G.A.R. 46

(See rule 190)

APPLICATION-CUM-BILL FOR REFUND OF LAPSED DEPOSIT

To

The....................................................
      (Judge, Magistrate or other Officer)
      ...................................................
        ...................................................

Sir,

The refund of lapsed deposits aggregating Rs......................Rupees............................) as mentioned in Cols. 1 to 4 below, is due to me/us and its payment may be arranged:—

Purpose for which deposited No. & date of Challan or authority with/under which deposited Amount deposited & Office/Bank in which deposited Amount claimed Amount lapsed to Govt. Particulars of lapsed statement Remarks
Year' Item No.
1 2 3 4 5 6 (a) 6 (b) 7
 

 

 

  

             

(Note:    Columns 5 to 7 are for use in Departmental Offices)

* Received payment

Date..........................

Signature of claimant(s)

I have satisfied myself about the identity of the claimant(s) and his/their title to the amount claimed vide details given in columns 5 to 7 above. It is requested that the payment may be made by cheque in favour of self/...........................I (Claiman (s) or by bank draft in favour of....................................... .(Claiment (s)] at...... . ......................... ....................... .(Station).

* Affixing revenue stamp wherever required).

No..................... 
Date.................... 

Signature............. ...
(Judge, Magistrate or other officer)

Forwarded to the Pay and accounts officer.
..................................................
..................................................

 

FOR USE IN PAY AND ACCOUNTS OFFICE

Head of Account ......... ...

Voucher No...........................

Claim verified for Rs................. ..(Rupees......................) and note kept against Sl. No. .................of the lapsed statement for year the 19. .......

 Jr. Accounts Officer

Passed for payment of Rs........................ .(Rupees.. ..................................) by Cheque/bank draft in favour of..........................................................at................................................ 

Paid vide Cheque No.......................dated............................

Pay and Accounts Officer 

 

POST CHECK

Certified that a final receipt for the full amount passed has been received and attached to the bill in the prescribed form. 

Sr. Accounts/ Jr. A.O.