V[d5,M.D[g8 ;NZ[ HDF SZJFGL YFI K[P
VPG\P VlWSFZLqSD"RFZLG]\ S], 5UFZ S5FJJF jIJ;FI X[ZMP
GFD TYF CMN'M 5F+ jIJ;FI J[ZFGL
J[ZFGL J;], ,LW[,
ZSD ZSD

! Z # $ 5 &
1 Di[.jyi.b).pT[l TALAL 46466.00 200.00 200.00
2 Di[.nyn.k[.Br&ci VlWSF
TALAL 42541.00 200.00 200.00
ZLP
VlWSF
JU"vZ
ZLP
S],PPP 400.00 400.00
JU"vZ
rupees four hundred only.
:Y/ o J,;F0
TFZLB D o [v!!
 - :: ANNEXURE ::-
BR"G]\ D]bI ;NZ o ZZ!_ Medical & P. H.
SF0"P.P G\P (&$
Sehedule perteining to the credcip Hed- 811 Insrance Fund and pensopn fund
Scheme 1981 for the Month of D[v!!

Name of the Office :- Supt. R.H. & C.H.C. Pardi. Dist. Valsad.

Total Nete Employese

undr the group Contivutio
Contivution n forwards
Sr.
Group forwards the the Tatal
No. Sub to Ins, Insurwncos
Sub.Ins. Savings
fund Saviagn fund
fund only
fund

1 2 3 4 5 6 7

1 A - 2 240.00 560.00 800

2 B - 0 0 0 0

3 C - 0 0 0 0

4 D - 0 0 0 0

Total 0 2 240 560 800

Err:511
 oo HM0F6 v Z oo
sGF6F lJEFUGF TFP!(v_ZvZ__Z GF 9ZFJ S|DF\S THZ !_vZ___v#&5 sZ__Zfh VgJI[ f

sp5F0 VG[ R]SJ6L VlWSFZLV[ ;\A\lWT A[gSG[ VF5JF DF8[f

p5F0 VG[ R]SJ6L VlWSFZLG]\ GFD o VlW1FSzL4 Z[OZ, CM:5L8, VG[ ;FD]lCS VFZMuI S[gN=4 5FZ0L4 TFZ

A[\SG\] GFD TYF XFBFGL lJUT o V[;P 8[=hZL R[S G\P

MONTH:- D[v!!
V[0JF.h G\AZ o

YFGL ZSD A[\SGF BFTFDF\ HDF SZFJJF V\U[GL lJUT NXF"JT] 5+SP

VPG VlWSFZLqSD"RFZLG]\ GFD TYF A[\S GM G\AZ S], 5UFZGL HDF SZFJJF
\P CMN'M ZSD 5F+ ZSD
! Z # $
1 Di[.jyi.b).pT[l TALAL VlWSFZLP
JU"vZ
!_&)!)$$_#( 44366 44366
2 Di[.nyn.k[.Br&ci TALAL VlWSFZLP
JU"vZ
#_#&5!*(#*Z 40941 40941

S],PPP 85307 85307

#ADDIN?
 BR"G]\ D]bI ;NZ o ZZ!_ Medical & P. H.
Income tax Deduction SF0"P.P G\P (&$
Month : D[v!!

Office : Supt. R.H. & C.H.C. Pardi. Dist. Valsad.

Incometax Card No. 510

Tan No. SRT 01619 –C

Sr. Name & Incometax Pan No. Total Salary Deduction Total Deducted
No. of Month Amount Incometax

1 2 3 4 5
1 Dr. JAYABEN B. PATEL 46466.00 1500.00 4500
Medical Officer CL- II
R.H. & CHC, Pardi
PAN No.AQUPP-0997 P
2 Dr.NAYAN K.BHARUCHA 42541.00 1000.00 3000
Medical Officer CL- II
R.H. & CHC, Pardi
PAN No.AQUPB4596 N
Total 2500.00

Err:511
_Z!& ov Z[g8 lA<0L\U CFp;L\UP BR"G]\ D]bI ;NZ o ZZ!_ Medical & P. H.
SF0"P.P G\P (&$

;ZSFZL DSFGGM p5IMU SZJF AN, DSFG EF0F S5FT N DFC[ ov D[v!!

VPG VlWSFZLqSD"RFZLG]\ DFl;S D}/ WZEF0F SJF8"Z G\AZ ;ZGFD] lJX[QF

\P GFD TYF CMN'M 5UFZ J;],FTGL GM\W
ZSD
! Di[.jyi.b).pT[l 22790.00 0.00 Z[PCMPVG[ v
;FPVFPS[P5FZ0LGF\
TALAL VlWSFZLP S[d5; BFT[ VFJ[, ;Lv!
JU"vZ

0.00
Err:511
G.P.V.) -101 7,00,000-1-2006 A4* WP-BI Outer General 1. e.& g. (Revised ) (Outer)
U]P ;P GF VFZMuI VG[ 5ZLJFZ S<IF6 lJEFUGF 9ZFJ S|P 5ZRq !_Z__5 q #(!*q A ;lRJF,I UF\\WLGUZ
GFPlJPGF 5+ SDF\SoTHZ !_Z__$q!ZZ&vhPVM)! sZ__5f VFp8Z HGP ! .P VG[ HLP s;]WFZ[, sVFp8Zf
VF AL, VJZ HJZ 5]:TLSFFORM TFPZ&q_5qZ_!_ VgJI[ TFP_!q_#q_) YL TFP Z(v_ZvZ_!! ;]WL C\UFDL HuIFVM RF,] ZFBJF D\H]ZL
TFP Z)v!vZ__5
GF
G. T. R. 30 VF5JFDF\ VFJ[, K[P
(See Rule 176 (1) Amount Amount
5FGPPPPPPPPPPPPPPPP Deduction 'A' Code Rs. Ps. Deduction 'B' Code Rs. Ps.
VG]S|D Bill Register No. . Income Tax 9 5 1 0 - 2500.00 I.A.S. Provident Fund 9 6 2 0 -
G\PPPPPPPPPPPPPPPPPPP Surcharge on Income Tax 9 5 2 0 - 0
PPPP GMWJFDF\ SF0"P.P G\P (&$ General Provident Fund Other than
Postal Life Insurance 9 5 3 0 - 0 Class IV 9 6 7 0 - 0.00
VFJ[, K[P
Pay Bill for the Establishment CL- II Name of Office C.H. C. PARADI DIST. VALSAD.

For the monthe of D[v!! . Generl Provident Fund Class IV 9 5 3 1 - 0.00 General Provident Fund of Divsional
Generl Provident Fund Accountants (State Employce) 9 6 8 0 -
For use in Treasury Workcharged 9 5 3 2 - 0 Contributory Provident Fund 9 6 9 0 -
Name of the Treasury PARADI DIST. VA;ASAD. Advances for Purchase of Fan 9 7 2 0 -
Bill Transit Reg. Sr. No. Date Token No Date : . Generl Provident Fund Rojamdar 9 5 3 3 - 0 Advances for Purchase of other
Bill Transit Reg. Sr. No. Date Token No Date : . Conveyance (Cycle) 9 7 4 0
Bill Transit Reg. Sr. No. Date Token No Date : . 0059 Rent of Bulding Rent of Interest on Advance 9 7 6 0 -
. Building 0216-9-106 General pool Jeep Rent 9 7 8 0 -
COMPUTER INPUTDATA Accommodation 9 5 5 0 - 0.00
(To be fuled in by Treasury) 0216-01-107 Police Housing 0216- Provident Fund adjustable by A.O.
01-700 Other Housing 9 5 6 0 - 0 other than A. G. Gujarat / D.A.T. 9 7 9 0 -
1 Distrct 6 9 2 Month & Year Miscellaneous Recoveris 9 9 1 0 -
3 Voucher No. Professional tax 9 5 7 0 - 400.00
4 Controlling Officer Budget Object of Expenditure Amount State Governmnt Employecs
Code EDP Code Rs. Ps. Group Insurancse Scheme 1979 9 5 8 0 - 0
5 Class of Expenditure 1 0 1 0 0 Salaries : 0 1 0 0 +
State Governmnt Employecs
0 1 0 1 Pay of Officer 0 1 0 1 + 43630 Group Insurancse Scheme 1981
6 Fund 3 0 1 0 2 Pay of Establishment 0 1 0 2 + Scheme Insurance Fund. 9 5 8 1 - 240.00
0 1 0 9 Leave Encashment 0 1 0 9 + 0.00
State Governmnt Employecs
7 Drawing Officer 7 4 5 0 1 0 3 Dearness Allowance 0 1 0 3 + 27815.00 Group Insurancse Scheme 1981,
0 1 1 0 House Rent Allowance 0 1 1 0 + 5454.00 Scheme Saving Fund. 9 5 8 2 - 560.00
8 Demand No. 0 9 6 Compensatory Local AIS Insurance Scheme 1980
0 1 1 1 Allowance 0 1 1 1 + Insurance Fund 9 5 8 3 - 0
9 Type of Budget 6 0 1 1 2 Iatrim Relief 0 1 1 2 + AIS Insurance Scheme 1980 Total Deductions : 3700.00
0 1 1 3 Transport Allowance 0 1 1 3 + 800.00 Saving Fund 9 5 8 4 - 0 Net Total : 85307.00
10 Scheme No. 1 2 7 1 6 0 + 0 1 0 4 Other Allowance 0 1 0 4 + 11108.00 Divisional Accountat Insu. Scheme
0 1 0 7 Medical Allowance 0 1 0 7 + 200.00 1980.I.F. 9 5 8 5 - 0 #ADDIN?
11 Head Chargeable . 0 1 0 8 Bonus 0 1 0 8 + Divisional Accountat Insu. Scheme
2 2 1 0 0 1 7 9 6 0 1 1 1 0 0 Travel Expenses (PTA) 1 1 0 1 + 1980.S.F. 9 5 8 6 - 0
1 3 0 0 Ofice Expenses 1 3 0 1 +
P.F. of employees on Deputation
DF\U6L G\AZ o )& Payment for Professional and adjustable by P.A. O/Other
D]bI ;NZ o ZZ!_ TALAL VG[ HFC[Z VFZMuI 2 8 0 0 Special Services 2 8 0 1 + Accounting circle. 9 5 8 7 - 0
5[8F D]bI ;NZ o !4 X[C[ZL VFZMuI ;[JFVM V[,MP 5 0 0 0 Other Charges 5 0 0 6 + Government Housing Fund 9 5 9 0 - 0
5MYLP 0 1 1 7 ROP Arrears (Gazetted) 0 1 1 7 + House Buliding Advance
UF{6 ;NZ o *)& VFlN HFTL lJ:TFZ 5[8F IMHGF 0 1 1 8 ROP Arrears (Non Gazetted) 0 1 1 8 + Principal/Intorest. 9 5 9 1 - 0
5[8F ;NZ o s!f V[RPV[,P8L #! .:5LTF,G[ 0 1 1 9 Derness Pay/Grade Pay 0 1 1 9 + 0.00
;\NE"GLR[ .:5LTF,DF\ Advance for purchase of Motor Car
TOTAL 89007 / Scooter / Moped Principal / Space for Specimen Signature Verification endorsement
O[ZJJL: VG[ T[G[ ;\ULG AGFJJLP0 s0
Detailed Head Interest. 9 5 9 2 - 0 By T.O / P. A. O.
%,FGf Rs.Rs. Festival Advance Rec. 5 7 0 1 - 0.00 Security Deposit 9 6 0 0 - 0
Food Grain Advance Rec. 5 8 0 1 - 0.00 D. A. / H. A/ / A. T. O. In charge of Cardes
Budget Allotment for 2 2010-2011 Recovery of Pay 0 1 0 1 - 0.00
Expenditur Including this bill . Leave Salary Advance 0 1 0 2 - Paid on Dt. .
Balance Availble . Total 'A' 3700.00
For use in Treasury Advice No. Dt. .
Gross Total 89007
* Please See Note for other object head of expendinure as shown revers. Pay Rs. ( ) Rs. Cheque No. .
Please issue cheques shown below In Cash
For Use In A. G. Office (1) In Favour of Drawing Officer for Rs. P. . Rs. ( ) by T. C. as at "A"
Admited for Rs. . (2) In favour of Officers
Objected for Rs. . (I) Shri for Rs. P. .
Reasons for Objection . 0 (II) Smt for Rs. P. .
(III) As Per cheque list attache for Rs. P. . Total : .
Total Rs. P.
Date : .
Accountant / Treasury Officer / Sub- Treasury
Officer / Pay and Accounts Officer.
Auditor Section Officer Gazetted Officer Signtur & Designation of Drawing Officer
 TALAL VlWSFZLv JU"vZ

[-][0101]
[1301]

(9510)
(9520)
(0102)

(0101)

(9590)
[0113]
(0110)
(0102)

[0111]
(0102)

[-] [5801]
(0119)
D\H]ZL EZ[,L BF,L

[0107]

[-] [5701]
[0108]

[1101]

[2801]
# # _

[-]
[Office Expencses] Other charges]
Payment for Profetional and
P.T.A.[Travel Expenses]
Section of Establishbent
and name of Incumbant

House Rent Allowance

for Use in Aoudit office

Leave salaryAdv. Adv.
CLA/Other Allowance

Transport Allowance

FoodGrain Advance
Leave Encashment

Washing Allowance

Gross Amount
Festival Advance
Madical Allounce

Recovery of pay

Srcharge on I.T.
Substantive pay

special services

Housing Found
Gross Total
Pay of Officers
Officiating pay

Leave Salary

Recovery of

Recovery of

Income Tax
.D.A. PAY
Ser. No.

(0109)

Bonus

[5000]

[0102]
D.A.
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
~FP 5{~FP 5{P~FP 5{~FP 5{ ~FP 5 ~FP ~FP 5{P ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{P
Di[.jyi.b).pT[l 0.00 22790 0.00 14529.00 0.00 2849.00 5698.00 100.00 0.00 0.00 400.00
TALAL VlWSFZLP 0.00 100.00 0.00 0.00 0.00 46466 1500.00
JU"vZ
9300-34800(PB2) 0.00
1 Pay band:- 17390 46466

Grade Pay :- 5400

Basic Pay:- 22790

Di[.nyn.k[.Br&ci 20840 0.00 13286.00 0.00 2605.00 5210.00 100.00 0.00 0.00 400.00
TALAL VlWSFZLP 100.00 0.00 0.00 0.00 42541 1000.00
JU"vZ
9300-34800(PB2)
2 Pay band:- 15440 42541
Grade Pay :- 5400
Basic Pay:- 20840

TOTAL 43630 0.00 27815.00 0.00 5454.00 11108.00 200.00 0.00 0.00 800.00 89007 0.00 0.00 0.00 89007 0.00 2500.00
 (9550) (9960)

(5801)

(9531)
(9580)

(9581)
(9540)

(9584)
(9582)
(9570)

(9583)

Motro Car Advance Pri/Intrerest (9592)

(5701)

(9740)
(9760)

(9591)

Recovery of pay/Leave Salary Leave

(9720)
(9760)

(9770)
(9531) (9532) (9533) (9620) (9670)

(9585)
Miscellaneous Recoveries (9910)
(9780)
Postal Life Insurance Premium

A.I.S. Insurance Scheme 1980

A.I.S. Insurance Scheme 1980

(9586)
Other Conveyance Advance
Provident Fund Contrbution
Group Insurance Scheme

House Building Advance

Insurance Scheme 1981
Scheme Insurance fund

Insurance Scheme 1981

State Govt. Employees

State Govt. Employees

State Govt. Employees

Pri/Intrest on Advance

Encashment Advance
Scheme Saving fund

Interest on Advance
Food Grin Advance

Intereston Advabce

Insurance Scheme
Festival Advance

Total Deductions
Professional tax

G. P.F. Class- 4
Insurance Fund
1979 Scheme

Deep/Car Rent
P.L.I. Permium

Fam Advance
(9680) (9690)
Rent Building

Saving Fund

Net Payable
Savin Fund
Div. Acett.
(9530)

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{P ~FP 5{P ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{ ~FP 5{P ~FP 5{ ~FP 5{ ~FP 5{P ~FP 5{P
0.00
0.00 200.00 0.00 120.00 280.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2100.00 44366

0.00 0.00
0.00
0.00 200.00 0.00 120.00 280.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 1600.00 40941

0.00 0.00

0.00 0.00 400.00 0.00 240.00 560.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3700.00 85307.00

#ADDIN?

vo 5|DF65+ ov
cc VFYL 5|DF65+ VF5JFDF\ VFJ[ K[ S[ ;NZ AL,LDF\ NXF"J[, TALAL
VlWSFZLV[ RF,] DF; NZdIFG DF\ SM. 5|F.J[8 5[S8L; SZ[, GYLP
VFYL 5|DF6LT SZJFDF\ VFJ[ K[ S[4 ;NZ TP VP GLP GJL lGD6]\S TFP _(v$v_5 GL
CM. GJL JWL"T 5[gXG IMHGF V\U[ J0L SR[ZL DFZOT[ BFT G\P !& VFS0FGM ,[JF
NZBF:T SZ[, K[P
VFYL 5|DF6L SZJFDF\ VFJ[ K[ S[4 ;NZ AL,GF ;ZJF/F D[ HFT[ T5F;TF AZFAZ DF,]D
50[, K[P
VFYL 5|dF6LT SZJFDF\ VFJ[ K[ S[4 ;NZ AL, VF VUFp VFSFZ[, GYL T[DH T[G]
R]SJ6]\ SZ[, GYLP
 CERTFICATE
1 Receved Cpntents Rs. In Words .
!P V\NZ H6FJ[[,L 85307.00 #ADDIN?
lJUT[ ~FP
2 Certifed that pay and Allowances Drawn in this bill are due and admissible as per rules and authoriy in force.

ZP 5|DFl6T SZJFDF\ VFJ[ K[ S[ VF AL,DF\ VFSFZ[, 5UFZ VG[ EyYF 5|JT"DFG lGIDM VG[ VlWS'T SIF" 5|
DF6[ D/JF5F+ VG[ ,[6F\ K[P
3 Certifed that have sarisfied myslf that all emoluments in bill drawn 1/2/3 months previous to this date except those
which have been short drawn in this bill or kept in my personal custody have been disbursed to the proper persons
and acqutances taken and filed in my office with receipt stamp duly canceled for every payment in excess of
Rs.5000.00.
#P 5|dFl6T SZJFDF\ VFJ[ K[ S[[ H[[GL ZSD VF lA,DF\ VMKL VFSFZJFDF\ VFJL K[ VYJF DFZF V\UT
SAHFDF\ ZFBL K[P V[ l;JFIGF VF TFZLBYL !qZq# DlCGF 5C[,F VFSFZ[,F lA,MGL TDFD ZSD ;\A\lWT4
jIlSTVMG[ R}SJL K[ VG[ T[DGL R}ST[ 5CM\R ,[JFDF\ VFJL K[[P VG[ ~FP 5___v__ YL JW] ZSDGL NZ[S
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4 Certified that all appointments and promotions grant of leave (Departure on and return from ) and the period of
suspension and the deputation and other events which are required to be recorded have been recorded in the
Service Book and leave account.
$ 5|DF6LT SZJFDF\ VFJ[ K[ S[ AWL lGD6]\SM VG[ A-TLVM4 VF5[,L ZHF4sZHF p5Z pTIF" TFZLB VG[ ZHF
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GM\WJL HZ]ZL CMI T[JL ALHL AFATM ;[JF5MYL VG[ ZHF lC;FADF\ GM\WJFDF\ VFJL K[P
5 Certified that persons who have been newly appointed possess the required qualifications and are within the
prescribed age limit and medical certificate obtained in respect of all persons who have completed six months
service.
5 5|DF6LT SZJFDF\ VFJ[ K[ S[ GJL lGDFI[,L jIlSTVM HZ]ZL X{1F6LS ,FISFT WZFJ[ K[ VG[ lGIT
JIvDIF"NFGL V\NZ K[ VG[ H[ jIlSTVMG[ GMSZLDF\ K DlCGF\ Y. UIF K[ T[ TDFD jIlSTVMGL AFATDF\
TALAL 5|DF65+ D[/JJFDF\ VFjIF K[P
Station :-...........PARDI DIST -VALSAD
:Y/ ovPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPP
Dated:-......................................
TFZLB ovPPPP December-21

*Note : Other Object Head of expenditure

Amount
Budget code object of Expenditure EDP Code
Rs. Ps.
O104 Non Prectice Allowance 0 1 2 8 +
(Medical Officer)
O104 Nursing Allowance 0 1 2 9 +
(Nursing Staff )
O104 Tribel Allowance 0 1 3 0 +
(Dony allowans)
O104 Uniform Allowance 0 1 3 1 +
O104 Washing Allowance 0 1 3 2 +
O104 Project Allowance 0 1 3 3 +
O104 Charge Allowance 0 1 3 4 +
O104 Parmenant Traveling 0 1 3 6 +
Allowance
O105 Ordery' Allowance 0 1 3 6 +
O114 Sumptury Allowance 0 1 1 4 +

Please pay to..................................................who has signed before me.

zLPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPPG[ R}SJ6L SZXM 4T[6[ DFZL Z]AZ]DF\ ;CL SZL K[P

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Pay band:- 15440 VlWSFZ
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