G. P. Fund Debit/Credit cum withdrawl Statement of Sh/Smt..............................................................A/C No..........................

Name of Treasury ..................................................................................................................................Year..............................

S.No.

Month Try.Vr.No.

Date Nature of the bill

Gross Amount of the bill

Net Amount of the bill

Amount Pertaining to subscriber Total Total Amount of the Schedule

withdrawl if any with Try, Vr.No. & Date

MonthlySubsc.

Ded. DA15%

RefundOf Adv

Total

Amount Try.Vr Data

G. Total

Signature of D D O