G. A. R.—23

(See rule 91

MEDICAL CHARGES REIMBURSEMENT BILL

Bill No.........

Ministry/Department/Office of................................................................................ ................................................................................................for the month/year..................:

Head of account—

Sl. No. Section of establishment and 
name of the incumbent
Gross Claim Recovery of Adv. Net amt. payable Remarks
1 2 3 4 5 6
 

 

 

  

         

Net amount required for payment (In words) Rupees........................................................................

1. Certified that I have satisfied myself that the amount included in bills drawn 1 month/2 months/3 months—previous to this date, with the exception of those detailed below (of which the total amount has been refunded by deduction from this bill) have been disbursed to the Govt. servants therein named and their receipts taken in the office of the bill or in a separate acquittance roll.

2. Details of Medical charges Refunded
    Section of establishment and name of incumbent Period                         Amount
3. Certified that Essentiality certificates, receipts etc. are appended.

Received Payment

Signature..............................
Designation of Drawing Officer
Appropriation for 19.......... .

Passed for Rs. ..........................

Expenditure including this bill ................................  
Station ......................

Dated................

Signature of the Controlling Officer 

Designation

Passed for payment of Rs.......... ........................... .(Rupees..................................................)

Payment through Cheque No.............

PAY AND ACCOUNTS OFFICER/Cheque drawing D.D.O.

Dated................


For use in Pay and Accounts Office
(Post Check)

Admitted for Rs..............
Objected to Rs. ..............
Reason for objection
Jr./ Sr.Accountant Jr. A.O. Pay and Accounts Officer