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Voucher No. ̹Ç×
Payable within 30 days from the date of issue 35
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Cheque No.

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ÉæÆ —ÌàºÇÆ/̱¾â Œ¹¼ºÆ/Debit Particulars : ............................................................................................................................... ........................
PAYABLE TO : ................................................................................................................................................... ´ ïª—Æ ÆêºëÆú /¯ÆÐ¯Æ Ì¯ÇկƯâºÆ
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Date ÁÀ+ƯȻ ͱÎÁ, ̱»Æ¶ ÍÁξ¯¿Æ £¾Æ¾× ÁÀ+ƯȻ ̹ÇݴƯ¿È Ûá ̹޺¶È Amount
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Detailed description of service rendered, work executed or goods supplied ô ±
and Certificate of Approving officer, where necessary Rs. cts.

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I certify from personal knowledge*/ from the certificates in the relevant files*/ that the above supplies*/ services*/ works* were duly authorised and performed and that
the payment of Rupees ....................................................................................................................................................................................................................................

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.............................................................. and cents ................................................................................................................................................................................... is in

accordance with regulations*/ contract*/ fair and reasonable.

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¼ú¾Æ/¶È¯¶È/Date : ..........................................................
—Æ¼Ä Ìͺø¨ ¨Ç¾ ¾øȽåÖÆåïªà ¡ºà̾ ÌÍ À¼—Æ.
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Signature and Title of Officer Certifying Expenditure.
Ìͺø¨ ¨ø×Ä´ ïÍåà ïªÑÄ´ ïÀÇ Äê.ïÇ.135-140 ¼¨àÉå ¡É½å¾Æ ïÆåÄê ¨Ç¾à¾.
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Before certifying / paying, draw attention to F.R.R. 135-140.
̴; _ *¡¼åÈ ï¾åɾ É®¾ ¨´êªå ¼Ä¾à¾. /¯ÁŒ¯Æ¯âºÆ :- ª½ÆÚδ¶Æ¶¾Æ¾Ç¶ Á±¸+Ưο ÌÁ´Æˆ Œ´âºÆ° /Note. – Strike out words inapplicable.
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RECEIVED this ........................................................................................... day of .................................................................. 20 ....................................... in payment of the

Account, overleaf the sum of Rupees ................................................................................................................................................................................................................

and cents ............................................................................

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̹޹ÁÇȁ Affix Stamp as per ί̻ǹƹºÆ
Signature of Stamp Duty Act Receiver

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Signature of Paying Officer and Date

20 .......................................................... Éæ¾ø ÌåÄå¾ñ / —ïÊàË ÂÈÀºòÆ /̹Ç×/ŒÍ±´ ¤Îµ ¥¾° : ..................................................................................

General/Special Warrant No. ...................................................................................... of 20 .................

20 .......................................................... Éæ¾ø ¡ºàºø¨åNJ/¨åÆñþ Äê¼Èà ÂÈÀºòÆ/۽ƹµºÆ/¯´ÆÕ·È¶È ¤Îµ ¥¾° : ...................................................................

Advance/ Imprest Warrant No. ......................................................................................

20 ........................................................................................................................................ Éæ¾ø ÂÈÆ

20 ................................................................ ¥¸» £¶È¯ÇÞ ¥¾ ......................................................

Authority No. ...................................................................................... of 20 .............................................

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