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) District . Sub-Account Voucher No. State provident Fund . Provident Fund Bill for withdrawing Final payment/Temporary Advance/Other withdrawals from the Provident fund of Sri. _________________________for the month of S.No. Name and Designation of subscriber October 2014 Pay . D.P.Code of . Branch . the establishment of th D.O.Code Nature of withdrawal Fund Account Number Number and date of sanction letter of authority Final Payments Temporary Advances 1) Total . . Deduct amounts short drawn in this bill . . Net amount . . Particulas of amount refundedS.No Name of subscriber and designation Fund account Number Date of withdrawal Particulars of amount drawn Amount now refunded Net amount required for payment (Rs. Rupees Signature of Drawing officer________ Designation______________________ Total Station . Contents Received Please credit this bill amount through ECS in favour of Date . Signature of Messenger________________ Signature__________________________________ . Remarks . ) . er___________________ __________________ f .hment of the office of rawal Others Acquittance yment (Rs. . drawn one month/two months/three months previous to this date favour of Account No. Objected . account number [1] [2] [3] [4] [5] 2.. Rs.40-A).2 1 Certified that I have satisfied myself that all sums included in bills (Form No. 2 Certified that the balance in the fund at 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.tax is admissible.Madras duly produced by me for scrutiny with the exception to those relating to________________________for Rs.Certified that this amount has not been Name of the subscriber with provident fund S. (Rupees_______________ (b) Certified that the policy is/policies are In full force and free from encumbrance. NOTE:- Auditor Accountant *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. one month/two months/three months previous to this date towards payment of Insurance forwarded to the Accountant General. 3 4 5 4 Certified that In respect of withdrawals made in bills (Form No.20.____________________ 6 (a) Certified that this amount drawn in this bill is for payment of the premium to take up a fresh policy. Treasury Examined and Entered Accountant Accounts For use In Audit Office Details of objection . Total .if any.40A). 5 (a) Certified that the number of policies financed from the Provident Fund does not exceed four. my credit on the date of withdrawal covers the sum drawn in the bill.____________________dated___________________________ Certificates: 1.No Number of policy Name of company Account of premium drawn and paid previously. with exception of those detailed* (of which the total has been been 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.. Item___________________of__________________ Premia.. 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 custody Certificate 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 . which exceed four were already accepted prior to 21st October 1953 Pay Rs. the original premia receipt have been within one month of the date of withdrawal Admitted .Certified that the interval between last temporary advance sanctioned and present 1 temporary advance sanctioned is not less 2 than Six months.____________________________ and that necessary endorsements have been made on the receipts to the effect that no abatement of income. Signature___________________ 5 (b) Or Certified that the number of policies financed from the Provident Fund. T.for payment of premium specified in the statement below the certificate (2). The period of grace should invariably be mentioned in the bill. N. C. T. 40-A . if any.Due date of Premium [6] Stock number [7] Madras _________________________ _____________________ ______________________________) Officer n . .