FORM B

Counterfoil (1) Counterfoil (2)

CENTRAL
[See sub paragraph (3) of paragraph
Subscriber's Copy Agent's Copy
4]
Public Provident Fund Scheme, Name of Agent Name of Agent ………….. Paper
1968 …………………… Toke No………
Name of Accounts Office Code No…………………. Code No…………………………
Account No…………. Date Public Provident Fund Scheme, PUBLIC PROVIDENT FUND
………… 1968 SCHEME, 1968
Challan for deposit of money into
Ledger Folio ……………. Name of Accounts Office Government Account ……………..
(name of Accounts Office)
Name of Subscriber Account No…………. Date Account No…………….. Date
…………………. ………… ……………..
Amount Deposited Cash/Cheque Name of Subscriber ………….
Ledger Folio …………….
(Rs.) Ledger Folio ……
Subscription Name of Subscriber Address
………………………… …………………. ………………………………………
Head of
Amount
Loan repayment Amount Deposited Cash/Cheque Cas Amou Govt
(in
…………………….. (Rs.) h nt Accoun
figures)
t
100 8006 -
Interest on loan Subscription x Subscripti Public
………………………… ………………………… 50 on Provide
x Loan nt Fund'
20
Fee
Loan repayment x Repaymen
…………………………………
…………………….. 10 t
…
x
Total Interest on loan
5x
………………………………… …………………………
2049 -
Interest
Fee *
Interest on Receipt
………………………………… Cheque/draft/
loan Fee s' Other
… Postal Order
Rupees (in words) Receipt
……………………… s
………………………………… Total
Total
………. …………………………………
Rupees (in words)
* Bank/PO on which drawn
………………………
……………. Number ……………
…………………………………
Rupees (in words)
……….
By (Depositor's Signature)