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FORM OF REFUND OF FSD/EMD/WITH HELD AMOUNT

1 Name of the work :

2 Amount of Estimate :

3 Ref to Sanction :

4 Name of the Contractor :

5 Agreement Bond No :

6 Date of Markout :

7 Date of Observation Period :


8 Amount of 1 ASD `
2 EMD `
3 FSD `
4 WH `

Total `

9 Date of Completion :

10 Ref to Final bill payment :


Liabilities outstanding against the
11 contractor on the work and to be :
recovered from the deposit

In case of any recover is detached


12 here after from the above work :
that same amount can be
recovered departmentally

Contractor, Section Officer, Dy.Exec.Engineer, Executive Engineer,

1. Certified that no I.R. paras and Audit Objections are outstanding on this work.
2. Certified that the work is satisfactorily as per the conditions of Agreement.
3. Certified that there are no recoveries to be made for the contractor on this work.

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FORM OF REFUND OF FSD

HAND RECEIPT

Received `…………………………… ( ` ………………………………………………………………..

……………………………………………………………only) from the Executive Engineer,………………………...

…………………………………………..towards refund of FSD on the work as noted in column above.

Signature of the Contractor.

CERTIFICATE

Certified that the refund order has been noted against the entry in the case book/Transfer

entry book and in deposit register vide item No…………………………………………………….

for `……………………..(` …………………………………………………………………………………………..

………………………………only)

Depositor Register Vr. No:


CBF No:/ Page No: Amount
No: &Month.

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